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HSMT 2103 Exam 2 Study Guide

Terms in this set (38)

Health Care Marketing
Consists of the kinds of activities a firm uses to satisfy customer needs; the approaches managers pursue to create, communicate, and deliver value in selected markets; and the means of capturing value in return.
Components of Strategic Marketing
Key Stakeholders: Customers, board of directors, suppliers, physicians, employers, society at large.
Controllable Variables: Product, price, promotion, place.
Uncontrollable Environment: Political, economic, social and cultural, technological, regulatory, competitive.
Strategic Marketing Process Framework
Organization purpose
Core strategy
Competitive positioning
Implementation
Marketing mix
Continous improvement
Differential advantage
Organization analysis
Evaluation and control
Target market
Industry analysis
Concentration Strategy
Targets a single market in order to specialize the objective of gaining a large share of the market. This specialization enables the health care provider to focus all marketing activities on creating, delivering, and sustaining long-term value to a distinct set of customers. However, the specialization may preclude the organization from entering other attractive markets.
Consumer Behavior
Refers to the totality of consumers' decisions with respect to the acquisition, consumption, and disposition of goods, services, time, and ideas by humans over time.
4 P's of Marketing
Product: Goods, services, or ideas
Price: Value placed on the product
Promotion: Marketing activities used to communicate to the target market, including public relations, advertising, personal selling, and integrated marketing campaigns
Place: The offering delivery route
Marketing Plan
A written document that serves to guide marketing initiatives across the organization. It is typically part of the broader strategic plan that has a long term horizon.
Types of Marketing
Social marketing: The design, implementation, and control of programs calculated to influence the acceptability of social ideas and involving consideration of product planning, pricing, communication, distribution, and marketing research
Cause-related marketing: Links a for-profit company and its offerings to a societal issue, with the goal of building brand equity and increasing profit.
Health Care Quality
May be defined in various ways, with differing implications for health care providers, patients, third party payers, policy makers, and other stakeholders. The degree to which health services for individuals or populations increase the likelihood of desired health outcomes and are consistent with the current professional knowledge. High quality services should be effective, achieving desired health outcomes for individuals. Health care services should achieve desire health outcomes for populations, while matching the societal preferences of policy makers and third party payers for efficiency. Health care providers should adhere to the professional standards and base treatments on their efficacy, as determined by the best scientific evidence available.
Donabedian Model (Structure, Process, Outcomes)
Structure: Involve the material and human resources of an organization and the facility itself. The quality of personnel is documented in their numbers (nurse staffing), skill level level (CNA), and various certifications, while the quality of facilities lies in accreditation and/or certification.
Process: Involves the actual delivery of care as well as its management.
Outcomes: Are the resulting health status of the patients
Donabedian Model (4 Components of Quality)
The technical management of health illness
The management of the interpersonal relationship between the providers of care and their clients
The amenities of care
The ethical principles that govern the conduct of affairs in general and the health care enterprise in particular.
Quality Improvement (Underuse, Overuse, Misuse)
Underuse: The failure to provide a service whose benefit is greater than its risk
Overuse: Occurs when a health service is provided when its risk outweighs its benefits or it simply has no added benefit, as with overuse of certain diagnostic tests
Misuse: When the right service is provided badly and an avoidable complication reduces the benefit the patient receives.
Health Informatics
The multidisciplinary field in which information technology is brought to bear on our health care system with a goal to improve quality, raise efficiency, and lower costs.
Total Quality Management / Continuous Quality Improvement
The qualiry impeovement philosophy articulated by Deming that encourages worker paripation in process change, focuses on data based decision making, and embraces a standardized approach to quality improvement
Common Elements of Quality Improvement
Measurement: The translation of observable events into quantitative terms
Metrics: The means actually used ti record these observable events.
Reliability: Repeated measures are consistent
Validity: Extent to which measurement actually measures the intended concept.
Approaches to Quality Improvement (FOCUS, PDCA)
FOCUS: Find, organize, clarify, understand, and select
PDCA: Plan, do, check, and act
Mapping Process Flow Charting
The main way that processes are mapped. A basic flowchart outlines the major steps in a process. A detailed flowchart is often more useful in quality improvement.
Workflow Diagram
Reflects movement of people, materials, documents, or information in process.
HIS Scope Model
Health Information Systems
Systems and management
Health informatics
Data and analytics
Research, policy, and public health
Networks (LAN, WLAN, Etc)
Can be categorized as Intranets (internal to an organization), or Extranets (External and allows user to share information). Can also be categorized as local area networks (LANs), wireless local area networks (WLANs), wide area networks (WANs), wireless wide area networks (WWANs), and storage area networks (SANs). The internet is a well known WAN.
System Applications in Health Care
Health care businesses are supported by traditional software applications used to run the business. The key purpose is to manage the organization's expenses and revenues. More sophisticated systems will manage two of their most costly resources - staff and equipment. Examples include: Standard office applications, budget systems, ERP systems, scheduling, marketing systems, fund raising systems, billing and accounts receivable systems
Clinical System Functions
idk. look it up.
5 Pillars of Health Outcomes Policy Priorities
Improve quality, safety, efficiency, and reduce health disparities
Engage patients and families in their health
Improve care coordination
Improve population and public health
Ensure adequate privacy and security for patient health information
Protected Health Information
Protect all individually identifiable health information such as past / present / or future health conditions, the provision of health care to the individual, past / present / or future payment, or anything that identifies the individual
Health Insurance Portability and Accountability Act (HIPAA)
The intent is to develop standards for health care data and their exchange and regulations on privacy protections
12 Health Care IT Issues
Unsupported, unpatched operating systems
Antivirus/antimalware issues
Poor security authentication
Unsecured wireless networks
No data redundancy, backups
Portable media and laptop security
Poor user training
Old, out of date, out of warranty systems
Lack of employee computer use policies
Email scams, hoaxes, phishing
Inept/untrained IT support resources
Data on workstations, laptops
Top National Health Expenditures
Hospital care
Physician and clinical services
Other professional, dental, and personal care services
Other health, residential, and personal care
Prescription drugs
Durable medical equipment and other nondurable medical products
Nursing home and home health care
Government administration
Net cost of health insurance
Public health activities
Research
Structures and equipment
Out of Pocket Payments
Payments by individuals who buy individual insurance policies, pay for services themselves, and/or pay for part of those services through copayments and/or deductibles
Private Health Insurance
Payments made by individuals and/or their employers for health insurance premiums, which in turn cover the costs of payments made by various health plans, including indemnity plans, preferred provider organization plans (PPOs), point of service plans (POSs), health maintenance organizations (HMOs), ad catastrophic plans, such as high deductible health plans (HDHPs)
Public Health Insurance
Includes funding from federal, state, and local government programs, including, among others, Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and the Military Health System
Fee for Service
This approach was developed by Blue Cross Blue Shield plans and is based on the idea of an insured individual purchasing coverage of a set of benefits, utilizing individual medical services, and paying the health provider for the services rendered. The provider is paid either by the insurer or out of pocket by the insured, who, in turn, is reimbursed by the insurer. Typically, the insured must meet deductibles and make copayments for their care
Health Maintenance Organization
Organization contracted by individuals or insurance companies to provide health care for a yearly fee. Such network health plans limit the choice of doctors and treatments. More than half of Americans are enrolled in health maintenance organizations or similar programs.
Preferred Provider Organization
A managed care organization structured as a network of health care providers who agree to perform services for plan members at discounted fees; usually, plan members can receive services from non-network providers for a higher charge.
Medicare
A federal program of health insurance for persons 65 years of age and older
Medicaid
A federal and state assistance program that pays for health care services for people who cannot afford them.
CHIP
Provide health coverage to low income children that do not qualify for Medicaid
Tricare
Covers active duty military personnel, retired military personnel, and their family members.
ACA and the Uninsured
The ACA has had a significant impact on the number on uninsured. Providing health care to the uninsured continues to fall primarily to hospitals, where much of it becomes uncompensated care. The cost of care provided to the uninsured is borne by the taxpayers, as well as insured patients, with those costs being passed along in the form of higher taxation and higher health insurance costs.
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