Networking contract constitute to the strength of any properly planned healthcare plan and it is usually made of contracted healthcare professionals, facilities and health systems, non-medical experts, therapeutic services and infrastructures as well as any other care providers. With the demands instilled by Affordable Care Act gaining effect in recent past, most healthcare facilities have assumed the central responsibility in enabling health professionals to enhancing reimbursements while on the other hand promoting patients’ care as well as reducing overall cost incurred by health insurance entities. As a result, every stakeholder, who includes the patient, healthcare provider and the insurance company, is able to generate maximum benefit (Health Insurance Exchange, 2013). This paper evaluates the type of networking contract employed at the Colorado University hospital.
Networking contract employed at the University of Colorado Hospital
University of Colorado Hospital (UCH) or what is commonly known as University Hospital is a nonprofit making healthcare facility, which constitutes to a part of Colorado University Healthcare system. Situated in Aurora in Colorado, UCH is primarily a teaching hospital serving medical students at the school of medicine in Colorado University. According to UCH (2012), the hospital is recognized as one of the largest and best healthcare facilities in United States and it constitutes to a part of the Anschutz Medical Campus, which is one of the world’s leading life science institutions. The hospital’s inpatient unit has a 467-bed capacity and it offers general rehabilitation services within an acute care setting as well as other inpatient consultation activities. In addition to this unit, UCH also has an outpatient unit that comprises of various outpatient settings that include amputee unit, physical therapy, general rehabilitation, psychological rehabilitation, tone management, and electromyography units.
The hospital has a huge annual patient admission estimated at 24,700 and it performs about 7400 inpatient as well as 8900 outpatient surgical operations. Similarly, its emergency room receives a relatively huge number of patient visits estimated at 67,000.UCH’s central focus is the patient and it has thus refurbished its entire healthcare system to ensure that all the care procedures from admission and discharging is aimed at promoting the best patient experience (UCH, 2012). The hospital has reviewed every single care process that patients go through and redesigned every activity to ensure that patient experience is improved. The hospital ensures that highly qualified medical professionals are at patients’ service and that they provide the best care at the most affordable cost and answer patients’ questions in the best way possible. There is also a well stocked retail pharmacy at the hospital waiting room, which offers the best drug prescriptions at the most affordable price when the patients are discharged. Based on this focus, UCH must adopt an appropriate networking contract that can help it to appropriately support its healthcare insurance exchanges on one hand while on the hand maintaining quality as well as reducing overall care cost (Health Insurance Exchange, 2013).
Health Maintenance Organization (HMO) is the most appropriate networking contract that UCH is likely to have. HMO is a well coordinated healthcare delivery system that integrates within the same healthcare institution the duty for financing on one hand and delivering services on the other. In exchange for a premium that is subscribed on a monthly basis, the beneficiaries can be able to access quality services from a comprehensive network of medical professionals, care providers, health-related infrastructures, and healthcare facilities (National Council on Disability, 2013). Under the initial version of HMO networking contract, the institution that owned as well as managed most of the health facilities from which the beneficiaries received treatment hired healthcare professionals. The version is however modified in that it currently allows for the existence three basic versions of the HMO networking contract. Today, HMO exists in form of a staff model under which medical professionals are waged workers of the contracting organization. It also exists in the form of a group model, which allows the insuring institution to contract a group of healthcare professionals working on a per capita basis. The group of professionals is usually paid on monthly basis as per the beneficiary fee paid in return for the open-ended services given to members of the beneficiary population (Valeta, 2014). The contract also exists in the form of a network model, which allows the healthcare institution to contract with various medical groups that ensure that physician service is furnished. This explains why MHO is most appropriate for UCH. This is because the networking contract would ensure that UCH is able to contract most qualified physicians that can be able to offer the best quality health care services to the patients. Although Preferred Provider Organization (PPO) would be more appropriate compared to HMO given the fact that it is less expensive compared to the latter, it does not allow care providers to contract with third party organizations. This requirement is however inappropriate for UCH as it contracts with third party professionals that have a common objective in making high quality care to be readily available to non-deserving Colorado citizens (UCH, 2012). Similarly, HMO networking contract is appropriate to UCH in that it ensures that the health facility it able to meet its primary objective in promoting maximum benefits for the healthcare beneficiaries, the contracting organization as well as the insuring company. According to National Council on Disability (2013), HMO plans are renowned for being the most effective cost-saving approach for the insuring companies, employers that incur premium costs on behalf of their workers as well as the healthcare consumers that cater for premium costs themselves. HMO enhances cost reduction by demanding for patients to consult their basic care physicians before pursuing for a more expensive specialty. This ensures that patients only seek for higher level specialty only when it is absolutely necessary, which ensures that the overall care cost inquired is drastically reduced. Another important factor that makes HMO an appropriate networking contract is that it allows healthcare facilities to contract services of specific health professionals that agree to offer quality healthcare services at a subsidized cost (Valeta, 2014). This factor complements UCH’s major objective as it aims to offer high quality services at a significantly reduced cost. While UCH’s intension is to improve patients’ experience by modifying every activity and process at significantly reduced cost, HMO offers an avenue upon which the facility can achieve this objective by ensuring that all categories of patients can access the most desired services at the fairest cost possible. According to Valeta (2014), HMO networking contract has the lowest premiums compared to other contracts, which offers the best option for patients that may be pursuing general healthcare services even if they might generally be healthy. The network also ensures that patients would be able to subscribe to an economical contracting systems even though they might rarely use it so as to be able to access quality services from highly qualified physicians contracted within the network when need be.
Networking contract is an appropriate healthcare plan in any given health facility as it enhances proper integration of highly qualified physicians, medical facilities, health-related infrastructures and other care providers. While different networking contracts can be employed in different healthcare facilities, HMO is the most appropriate networking contract that is likely to be employed at UCH. This is because the networking contract complies with the various objectives that the hospital has set as well as those that guide its focus.
Health Insurance Exchange. (2013). New Provider Network will Support Health Plans Sold on and Off the Health Insurance Marketplace. Retrieved on 19th May, 2015 from http://www.anthem.com/provider/co/f5/s6/t0/pw_e205746.pdf?refer=ahpprovider
National Council on Disability. (2013). Types of Network –Based Health Plans. Retrieved on 19th May, 2015 from http://www.ncd.gov/publications/2013/20130315/20130513_AppendixD
UCH. (2012). University of Colorado Health and Welfare Trust: Trust Committee Resolutions Adopted As Of June 18, 2012. Retrieved on 19th May, 2015 from https://www.cusys.edu/trust/meetings/h-2012_06-18_Resolution.pdf
Valeta, M. (2014). Too narrow for Comfort? Get a First Look at 2015 Colorado Insurance Plan Provider Networks. Retrieved on 19th May, 2015 from http://cohealthinitiative.org/blog/2014-12-05/too-narrow-comfort