Health Organization

13.05.2020 in Case Study
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UnitedHealthcare is believed to be the largest medical insurance provider in the United States. The organization is well-known for its detailed strategic approaches to health care insurance and its strong commitment to innovations and cost-effective developments targeting most, if not all, community members. Today, UnitedHealthcare is looking for new ways to strengthen its market position and enhance the quality of its services. One of the distinguishing features of the health organization is the presence of a detailed strategy that confirms its readiness to meet the needs of citizens in the next decade. Still, the organization will have to be more detailed in meeting the needs of the most vulnerable population groups and, at the same time, learn to balance the objective requirements for medical care quality and subjective criteria of patients’ experiences and satisfaction with UnitedHealthcare. 

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UnitedHealthcare: Background Information

UnitedHealthcare is one of the leaders in the U.S. medical insurance industry and the largest health carrier in the U.S. The company is strongly committed to delivering innovative health and insurance products and services to more than 70 million Americans (UnitedHealthcare, 2012a). The organization’s nationwide network currently covers more than 700,000 physicians, 80,000 dentists, and almost 6,000 hospitals (UnitedHealthcare, 2012a). The organization’s pharmaceutical management program provides affordable drugs and pharmaceutical preparations to almost 13 million people (UnitedHealthcare, 2012a). UnitedHealthcare claims to be making considerable investments in research and development. The organization also reports considerable improvements made to the quality and efficiency of the service delivery due to such investments (UnitedHealthcare, 2012a). However, this information alone cannot help assess the organization’s readiness to meet the needs of citizens in the next decade. Therefore, the needs and requirements imposed on health care in the next decade need to be evaluated.

UnitedHealthcare: Readiness to Meet the Needs of Citizens in the Next Decade

Apparently, the quality of the organization’s decisions and activities in the next decade will be determined primarily by the growing costs of health care and the growing scope of insurance coverage in the U.S. The most problematic will be meeting the needs of the low-income populations, which have not typically had any medical insurance and, therefore, may experience serious health problems (UHC Community, 2013). The organization will need to estimate possible enrollment targets, establish rates and deliver new care packages (UHC Community, 2013). Taking into account the new legal requirements and the implementation of the new health care reform, UnitedHealthcare is likely to face tough organizational, medical, and cost challenges as it is trying to preserve its strong competitive position in U.S. health care. 

At present, the organization is only partially ready to meet the health needs and challenges to be presented by citizens in the next decade. On the one hand, UnitedHealthcare realizes the dramatic impacts which the expansion of Medicaid and other reform provisions will have on the nation’s health system (UHC Community, 2013). The organization has set explicit strategic objectives and developed a comprehensive reform timeline that will facilitate the development and provision of adequate health policies. Value-based contracting and accountable care organizations (ACO) are likely to become the chief element in the creation of new models and approaches to health care in the U.S. Still, the mere realization of the next-decade challenges can hardly suffice to bring UnitedHealthcare to the desired strategic outcomes. The organization will have to make a series of strategic steps to ensure a high level of readiness for the next-decade work. UnitedHealthcare should understand that those with the most urgent health needs will enroll first (UHC Community, 2013). Consequently, the organization will have to develop new insurance and health care models to ensure that it can serve the needs of the newly enrolled populations in a cost-effective manner. At present, UnitedHealthcare may not have enough network capacity to serve the needs of the newly enrolled population (UHC Community, 2013). Thus, special attention will have to be paid to network expansion and growth. Finally, UnitedHealthcare does not seem to have enough benefits and delivery packages to serve the needs of future enrollees (UHC Community, 2013). Obviously, UnitedHealthcare will have to pass a long way to become an ideal partner and a cost-effective provider of quality health care to the existing and new populations. 

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Strategic Plan

Network Growth

It is through effective network growth that UnitedHealthcare will be able to meet the needs of citizens in the coming decade. To meet these goals, the organization will have to evaluate its current and future position and the extent, to which its goals and mission reflect the future changes in the health care system (Weil, 2001). The future volume of programs and services will also have to be based on the estimated demographic changes and their implications for Medicaid enrolment (Weil, 2001). UnitedHealthcare will have to consider possible cross-cultural problems that arise in the process of developing and expanding its strategic network. Finally, the organization will have to review its management approaches and principles as the latter has generated considerable controversy and often became an object of patients’ complaints (Ferber, 2009). 

Nursing staffing

With the growing number of health care system enrollees, UnitedHealthcare will have to address the issues of nursing staffing. At present, the organization has a good basis for the development of its medical and nursing staff: the Center for Nursing Advancement was established by UnitedHealthcare in 2008 to act as a liaison between the health care system and the emerging need for quality nursing (UnitedHealthcare, 2012b). The organization claims that its nurses are much better positioned to support the changing needs of health consumers (UnitedHealthcare, 2012b). However, the Center for Nursing Advancement does not say anything about reducing the shortage of nurses and making them better prepared to work with new low-income enrollees. Consequently, UnitedHealthcare will have to develop a plan to hire and prepare additional nursing staff to reduce the scope of the shortage problem and ensure the delivery of adequate nursing care to the new and existing enrollees. 

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Resource management

With the growing number of enrollees facing chronic health conditions, UnitedHealthcare will need to optimize its resource management system. According to UnitedHealthcare (2009), personalization is the best solution to effectiveness problems, when it comes to resource management. This being said, the organization will need to develop new and leverage the existing technologies and, at the same time, disseminate personalized health messages to proactively identify health opportunities and ensure consumer engagement in measurable health care provision. 

Patient satisfaction

UnitedHealthcare is a part of the profit-driven health care system, and patient satisfaction remains one of the most pressing issues (Ferber, 2009). As mentioned earlier, changes in management approaches will partially contribute to the development of better relationships with patients. From a long-term perspective, the organization will have to learn to distinguish between patient satisfaction and the objective quality of medical services. The organization will need to develop effective methods to measure patient satisfaction and balance the results of such measurements with the calls for more cost-effective health care. 

UnitedHealthcare will have to monitor changes in patient satisfaction, whereas consumer engagement will provide relevant information as to the most problematic aspects of the organization’s performance. By following the proposed steps, UnitedHealthcare will secure itself from the risks of failure and, at the same time, will have better chances to retain its competitive position in the health care industry.

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