[ANSWERED 2023] Considering the five stakeholders in health care: consumers, providers, payers, suppliers, and regulators – what role can each play in health care quality, and cost containment?

Considering the five stakeholders in health care: consumers, providers, payers, suppliers, and regulators

Module 1: Assignment

Assignment:

Professional Development

• Considering the five stakeholders in health care: consumers, providers, payers, suppliers, and regulators – what role can each play in health care quality, and cost containment?
• In your opinion, what health policy has had the greatest impact on health care in the United States? Why?
• Frame some arguments for or against the policy of mandated minimum staffing ratios in the positive versus normative economic dichotomy.

This APA essay will have 1200-1500 words with 4 supporting references. Make certain to include an introduction and conclusion paragraph, along a title and reference page.

Expert Answer and Explanation

Professional Development

Engaging with stakeholders is an essential element in which the organization can attain its success.  The organization has to ensure a clear vision obtained from a comprehensive and strategic process of planning and the marketing plan.  A healthcare setting that facilitates active engagement can easily translate their needs to meet the industry requirements or otherwise facilitate strategic development.  Stakeholder understanding also ads in the identification of a common ground that unifies all the stakeholders with regards to their requirements and needs (Yoo, 2018).

Each stakeholder is unique, and their needs might either be dependent on each other or entirely independent.  Both external and internal stakeholders have to work together to ensure that they meet the required stipulations and increase the organization’s performance. Internal stakeholders interact with the healthcare facility daily and can ensure that the organization meets all the required thresholds.  This consolidation of stakeholder requirements, healthcare organization, consummate affect the overall health and cost of containment.

Role of Consumers in Healthcare Quality and Containment

Consumers within the healthcare system comprised of the patients and other individuals that need medical services.  Patients are required to be treated with the high measure of quality, ensure satisfaction, and guarantee on the various ways in which care will be provided to them while at the facility.  For the healthcare facility to attend and meet each patient’s demand, they have first to identify the current trends that are prevailing in facilitating patient outcome and satisfaction (Okeke, Tseng, Piantella, Brown, Kaur, Sterling, & Dell, 2019).

Different patients present different medical conditions that required advanced medical expertise and medical equipment to mitigate. Some may also seek medical care with comorbid illnesses that are complex to diagnose and treat.  These conditions have an impact on the overall quality of care, as well as the cost of containment.  For instance, it becomes costly to handle and offer continuous quality care to a patient with multiple illnesses without proper finances.

Role of Providers in Healthcare Quality and Containment

Health care providers constitute the internal stakeholders as they comprise the administration, nurses, and doctors required to attend to patient needs.  A healthcare facility has to ensure that they provide high-quality care that meets the demands of the patient.  The facility also needs to abide by industry standards.  The quality of care is dependent on the ability of the providers to guarantee their effectiveness (Bastian, Munoz, & Ventura, 2016).  This construct defines the role in which the providers can ensure high-quality care and cost containment. One way to facilitate quality care is by hiring quality personnel to oversee the facility’s operations.

Quality nurses and doctors reflect the potential to deliver quality care.  Health care providers can also ensure that there is sufficient and high-quality technology in line with industry-specific needs.  Through the use of the electronic records system, the facility can ensure that the services provided are of high quality (Okeke et al., 2019).  These two services may have a first implication on the cost.  The provision of high-quality care will help with cost containment by offering a useful positive healthcare image and an increased number of patients.  Providers also facilitate the issue of quality in healthcare by adopting the standard and acceptable models of practice, such as the use of EBP, which inform the best treatment options and create policies.

Role of Payers in Healthcare Quality and Containment

Health care payers include insurance companies, employers, the government, and the out-of-pocket payment model.  These alternatives have a role to play when it comes to ascertaining the nature of care and the overall cost containment.  To begin with, the insurance company act as an intermediary between the patient and the healthcare facility.  With the insurance in place, the patient is guaranteed access to quality care without considering the financial implication.

For instance, Medicare and Medicaid offer financial aid to elderly patients within the United States, helping them acquire medical care that is of high quality and specific to their specific needs. Insurance agencies also create measures that limit the charges that the healthcare organization charge on specific service provisions (Bastian, Munoz, & Ventura, 2016).  The agencies also limit the amount that the organization can charge a patient in a single hospital visit creating a measure against cost containment.

Secondly, the government also has direct impacts on the quality of care as well as cost containment.  The government is the principal financier for public hospitals and other government-owned insurance covers.  In this manner, the government, either state or federal, can ensure that the public healthcare facilities are well equipped and create policies that dictate the aspect of care that can provide to patients (Bastian, Munoz, & Ventura, 2016).

Similarly, it also offers the same services as the private insurance companies but allows the beneficiaries to afford the provide healthcare services.  On the other hand, out-of-pocket payment is also a viable payment option, but people with low income may hinder the affordability of quality services.

Role of Suppliers in Healthcare Quality and Containment

The quality of healthcare performance can establish the supplier able to provide quality equipment and medication.  Suppliers also play a critical role in ensuring the provision of quality care within an organization.  First, suppliers of medicines can ensure that the drug is delivered on time and meet s the standards required by the market’s rules.  Additionally, supplier integrity is essential in ensuring the medical supplies provided are up to standard and perform what he or she meant to (Falasca, & Kros, 2018).

Technological suppliers also have to ensure adherence to the rules of healthcare IT supplies.  One of the healthcare facilities ‘ objectives is to provide the provision of quality care, and the use of medical technology equipment and medicines from the supplier is an essential way to achieve these goals.  Suppliers also help with the aspect of cost containment in one direction.

Timely delivery of materials and medication facilitates the efficiency of services and long-term benefits (Falasca, & Kros, 2018). Suppliers can also participate in cost containment when they enter into a long term understanding with the healthcare facility to acquire medical supplies and equipment at a reduced price.  In this way, the healthcare facility can cut costs used to purchase medical supplies.

Role of Regulators in Healthcare Quality and Containment

Health care regulators provide guidelines and policies that healthcare provides need to use to facilitate efficient care.  Regulators mainly emphasize how the healthcare consumer will be able to get quality healthcare by ensuring that the facility operates at optimal capacity.  Another way that the regulator helps with the provision of quality care includes the use of licensing and certifications as are necessary by the organization to achieve some aspects elements of care.

Licensing of healthcare organization requires strict adherence by the facility on standard procedures as are required in a healthcare facility (Hosseinichimeh, Kim, Ebrahimvandi, Iams, & Andersen, 2019).  These features maximize patient security and the nature of quality care. Regulators also provide rules on how to ensure patient safety and security of their data.  Patient safety also facilitates an environment of trust between the patient and the facility.  This correlation will ensure that the patients accorded quality treatment and care, ensuring satisfaction.

Health Care Policy with Greatest Impact

In my opinion, the Affordable Care Act of 2010 had the most significant impact in the United States on health care.  The implementation of the Act, the American healthcare system has drastically changed with the inclusion of numerous incentives for both the patient and the healthcare industry.  Starting with the policy leads to increased accessibility to healthcare by many people (Griffith, Evans, & Bor, 2017).  Though the provision of insurance covers that are affordable by the low-income earners, the policy facilitated an increase in the people with healthcare coverage.

Additionally, the health care system was able to encounter an increase in the number of consumers prompting them to increase their overall size and practitioners to attend to the high numbers of patients able to afford the care.  The Affordable Care Act provides financial aid to the elderly in the community, children, and the disabled.  The incentives contributed, and the health care quality they offer is of high quality, leading to patients’ leading quality life (Griffith, Evans, & Bor, 2017).  The policy also creates a working environment that facilitates a standard nurse-patient ratio leading to a shortage of nurses and the need for the organization to enable employment additional nurses.

Mandated Minimum Staffing Ratios

The prescribed staffing ratios aid with ensuring a balance between service providers and the patient population.  The policy ensures that while the nurses are providing high-quality care, there is also guaranteed safety of their health and emotional standpoint (Griffith, Evans, & Bor, 2017).  The policy also creates a working environment that facilitates a standard nurse-patient ratio leading to a shortage of nurses and the need for the organization to enable the employment of additional nurses.  Be that as it may, the current COVID-19 has had a hit on the normative economy, making it challenging to balance the ratios.  However, the facilities can still ensure maintained healthcare services and retention of the available nurses.

Conclusion

The consolidation of stakeholder requirements and that of the healthcare organization can affect the overall health and cost of containment.  Different stakeholders have different needs and impacts on a healthcare facility.  To meet these demands, they have to work together to benefit from quality healthcare and cost containment.  Alternatively, the Affordable Care Act has been essential in facilitating improved patient care for the patients and creating a safe environment for providing healthcare services.

References

Bastian, N. D., Munoz, D., & Ventura, M. (2016). A mixed-methods research framework for healthcare process improvement. Journal of Pediatric Nursing, 31(1), e39-e51.

Falasca, M., & Kros, J. F. (2018). Success factors and performance outcomes of healthcare industrial vending systems: An empirical analysis. Technological Forecasting and Social Change, 126, 41-52.

Griffith, K., Evans, L., & Bor, J. (2017). The Affordable Care Act reduced socioeconomic disparities in health care access. Health Affairs, 36(8), 1503-1510.

Hosseinichimeh, N., Kim, H., Ebrahimvandi, A., Iams, J., & Andersen, D. (2019). Using a stakeholder analysis to improve systems modelling of health issues: the impact of progesterone therapy on infant mortality in Ohio. Systems Research and Behavioral Science, 36(4), 476-493.

Okeke, F., Tseng, E., Piantella, B., Brown, M., Kaur, H., Sterling, M. R., & Dell, N. (2019, July). Technology, home health care, and heart failure: A qualitative analysis with multiple stakeholders. In Proceedings of the 2nd ACM SIGCAS Conference on Computing and Sustainable Societies (pp. 122-133).

Yoo, D. (2018). Stakeholder Tokens: a constructive method for value sensitive design stakeholder analysis. Ethics and Information Technology, 1-5.

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Other Questions Related to this Class:

Module 1: Discussion Question

Discussion Question:

• From an economic perspective, describe the cost of regulation in the healthcare environment.

Module 2: Discussion Question

Discussion Question:

• Why is it so important for everyone from the CEO to the nurse manager to do rounds? Give examples of what can be accomplished during rounds?

Module 2: Assignment

Assignment:

• What are the characteristics of the consumers that you regularly see in your current work environment? What are some ways in that they are impacted by the other identified healthcare stakeholders?
• What effect has ACA had on stakeholders? Explain what strategies a nurse leader might adopt that would make it more effective?
• What is important for nurse leaders to share with their staff regarding payers? Why?
• Who are the various regulators that affect your healthcare organization? What is your role in the respective regulatory process?

This PowerPoint® (Microsoft Office) or Impress® (Open Office) presentation should be a minimum of 20 slides, including a title and reference slide, with detailed speaker notes on content slides. Use at least four scholarly sources.

Module 3: Discussion Question

Discussion Question:

• Generally, it is believed that when quality improves, cost is reduced. What statements would you make to defend this position? Identify the basic factors that affect the cost of quality. How can you as a nurse or nursing manager influence this area?

Module 3: Assignment

Assignment:

• Why is it important for the nurse leader to provide a reasonable and fair operation budget?
• Although budget figures are estimates of future projections, why and how should nurse leaders be prepared to explain short-term variations?
• Nurse leaders have many responsibilities when it comes to the development of the budget. What issues would be considered most important for the nurse leader in this process?
• How should a nurse leader prepare to handle minimum staffing requirement costs in the budget process in case this is challenged?
• Besides a department budget approach, what other alternatives are available in the budgeting process?

This APA essay will have 1200-1500 words with 4 supporting references. Make certain to include an introduction and conclusion paragraph, along a title and reference page.

Module 4: Discussion Question

Assignment:

• Why is it important to provide evidence-based care? Discuss some of the challenges nurse administrators face in creating an environment in which bedside nurses use evidence-based care.
• Discuss the use of run charts and control charts to improve quality.
• Discuss how Lean thinking and Six Sigma can be used together to improve healthcare quality.
• What are ways to promote employee safety?
• Describe how complexity theory applies to your practice.
• Explain reasons that chaos theory offers hope for the future of health care.

This PowerPoint® (Microsoft Office) or Impress® (Open Office) presentation should be a minimum of 20 slides, including a title and reference slide, with detailed speaker notes on content slides. Use at least four scholarly sources.

Module 5: Discussion Question

Discussion Question:

• Are hospitals competing on the basis of price, quality, or both? Should hospitals and other health care facilities make a profit? Why or why not?

Module 5: Assignment

Assignment:

• What is it important for a nurse leader to understand variance reporting? How does this reporting become a valuable tool?
• Because staffing is usually the most expensive resource in the provision of care, what reports would provide you with valuable information for this expense?
• Contract labor is usually the most expensive man-hours. Why?
• What is a cost-to-charge ratio? Why should a nurse manager understand this ratio, and how would he or she use it?
• Finance departments regard nursing units as not being revenue generators. Why do you believe they are inaccurate in their assessment?
• In the new value-based reimbursement environment, what other measures can a nurse manager take to enhance reimbursement and prevent revenue loss?

This APA essay will have 1200-1500 words with 4 supporting references. Make certain to include an introduction and conclusion paragraph, along a title and reference page.

Module 6: Discussion Question

Discussion Question:

• Describe the difference in Capital and Operational budgeting. How does the manager go about “justifying” them? Is there a difference in how to justify?

Module 6: Assignment

Assignment:

• How does “minimum staffing” impact your ability to meet your budgeted numbers?
• This chapter deals with specific units of service for nursing workload requirements. What role should the nurse leader play and how should the leader interact with the finance department for a standard definition of measurement?
• As a nurse leader, you have to set up a new patient service budget. What sources of information do you need to build the budget?
• How should a nurse leader use a patient classification (acuity) system to justify nursing hours per day/staffing mix/nurse-to-patient ratios for budget purposes that would be understood by the finance department?

This PowerPoint® (Microsoft Office) or Impress® (Open Office) presentation should be a minimum of 20 slides, including a title and reference slide, with detailed speaker notes on content slides. Use at least four scholarly sources.

Module 7: Discussion Question

Discussion Question:

• Describe the similarities and difference between a classical budgetary process and a rolling forecast process. Who are the key players in each and what is his or her role? What are the advantages and disadvantages of each?

Module 7: Assignment

Assignment:  This assignment has two parts: an essay and a business plan.

PART I – develop an essay to address the following information:

• Reflect on the mission, vision, values, and goals of your healthcare organization and provide examples of how individual employees, departments, and work units support all four of these as a foundation for directional strategies.

• Describe positive and negative aspects of abandoning traditional healthcare strategic planning processes and adopting a contemporary approach.
• How does complexity influence budget strategies and their implementation? Give examples.

• Discuss the process of external and internal environmental analyses, and then speculate on scenarios that may result if these steps in strategic planning are omitted or are not done well.
• Discuss mechanisms that nurse manager can use to ensure they make the best decisions for supporting the financial goals of the organization.

• Identify an opportunity for implementing a new service or a cost-reducing idea in your organization and write a business plan to describe your idea: explain the need (why) for it, identify stakeholders (who) will be impacted, discuss the benefits versus the disadvantages, describe the costs/expenses for the idea, and outline the implementation plan. 

Module 8: Discussion Question

Discussion Question:

• Which ratios would you consider most important in the daily and monthly operation of the organization? Why? If you were analyzing an organization’s ability to borrow money, which ratios would be most helpful?

Module 8: Signature Assignment

Signature Assignment Title: Health Care Finance and Economics

Signature Assignment Description/Directions: Presentation

• Why are balance sheets important to healthcare organization finance and what area of the balance sheet would you consider the most critical?
• Comparing organizational costs, which costs does nursing administration have little control over and why? Which costs would be most important if you are expanding your services and considering quality improvement measures?
• Compare and contrast for-profit and not-for-profit corporate structures based on the information available from a balance sheet and an income statement? Fundamentally, what are the differences?
• Goodwill and patents are considered what types of assets? Give detailed examples and explain.
• Compare and contrast assets which are the essential economic lifeblood of a healthcare organization stability. Give detailed examples and explain.

This PowerPoint® (Microsoft Office) or Impress® (Open Office) presentation should be a minimum of 20 slides, including a title, introduction, conclusion and reference slide, with detailed speaker notes and recorded audio comments for all content slides. Review and use at least four scholarly sources to support your perspective and make certain to review the module’s rubric before starting your presentation.

Total Point Value of Assignment: 400 pts.

FAQs

What are the roles and responsibilities of stakeholders in healthcare?

Stakeholders in healthcare play crucial roles in ensuring the effective delivery of healthcare services and the overall well-being of patients. The term “stakeholders” refers to individuals, groups, or organizations that have an interest or stake in the healthcare system. The key stakeholders in healthcare include:

1. Patients and their Families:
   • Responsibilities: Actively participate in their own care, follow medical advice, provide accurate health information, and make informed decisions about treatment options.
2. Healthcare Providers (Physicians, Nurses, Allied Health Professionals):
   • Responsibilities: Diagnose and treat illnesses, provide preventive care, communicate effectively with patients, coordinate care, and adhere to ethical standards and professional guidelines.
3. Healthcare Administrators and Managers:
   • Responsibilities: Oversee the operations of healthcare facilities, manage resources, implement policies, ensure compliance with regulations, and optimize the delivery of healthcare services.
4. Health Insurers and Payers:
   • Responsibilities: Provide insurance coverage, process claims, negotiate contracts with healthcare providers, and promote cost-effective and high-quality care.
5. Government and Regulatory Bodies:
   • Responsibilities: Develop and enforce healthcare policies and regulations, ensure public health and safety, allocate resources, and monitor the quality of healthcare services.
6. Pharmaceutical and Medical Device Companies:
   • Responsibilities: Research and develop new drugs and medical technologies, ensure product safety and efficacy, and comply with regulatory requirements.
7. Research and Academic Institutions:
   • Responsibilities: Conduct medical research, train healthcare professionals, contribute to the development of medical knowledge, and disseminate information to improve healthcare practices.
8. Nonprofit and Advocacy Organizations:
   • Responsibilities: Advocate for patient rights, raise awareness of specific health issues, fund research, and provide support services for patients and their families.
9. Community and Public Health Organizations:
   • Responsibilities: Promote public health initiatives, disease prevention, and health education, and collaborate with communities to address health disparities.
10. Technology and Information Systems Providers:
    • Responsibilities: Develop and maintain healthcare information systems, ensure data security and privacy, and support the adoption of technology for improved patient care and communication.
11. Suppliers and Vendors:
    • Responsibilities: Provide healthcare facilities with necessary equipment, supplies, and services, ensuring quality and reliability.

Effective communication and collaboration among these stakeholders are essential for a well-functioning healthcare system. Each stakeholder’s role contributes to the overall goal of providing accessible, high-quality, and patient-centered care.

Who are the stakeholders in the health care payer system?

In the healthcare payer system, various stakeholders play critical roles in managing and facilitating the financial aspects of healthcare. These stakeholders include:

1. Health Insurance Companies:
   • Role: Provide health insurance coverage to individuals or groups, manage policy enrollment, and process claims for medical services.
2. Government Payers:
   • Role: Government-funded programs such as Medicare (for seniors) and Medicaid (for low-income individuals) serve as payers, covering eligible individuals’ healthcare costs.
3. Employers:
   • Role: Some employers offer health insurance coverage as part of employee benefits, either by fully funding or subsidizing premiums.
4. Healthcare Providers:
   • Role: Hospitals, clinics, and individual healthcare practitioners are stakeholders as they provide services to patients and interact with payers to receive reimbursement for covered services.
5. Patients:
   • Role: Individuals covered by health insurance plans are stakeholders who may contribute to premiums, copayments, or deductibles and access healthcare services based on their coverage.
6. Brokers and Agents:
   • Role: Intermediaries who assist individuals and businesses in selecting and purchasing health insurance plans, often earning commissions from insurers.
7. Third-Party Administrators (TPAs):
   • Role: Companies that process insurance claims, manage benefits, and perform administrative tasks on behalf of health insurance providers.
8. Pharmaceutical Companies:
   • Role: Involved in the healthcare payer system as the cost of medications is often covered or partially reimbursed by insurance plans.
9. Medical Equipment and Device Manufacturers:
   • Role: Similar to pharmaceutical companies, they are part of the payer system as costs related to medical equipment may be covered by insurance.
10. Regulatory Bodies:
    • Role: Government agencies and regulatory bodies oversee and regulate the health insurance industry, ensuring compliance with laws and standards.
11. Health Information Exchanges (HIEs):
    • Role: Organizations that facilitate the secure exchange of health information between payers, providers, and other stakeholders to improve coordination of care and reduce costs.