Blue Cross Blue Shield Of Georgia

The risk management program in any business, especially in a health care organization is an integral part of its day to day operation. The purpose of the risk management department is summed up by Kavaler & Alexander (2014), “…a program designed to reduce the incidence of preventable accidents and injuries to minimize the financial loss to the institution should any accident or injury occur” (p. 5). Protecting employees, patients, vendors and visitors is an ongoing process and one that needs to be updated when the healthcare organization has deemed necessary. This paper will demonstrate the importance of presenting the risk management program to new employees, compliance with the standards set forth by the American Society of Healthcare Risk Management (ASHRM), propose recommendations or changes needed to further improve the program, as well as examine the administrative process of managing a risk program.

Risk management is about reducing the likelihood of errors with the aim of improving and monitoring the quality of health care services. The purpose for risk and quality management is to improve the care of the patients and reduce liability among the staff and the patients. In following risk and quality management protocols

Quality management is essential to the success of the quality improvement of the health care industry. “Management uses management and planning tools to organize the decision making process and create a hierarchy when faced with competing priorities “( Ransom, et al., 2008). Quality measures should have these goals: effective, safe, efficient, patient-centered, equitable, and timely care (Quality Measures, Center for Medicare & Medicaid Services, 2011).

The Joint Commission has instituted a number of goals nationally; the aim is to improve patient’s safety. The goals selected look at areas that are of concern in the healthcare industry particularly how it affect patients safety and make recommendations how to reduce if not eradicated these. The Joint Commission is the governing body that accredited hospitals and other health care organizations. The two hospitals that this paper will be comparing, using the goals and criteria recommended by the Joint commission, is Holy Cross Hospital located at 1500 Forest Glen Road, Silver Spring, MD and Shady Grove Hospital situated at, 9901 Medical Center Drive, Rockville, MD.

This quality improvement discussion will review the purpose of quality management in health care industry and why it is needed. Included in this QI report will be an explanation of the

The book discuss about three major types of managed care organization: health maintenance organizations (HMO), preferred provider organizations(PPO), and point of service plans(POS). Managed care has been around for minute. This organization has been around since 1930s. The three managed care organizations are require an agreement between the insurer and a network of health care providers. Policy holders are encouraged to use the providers in the network by the fact a percentage will pay the cost of care if received outside the network.

BlueCross BlueShield Association (BCBSA) is an independent health insurance association which is founded in 1929. It is made up by 37 different health insurance organizations and companies in the United States. They directly or indirectly provide health insurance to over 100 million Americans. Under the Association, it has two famous products. One is Health Maintenance Organizations (HMOs), and the other is Preferred Provider Organization (PPOs). Most American who has health insurance from their employer are enrolled either an HMO or PPO. All of these managed care plans go through the health plan’s network, which contract with doctors, health care providers, clinics, and hospital.

The Joint Commission has set forth standards for health care organizations to reduce the number of risks and amend the quality of care and the safety of the patient. Risk management and quality management focus on these attributes of the organization and the patient. Risks are impossible to avoid since it linked to everyday living and the workforce. Risk management must take the initiative to distinguish and oversee these risks. Due to the lack of consistency in the quality of care, health care organizations aim to reduce the negative outcomes of the patient safety through quality management methods. Internal and external factors may pose a risk that can have an impact on the organization and the consequence of the patient care and safety.

BlueCross BlueShield of Pennsylvania offers health insurance plans such as Medicare, dental, vision, and individual and family insurance. Individual and family plans are distinguished as platinum, gold, silver and bronze plans. Other plans include catastrophe and multi-state plans.

Blue cross was founded in 1929 by Justin Ford Kimball, a vice president of Baylor University health care facility in Dallas who introduced the plan to provide hospital care services. Justin Kimball first plan was to guarantee teachers 21 days of hospital care for $6 dollars a year. The plan became popular it was extended to other groups nationally, and other employees started using it throughout the United States. In 1939 blue shield was founded in California by a group of employers providing medical care to their employees by providing a monthly fee, which help pay for physician services. Later in 1980s both company merged, and became successful since providing the best health care service at a low cost nationwide.

Healthcare risk management ( HRM) began in The late 1970s, when hospitals are facing a malpractice crisis (Kavaler & Alexander, 2014). According to Kavaler and Alexander (2014), it is estimated more than 140,000 Americans die from medical errors and the cost ranges between $17 billion and $29 billion each year in the United States (Kavaler & Alexander, 2014). In this essay, the student will explain a healthcare risk management program, evaluate the program for compliance with the American Society for Healthcare Risk Management (ASHRM), and Examine the administrative process of management the risk program.

The purpose of this paper is to identify a quality safety issue. I will summarize the impact that this issue has on health care delivery. In addition, I will identify quality improvement strategies. Finally, I will share a plan to effectively implement this quality improvement strategy.

All business like Blue Cross & Blue Shield performs internal activities to ensure they provide value to their customers. They implement their core set of elements which helps them maximize their return on effort investment to drive change. Businesses develop core competencies to not only deliver unique value but to create sustainable competitive advantage. I notice most companies use the SWOT analysis (Strengths, Weakness, Opportunities and Threats) to determine their internal strengths and external weaknesses which analyze the company’s future performance.

Quality is something that every health care agency strives to achieve. The Institute of Medicine (IOM) suggests that health care organizations develop a culture of safety such that an organization's care processes and workforce are focused on improving the reliability and safety of care for patients (Groves, Meisenbach, & Scott-Cawiezell, 2011). In order to address an issue related to health care quality, it is important to look at the frameworks that will analyze an organization and identify opportunities to improve performance. The purpose of this paper is to provide a description of an organization and an analysis of the following: mission, vision and values, strategic plan, goals,

The World Health Organization defines Safety and Risk Management as “ activities or measures taken by an individual or health care organization to prevent, remedy or mitigate occurrence of a real or potential (patient) safety event”1