Using strategic planning to address managed care growth.
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Economic Competition↗
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Marketing in a managed care environment.
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Economic Competition↗
Marketing through the eyes of financial managers.
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Administrative Personnel↗
Managing organizational mergers.
Reimbursement, competition, and other significant trends in the health field have stimulated an increase in mergers among health care organizations. Mergers inevitably produce significant ramifications for clinicians. Nurses have discovered that mergers produce a greater need for efficient patient care, but not necessarily the mechanism or guidance for achieving this goal. Nursing administrators are responsible for minimizing the negative impact of a merger on nurses while simultaneously promoting merger goals. Despite this increase in mergers and the subsequent challenge to clinicians, little information is available about how to manage mergers. This article reviews the impact of the merger between the Veterans Administration Medical Center and the Kirtland Air Force Base Hospital in Albuquerque, New Mexico. A nursing perspective is used to understand what problems arise and how nursing administrators can effectively manage these problems.
Attitude of Health Personnel↗
Planning evolution in hospital management.
In today's competitive health care market, hospitals are adopting more sophisticated and aggressive planning systems. The development of hospital planning can be visualized as an evolutionary progression from financially based systems to advanced systems of strategic analysis. This article offers a prescriptive model that hospital administrators can use to assess their organization's planning capabilities and move along the path to more effective planning.
Financial Management, Hospital↗
Disease management.
Disease management efforts are becoming an important competitive strategy for providers and managed care plans alike. More than ever, purchasers of care want value from their health care dollars, and integrated delivery systems want to better coordinate care. Information technology will be crucial in implementing disease management programs.
Capitation Fee↗
Impact of managed care on cancer trial enrollment.
PURPOSE: To determine the relationship between managed care market activity and cancer trial enrollment. METHODS: Trial participant data were obtained from the National Cancer Institute. Participants in cooperative group trials of breast, colorectal, lung, or prostate cancer during the years 1996 through 2001 were assigned to counties based on their zip code of residence. Linear regression was used to determine the relationship between county enrollment rate and two measures of county managed care activity (penetration and index of competition [IOC]), adjusting for other county characteristics. RESULTS: In bivariate analysis, there was a strong inverse correlation between trial enrollment rate and IOC (r = -0.23; P < .001) as well as the proportion of the population uninsured (-0.31; P < .001) and the percentage below poverty (-0.16; P < .001). In the multivariate model, greater county managed care competition (IOC) was inversely related to trial enrollment rate (P < .008 for comparison of each quartile v lowest quartile) after accounting for managed care penetration, proportion uninsured, and other county characteristics. Counties in the lowest quartile of managed care penetration tended to have lower enrollment rates than the remaining counties (r = -0.05; P = .048), while counties in the second, third, and fourth quartiles of penetration all had similar enrollment rates to one another. CONCLUSION: Cancer trial enrollment rates were suboptimal across all counties, and counties with higher levels of managed care competition had significantly lower enrollment rates. The relationship between managed care penetration and trial enrollment was less consistent. Future efforts to enhance trial participation should address the potential negative influence of market factors.
Breast Neoplasms↗
The relationship between evaluative concerns and sport competition state anxiety among youth skiers.
Thirty-four youth competitive skiers (mean age = 13.74 years) completed measures of social evaluative concern and competitive anxiety. Consistent with past research, regression analyses showed that cognitive anxiety was related to performance-specific evaluative concerns. However, contrary to current conceptualizations of sport competition anxiety, somatic anxiety was correlated with concerns about evaluation of other non-performance aspects of ski racing. Competitive skiers were most concerned about parents' and friends' evaluations of their performance, and other competitors' and friends' evaluations of their skiing in general. These findings are discussed in relation to the theory and management of sport competition state anxiety.
Adolescent↗
Changes in soil characteristics and plant species composition along a moisture gradient in a Mediterranean pasture.
Soil physicochemical characteristics, total aboveground biomass, number of species and relative abundance of groups and individual species were measured along a moisture gradient in a pasture, flooded in part during winter through early summer, adjacent to Pamvotis lake in Ioannina, Greece. Soil and vegetation measurements were conducted in 39 quadrats arranged in four zones perpendicular to the moisture gradient. The zone closest to the lake, recently separated from the lake, became part of the pasture and its soil texture was quite different from that of the other zones with a substrate containing 91% sand. Except for pH, this zone had the lowest values in the other five soil physicochemical characteristics measured (organic matter, total and extracted inorganic nitrogen, Olsen extracted phosphorus and extractable potassium); in the other zones organic matter, total nitrogen, phosphorus and potassium tended to increase from the driest to the wettest zone. Total aboveground biomass, ranging from 280 to 840 gm-2, is high for herbaceous pastures in the conditions of Mediterranean climate and it was not related to distance from the lake's shoreline, although the highest values were measured at intermediate distances, or to any of the various soil characteristics measured. Also, the number of species/0.25 m2 was not related to any of the various soil characteristics, but it was highest at the intermediate distances from the lake's shoreline. Species composition varied along the moisture gradient. Forbs as well as annual grasses and legumes declined in abundance from the driest to the wettest places; the reverse was the case for sedges and perennial grasses and legumes. These results indicate that the soil moisture gradient was the principal factor affecting soil characteristics and plant species composition. Since most species were recorded in all the four zones of the pasture, indicating that these can tolerate all variations in abiotic conditions of pasture, the vegetation zonation seems to be influenced by competition. Each functional group of species tends to dominate in a particular range of the soil moisture gradient where it is better suited and tends to exclude competitively other species. Management practices (mowing and grazing) affect the kinds of processes which maintain the observed community structure either by preventing the establishment of later successional species, like reeds and woody species, or by moderating the shoot competition, especially in the wetter zones, and thus permitting the creeping species to grow successfully.
Agriculture↗
Ethical issues of managed care.
In a competitive, monetized medical system, a clash of principles is inevitable; however, amid the tumult in the medical marketplace, the underlying tenets of emergency medical ethics remain inviolate. Although the goals of providing excellent and cost-effective care are not mutually exclusive, the conflicts encountered can only be resolved by appeal to a higher goal: the good of the patient. Both MCOs and EPs must function as agents of individual patients first and foremost. The enterprise of healthcare rests on fidelity, integrity, and trust; therefore, physicians and MCOs must accept and take seriously their important moral, legal, and social obligations to patients and society. Otherwise, third-party cost considerations and provider greed irreversibly could pervert the practice of medicine and destroy the last vestiges of fidelity in the patient-physician relationship.
Conflict of Interest↗
Positioning hospital-based home care agencies for managed care.
Over the next several years, Medicare cost-cutting strategies and changing market forces will decrease home health visits and revenue per visit and will probably eliminate the Medicare overhead allocation for hospital-based home care agencies and freestanding home care facilities. Consequently, home care agency managers need to plan now to make their operations more efficient and more competitive in the future. Managers should improve their collection of data needed for cost-reporting to optimize overhead reimbursement while it is still allowed and to begin lowering costs per visit. Chief financial officers have an important role to play in making hospital-based home care agencies financially successful.
Cost Allocation↗
The impact of competition on the importance of conforming to social norms: strategies for managed care organizations.
PURPOSE: This study focuses around the central question of whether or not the relative importance of conformity to institutional norms varies as markets become more competitive. DESIGN/METHODOLOGY/APPROACH: Using data gathered for 187 managed health care plans in the U.S., this study uses hierarchical regression analysis involving blocked variables. FINDINGS: This study finds that conformity to technical environmental requirements has a significant impact on performance at all levels of competition. However, the importance of conformity to institutional norms increases as markets becomes more competitive. PRACTICAL IMPLICATIONS: From the perspective of MCOs, this means that managers need to carefully monitor the prevailing technical and institutional environmental forces and match their responses according to the competitiveness of their individual markets. From a societal perspective, this study suggests that improved health care delivery is likely to result from increased competition in the managed care market. ORIGINALITY/VALUE: Prior research has shown that conformity to social norms is important for MCO performance. However, this is the first study to examine the whether the importance of conformity to social norms varies as a function of market competition.
Economic Competition↗
Adapting a strategic management model to hospital operating strategies. A model development and justification.
Industrial organizations have employed the process of strategic management in their attempts to cope effectively with global competitive pressures, while attempting to build and maintain competitive advantage. With health-care organizations presently trying to cope with an increasingly turbulent environment created by the uncertainty as to pending legislation and anticipated reform, the need for such organizational strategic planning is apparent. Presents and discusses a methodology for adapting a business-oriented model of strategic planning to health care.
Continuity of Patient Care↗
TOPS: the Optimum Performance Scale approach to improving nursing home performance.
Although nursing homes, a major and expensive institution in American life, are dedicated to caring for our elders when they need nursing care, they largely fail in that mission. Instead, nursing homes are widely feared as the place where elders go to die, neglected. Staffing is chronically short, as staff do not see nursing homes as preferred places to work. Society's efforts to cure this situation have generally failed, in that we all paid for decades of foundation support, academic research, expert consultants, and government financial support and regulation in an effort to improve nursing homes, without getting significant results. Nursing homes taken as a whole have proven strongly resistant to even incremental improvements, let alone wholesale change, and as a result the failure persists. Most nursing homes are blind to the possibility of success. The issue and problem highlighted by these general failures of outside pressure to bring improvement, coupled with general blindness to potential success is: How can we get the nursing home industry to improve itself. The response outlined in this article is TOPS, The Optimum Performance System. TOPS works by delivering to participating managers (and their staff and board) a personal computer application (the TOPS Tool) that compares the performance of the participant to its peers, including descriptions of what all participants have done to produce their performance. The comparison is holistic, measuring all the main components of performance (quality of living medical health, and cost) and all the sources of performance (management and operations, facilities, and community relations). The instinctual competitive needs of each manager will urge them to use this knowledge to improve their own performance.
Aged↗
Implementation of nutrition care service development plan at Banning Memorial Hospital: a case study.
Health care service markets in general and hospital care service markets in particular are characterized by many competitive developments. Hence, hospital marketing managers are forced to respond to these emerging competitive pressures. However, in formulating appropriate marketing management strategies, hospital managers need to have detailed knowledge about consumers and their behaviors in the marketplace. This paper focuses on the Nutrition Care division of the Department of Nutrition Service at a hospital and its venture into new service development. This case study is intended to emphasize the significance of acquiring adequate knowledge of customers in the health care services industry. It particularly emphasizes the critical role that this type of information concerning customer behavior plays in the development and implementation of an appropriate business expansion strategy. Furthermore, the aim of this case study is to help the reader to relate the acquired marketing information to the problem at hand, and make the appropriate marketing management decision.
Adult↗
How the best managers are preparing for new patterns of competition. 1992: moves Europeans are making.
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Administrative Personnel↗
Opportunities in Medicare for federally qualified health centers.
Competition for Medicaid managed care recipients has cut into the resources traditionally available to safety net providers. At the same time, a lack of primary care providers in many rural areas has increased the demand for federally funded community health centers to serve senior citizens. To meet the needs of the communities they serve and to maintain revenue streams, community health centers are increasingly serving the Medicare population.
Aged↗
Organigraphs: drawing how companies really work.
Walk into any organization and you will get a snapshot of the company in action--people and products moving every which way. But ask for a picture of the company and you will be given the org chart, with its orderly little boxes showing just the names and titles of managers. Now there's a more revealing way to depict the people and operations within an organization--an approach called the organigraph. The organigraph is not a chart. It's a map that offers an overview of the company's functions and the ways that people organize themselves at work. Perhaps most important, an organigraph can help managers see untapped competitive opportunities. Drawing on the organigraphs they created for about a dozen companies, authors Mintzberg and Van der Heyden illustrate just how valuable a tool the organigraph is. For instance, one they created for Electrocomponents, a British distributor of electrical and mechanical items, led managers to a better understanding of the company's real expertise--business-to-business relationships. As a result of that insight, the company wisely decided to expand in Asia and to increase its Internet business. As one manager says, "It allowed the company to see all sorts of new possibilities." With traditional hierarchies vanishing and newfangled--and often quite complex--organizational forms taking their place, people are struggling to understand how their companies work. What parts connect to one another? How should processes and people come together? Whose ideas have to flow where? With their flexibility and realism, organigraphs give managers a new way to answer those questions.
Creativity↗