Evan Hedrick (2015) presents: Central Healthcare Billing Agency - Because a Patient's Focus Shoul...

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Evan Hedrick (2015) presents: Central Healthcare Billing Agency - Because a Patient's Focus Should be on Recovering by Mind Map: Evan Hedrick (2015) presents: Central Healthcare Billing Agency - Because a Patient's Focus Should be on Recovering

1. Description

1.1. A private service that works similarly to the Medicare Advantage Plan

1.1.1. Works in conjunction with any insurance provider Does not assume liability or cover medical costs incurred by patient

1.1.2. Has auditors that can check and verify the medical work needed for the patient

1.1.3. Negotiates patient bill items' prices

1.1.4. Fights to cover all bills arising from a medical event

1.1.5. Minimally impacts the patient so the patient can focus on recovering, not an endless stream of bills

1.1.6. Carries a fair and minimal daily co-pay Between $50 and $150 depending on the nature of the medical event

1.2. Open and available to patients of all ages

2. Use Rationale

2.1. There is a need for the CHBA

2.1.1. Moderate to severe medical events can cost patients with less than ideal medical coverage a small fortune. Typically health plan coverage is less for care rendered by non-network providers. Many people inadvertently received non-network care while hospitalized. Though they had selected a network facility, other hospital-based professionals whom they did not and could not select – such as anesthesiologists and emergency physicians – were not in network. As a result, patients owed much more out-of-pocket than expected (Medical Debt, 2014). The economic and personal impact of medical debt can be devastating. Most ended up declaring bankruptcy as a direct result of high medical bills. Others depleted retirement or college savings, lost homes to foreclosure, or did without basics such as home heat. Almost all suffered damage to their credit rating. Some eventually bounced back from medical debt problems while others permanently reduced their standard of living. Some people experienced barriers to care. Nearly all expressed a strong ethic to pay their bills and deep regret, even shame, to be in medical debt (Medical Debt, 2014).

2.1.2. Bills from "out of network" services can be extensive In some cases, patients were left to pay bills for care their policy simply didn’t cover. Some also fell into debt trying to pay health insurance premiums they couldn’t afford (Medical Debt, 2014).

2.1.3. Too many people pay a bill they receive without knowing that they may be getting taken advantage of.

2.2. This program is designed to be used for patients of all ages, not just those over the age of 65.

2.2.1. The benefits and services made available to citizens over the age of 65 should be available to citizens of any age and regardless of their level of healtcare covereage (assuming they have minimum coverage)

2.2.2. This program offers a higher level of protection from unwarranted and unethical billing practices

3. Social Context/Synthesis

3.1. Larger Social Context

3.1.1. Healthcare is expanding and the demands that people have and retain some level of healthcare is now a certainty (Affordable Care Act)

3.1.2. Most people cannot afford the deluxe healthcare plans and are being forced to buy lower-end plans that do not cover very much.

3.1.3. As a result those people are having to pay a premium as a result of any medical events involving hospitals.

3.2. Broader Demand

3.2.1. Since the affordable Care Act has mandated that all adults (18+ in most cases) carry health insurance in the United States, over 250 million people will have a need for the services of the CHBA. This organization will attempt to not create "immense instability...[by] struggling to get ahead of the competition" (Fonseca, 2002 p 4)

3.2.2. The CHBA can potentially save Americans in excess of tens of millions of dollars per year.

3.2.3. The CHBA can alleviate massive levels of stress that can further improve patient outcomes. "These practices are both the outcome and the medium of individual interactions in the process of which individual capacities for action are themselves formed" (Fonseca, 2002 p 7-8).

4. Refererences

5. Stakeholders

5.1. Chief Financial Officer (CFO)

5.2. Agency for Healthcare Research and Quality (AHRQ)

5.3. Chief Executive Officer (CEO)

5.4. Executive Vice President (EVP)

5.5. Board of Directors

5.6. “The call for organizations, governments and school systems to contribute to the development of leaders” (Weiss & Legrand, 2011).

5.6.1. State/Local Government

5.6.2. Federal Government

6. Project Plan

6.1. Innovative Thinking Process (Weiss D. and Legrand C., 2011, p 124)

6.1.1. 1. Framework understand the business issue

6.1.2. 2. Issue Redefinition surface the underlying issues

6.1.3. 3. Idea Generation discover one or more innovative solutions to the problem

6.1.4. 4. Implementation Planning evaluate the best ideas and mitigate risks

6.2. VAT - (Hardwick, 2014)

6.2.1. "Contemporary leaders must recognize the importance of adaptive and predictive skills related to managing teams" (Porter-O'Grady & Malloch, 2011, p. 205). Visual Learners Apply tactics to improve intellectual capacity Apply tactics to improve emotional intelligence Apply tactics to improves emotional competence Auditory Learners Apply tactics to improve intellectual capacity Apply tactics to improve emotional intelligence Apply tactics to improves emotional competence Tactile Learners Apply tactics to improve intellectual capacity Apply tactics to improve emotional intelligence Apply tactics to improves emotional competence

6.3. Engage individuals, department, team to solve issues with innovative and novel ideas

6.3.1. Knowledge creation

6.3.2. Knowledge generation

6.3.3. Knowledge application

6.3.4. Knowledge evaluation

6.4. DiSC - (Hardwick, 2014)

6.4.1. Use DiSC assessments to apply strengths and strengthen weaknesses of team members

6.4.2. Use DiSC assessment to enlighten team members and improve efficiency

6.4.3. Use DiSC assessment to improve team cohesiveness

7. Investigation

7.1. Questions

7.1.1. Where would the funding for this program come from? Would this funding be federal in nature? Would bonds or measures (O or similar) be appropriate?

7.1.2. What kind of funding figures would be needed to approximate the cost of getting the CHBA up a running without drastically underestimating?

7.1.3. Once in place, who would have direct oversight? What responsibilities would each individual have? What would the org structure look like? The role of the individual is important, the "perceived and incongruence and redefined the situation" (Fonseca, 2002, p 44).

7.1.4. What type of investments would this project require? Innovation investment companies like Creek Project Investments are looking for "good growth potential in key business undertakings which are viable now and in the future" (Creek, 2012). http://www.creekprojectplc.com/

7.1.5. "Most teams can identify a large number of strengths for the innovative idea but usually very few weaknesses...the team must identify... actual and potential weaknesses" (Weiss D. and Legrand C., 2011, p 150).

7.2. Information

7.2.1. Funding program info (budget figures)

7.2.2. Rent vs. own (building) If rent, figures for rent, utilities, communication equipment, etc. If own, purchase price

8. Project Evaluation

8.1. Outcomes

8.1.1. Patient interactions The ideal outcome for patient interactions will be for patients to look more favorably on attending and interacting with professional healthcare staff at a medical facility due to the mediation of the CHBA The ideal outcome for patient interactions will also include the significant reduction of unwarranted and unneeded specialist care which directly affects a patient's bill total "In this case, we had Dr. Fata administering chemotherapy to people who didn't need it, essentially putting poison into their bodies and telling them that they had cancer when they didn't have cancer," McQuade told the Free Press. "The idea that a doctor would lie to a patient just to make money is shocking... Dr. Fata... saw patients not as people to heal, but as commodities to exploit" (Baldas, 2014).

8.1.2. Patient bill totals The ideal outcome for patient bill totals will be a significantly reduced patient bill from the medical facility that has been effectively negotiated down by the CHBA in conjunction with the insurance provider. The ideal outcome for patient bill totals will be for them to represent a FAIR price, both to patient and provider, for services rendered.

8.1.3. Patient morale The ideal outcome for patient morale is to alleviate a significant portion of the patient's financial burden thus lessening patient stress, accellerating the healing process and ultimately improving patient outcomes related to patient mood and morale. "Mood can indeed influence health outcomes. Probably the strongest evidence we have relating to how mood influences health outcomes is with clinical depression — also known as major depressive disorder (MDD)...Many lines of evidence suggest that depression (especially severe depression) negatively impacts numerous diseases, including autoimmune diseases, infectious diseases, chronic pain conditions, cardiovascular disease, stroke, and epilepsy" (Conway, 2015).

8.2. Statistics

8.2.1. Baseline Obtain statistics for patients that do not currently have CHBA help. Definition of a "major health incident" Survival rate after major health incident Average cost after major health incident Average number of bills recieved

8.2.2. Measureables Survival rate Average cost Average number of bills recieved

8.2.3. Evalutation plan Compare survival rate of patients with CHBA program to survival rates of patients without CHBA program. Basic Analysis of Variance (ANOVA) to demonstrate statistical significance in difference Compare average cost of a major health incident of patients without CHBA program to average cost to patients with CHBA program. Basic Analysis of Variance (ANOVA) to demonstrate statistical significance in difference Compare the average number of bills a patient recieves without using the CHBA program to the average number of bills a patint recieves while using the CHBA program. Basic Analysis of Variance (ANOVA) to demonstrate statistical significance in difference

9. Forces that Impact Success

9.1. Which organizational forces impact the success of your project?

9.1.1. Critical mass of misunderstanding When individuals form “power relations and consequent feelings of inclusion and exclusion” (Fonseca, 2002, p 53) are realized.

9.1.2. Analytical intelligence versus innovative intelligence Innovative intelligence and "operations' strategy reflects the primary means by which firms can influence and shape their competitive position and thus achieve strategic goals. Firms that offer competitive products in terms of quality, cost, delivery, and variety which match customer' needs and wants are in a superior position to create a sustainable competitive advantage" (Mohamad, 2012, p 713).

9.1.3. Analytical intelligence paradox

9.1.4. Innovative intelligence paradox

9.2. Which barriers have you identified, and how might you approach them?

9.2.1. Stakeholders struggling to access their innovative intelligence. Analytical intelligence is based on memory and logic where innovative intelligence is not. This takes a specialist in his or her respective analytical knowledge-base and asks him or her to think in a way that they know hasn’t been successful for them. It is likely not for a lack of trying, mind you, but simply because analytical thinking has brought them success and that is difficult to deviate from. If all the resistance may be stemming from stakeholders being able to “understand the need to play a prominent role in establishing…innovation. But they are not always certain how to go about it” (Weiss and Legrand, 2011, p 203) then the role of the innovation leader is simple, show stakeholders how to go about launching an innovative project.

9.2.2. Exclusive groups and power cliques When individuals form “power relations and consequent feelings of inclusion and exclusion” (Fonseca, 2002, p 53) are realized.

10. Implementation Plan/Timeline

10.1. Project implementation start - March 2, 2015

10.1.1. Establish Objectives Meet the proposed timeline Gain full project independance by 6 month time point Become financially stable by 1 year time point Show project effectiveness through comparing measureables to baseline data

10.2. Implementation Plan - 1 month from start

10.2.1. Risk analysis and mitigation strategies Innovative solutions Team implementation of solutions

10.2.2. Establish Mission statement, project values and project vision

10.2.3. Establish statkeholder committment - March 2, 2015 Address the 3 Intelligences Emotional Intelligence Innovative Intelligence Analytical Intelligence

10.2.4. Secure funding Grants Measures Donations

10.2.5. Market project

10.3. Project Independence - 6 months from start

10.3.1. Begin enrolling patients

10.4. Full project Implementation - 1 year from start

10.4.1. Measure impact Have objectives been met? What is the leadership perception? What is the quality of the leadership and employee engagement?

10.5. 1 year evaluation (annually after 1st year)

10.5.1. Flexibility

10.5.2. Progress

10.5.3. Innovative solutions to unforseen issues