Running head: OPERATIONS DEVELOPMENT IN HEALTH CARE ORGANIZATIONS 1. Operations Development in Health Care Organizations. Theodore H.

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1 Running head: OPERATIONS DEVELOPMENT IN HEALTH CARE ORGANIZATIONS 1 Operations Development in Health Care Organizations Theodore H. Cacciola Charter Oak State College Author Note Correspondence concerning this article can be submitted via to Theodore Cacciola at tcacciola@charteroak.edu or theodorecacciola@gmail.com.

2 OPERATIONS DEVELOPMENT IN HEALTH CARE ORGANIZATIONS 2 Abstract The development of healthcare organizations has flourished since the introduction of managed care organizations working with large unions in the nineteenth century. The development of these systems and operations over time has been crucial to the development of healthcare operations on a global level. Throughout the history of healthcare, most issues have been mitigated through the development of parallel systems which counteract the issues associated with these developments in health care. The continued development of major health organizations is critical in the overall wellbeing of the biomedical services industry. Keywords: healthcare development, health insurance development, healthcare efficiency, healthcare operations, healthcare issues, healthcare solutions, managed health care, geographic healthcare, healthcare security, healthcare technology

3 OPERATIONS DEVELOPMENT IN HEALTH CARE ORGANIZATIONS 3 Operations Development in Health Care Organizations Development in the operations of healthcare services over time improves the efficiency of both medical facilities and patient care. Within each modern development issues have developed which must be addressed. Throughout this text we lay out the issues pertaining to health care in the 21 st century and separately comprise solutions which negate the issues associated with these new advancements. Modern Issues in Health Care Health Insurance Issues The development of vast managed healthcare organizations has created issues within the spectrum of health insurance. Managed care organizations have started networks and group practices and most insurance programs only let their members see in-network physicians. This creates serious limitations by which the providers a member can see is limited to the number of practitioners available as referrals. Increased drug costs have also come about because of the proponents of managed care organizations. The amount of money of which many patients spend on health insurance has created donut holes in coverage where after a specific amount of money has been spent by the insurance company, patients must cover an additional amount before coverage can continue. While generic prescriptions may lessen the burden, the continued increase in prescription drug prices is a challenge to managed care organizations [where] as cost sharing continues to grow for consumers patients are having trouble paying for their medications (Niles, 2018). Technological Issues With the advancements in technology digital healthcare solutions have started to flourish. The first of these issues has been the movement from physical prescriptions to digital

4 OPERATIONS DEVELOPMENT IN HEALTH CARE ORGANIZATIONS 4 prescriptions, where physicians can send digital prescriptions directly to pharmacy s along with both practitioners and pharmacists having digital copies of each prescription issued. While this may sound like a perfect system, there are issues inherent to the introduction of the use of this technology. Prior to digital prescriptions, providers handed hand-written prescriptions to patients and only had to worry about their prescription pads being stolen. Now, these prescriptions must be digitally secured using digital defense technology which increases not only the ability to be hacked, but the number of people who could get ahold of this information. Secondly, with patient information and notes being stored digitally, solutions which were initially created to help both patients and physicians are now vastly available to any hacker with the technological ability to obtain them. Internet security solutions must be developed and rigorously maintained to secure these notes and patient information 24/7, and this digital information does not only pertain to practitioners. Insurance companies and providers must also secure patient information which may include all information pertaining to the treatment and insurance coverage of any patient which contains sensitive information. Geographic Issues Additionally, geographic issues have come about within the development of group networks in health insurance. The affordable healthcare act created a stimulus for practitioners to operate as groups and in networks rather than to operate individually, and a trend was created for group practices to operate in heavily populated areas rather than in rural areas where they would not be able to guarantee income. Preferred provider networks have become the only specific networks which offer value to people living in less-populated rural areas, at a cost. Also known as geographic maldistribution, this is an issue where physicians prefer to practice in urban and suburban areas where there is a higher probability of increased income

5 OPERATIONS DEVELOPMENT IN HEALTH CARE ORGANIZATIONS 5 (Niles, 2018). This is exacerbated when better physicians operate in more densely populated areas, and lesser accredited physicians practice medicine in rural areas increasingly limiting the scale of care of which specialists operate in rural areas. Specialists yield the highest income of all professionals yet their presence in rural areas is almost non-existent, with these specialists averaging over $411,000 yearly (Niles, 2018). This level of care in rural areas has been designated to hospital networks operating in rural areas and is being mitigated by technological advancements for telemedicine and new designations for primary care physicians. Solutions in Health Care Health Insurance Solutions While the concept of networks increases the costs of healthcare facilities, the scale of hospital operations is expanding. Through solutions like telemedicine health insurers can reach patients in hard to reach areas providing quality care at costs available to individuals in rural areas. This way, states with smaller populations now can create state-wide hospital networks which provide complete care by providing smaller hospitals and more clinics to lesser populated rural areas. Legislation has come about which lessens the number of beds needed for facilities to be considered hospitals and operate as such and the expansion of the availability for nurse practitioners to operate as primary care physicians has increased the quality of care as well. Technological Solutions In 1996 the HIPAA (Health Insurance Portability and Accountability Act) adopted national standards for the security of electronic protected health information (Herzig, 2013). This act proposed sanctions on newly acquired technology to increase security of healthcare IT solutions. While most, if not all software solutions can be vulnerable to exposure software technology providers of healthcare security have been regulated to create unique systems which

6 OPERATIONS DEVELOPMENT IN HEALTH CARE ORGANIZATIONS 6 do not pose a threat to vulnerability. In the exchange of prescription and patient information, the key electronic security solutions (for) healthcare protection are intrusion detection, access control, and video surveillance (Colling, 2009). These security measures give full-scale protection for health care security in a modern technological era. Traditionally, physical security and well-trained security professionals were the back-bone for health management security solutions but the use of technological solutions in healthcare is becoming more widespread. In today s healthcare information technology spectrum unique systems to the operations of healthcare are monitored 24/7 by security solutions to avoid intrusion detection, and make any suspected intrusion aware to the practitioner s data in question. One larger healthcare technology solution in question would be access control initially a form of password has expanded to allow technology users to sign in using fingerprint access or access areas of the hospital using radio frequency identification. These RFID chips allow physical security individuals access to parts of the hospital with the use of range based technology chips to assuage any access by individuals other than those of which have been authorized and video surveillance can be alarmed when security software is notified that, for example an RFID chip has not been used to access a restricted area and the issue is then addressed in real time. Geographic Solutions Preferred provider networks are a newer form of insurance coverage and typically have deductibles which are typically more expensive to people living in rural areas insured with managed healthcare organizations. This geolocation burden has been lessened due to increases in the availability and cost of telemedicine. Traditionally, telemedicine was created for conditions which were commonly rare, and in some cases used radio networks and phone conferences so that specific practitioners could reach patients across the country.

7 OPERATIONS DEVELOPMENT IN HEALTH CARE ORGANIZATIONS 7 As technology has advanced and the introduction of nationwide high-speed internet connections have become available telemedicine has developed to include secure video conferences in which providers can reach the entire populous as part of their insurance network. In some cases, patients can now even choose managed health insurance using telemedicine to find providers outside their geographical area typically specialists. The influx of patients and the movement towards primary care physicians has also created a system where practitioners have less incentives to treat patients as primary care physicians. Legislation has developed which allows nurse practitioners, sometimes even RN s, to operate as primary care physicians. This change has improved the benefits of geolocation to include increases in trust between patients and primary care physicians. Conclusion Throughout the history of health care, developments in the operations structure of the health services has come with positives and negatives. Negating these problems involves understanding the drawbacks of new advancements and mitigating these issues. The implementation of the ACA and other legislations have created geolocation issues but technological structures have advanced telemedicine to allow health services to reach rural areas. Problems involved with the implementation of new technology and the transition from physical security has allowed video monitoring to work alongside RFID to asses problems associated with the operations of hospitals. While there are clearly issues regarding the U.S.A. having privatized healthcare these issues have surely been mitigated sooner through the ability for free markets to adapt.

8 OPERATIONS DEVELOPMENT IN HEALTH CARE ORGANIZATIONS 8 References Niles, Nancy J. (2018). Basics of the U.S. Health Care System. 3rd ed. Burlington, MA: Jones and Bartlett. Colling, R. L., & York, T. W. (2010). Hospital and Healthcare Security (Fifth ed.). Burlington, MA: Elsevier. Herzig, T. W., Walsh, T., & Gallagher, L. A. (2013). Implementing Information Security in Healthcare. Chicago, IL: HIMSS Mission. World Health Report Now More than Ever (2008 ed.). (2008). Geneva: World Health Organization. Hopp, W. J., & Lovejoy, W. S. (2013). Hospital Operations: Principles of High Efficiency Health Care. Upper Saddle River, NJ: Pearson Education.