UnitedHealthcare is a key operating segment of UnitedHealth Group, which is the single largest health care delivery service in the US serving over 70 million people. The organization strives to enhance the quality and efficiency of health care while improving access to numerous health benefits to Americans. UnitedHealth Group achieves this by inventing products and services that aim at making health care to be more affordable through technology and innovation. The network comprises over 595,000 physicians, 80,000 dentists, and 4,965 hospitals (UnitedHealthCare Group, 2013). Within the past five years, the group has invested in research, technology, and business process improvements. Furthermore, it has tried to line up its commercial, Medicare, and Medicaid businesses into a solitary brand to make individuals access health care benefits across every phase.
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Evaluation of Programs
UnitedHealthcare utilizes a single premise program that aims at empowering individuals to identify their health care solutions that work efficiently for them. The organization focuses on innovation and differentiation to coordinate health care services. The services offered by UnitedHealthcare are of high volume, multifaceted, and intensive where each patient requires exclusive and broad evaluation processes. Such a process brings into light the organization’s conviction that excellence in healthcare service is directly linked to cautious selection with the individual performance of physicians, nurses, and dentists (UnitedHealthCare Group, 2013).
The chain hands-off approach is evident through the organization’s processes of managing, analyzing, and circulating its storage of health care data among its medical professionals and clients. This information is used to examine, assess, and aid in decision-making in addition to the creation of innovative treatment methods (Chaplin, 1996). Furthermore, the client-provider relationship referred to as optimum is the key to the UnitedHealthcare process. This process entails the simplification of the contact between outside providers such as insurance companies with the clients (UnitedHealthCare Group, 2013). Afterward, the facility head of admission makes certain that conditions of patient satisfaction are attained before reporting to the nurse or physician liaison. Consequently, the facility liaison personnel reports to the outside provider to confirm that the conditions have been satisfied. If the outside provider is satisfied with the conditions, pre-admission procedures for the patients are performed and the patients provide direct feedback to the outside provider regarding the quality of service. Notably, such feedback is used to initiate further improvements and modifications (UnitedHealthCare Group, 2013).
However, this methodology observed several shortcomings with the most significant being the extremely high composition of sub-processes that make the workflow to be quite linear (Bigelow & Arndt, 2005). In particular, the American health care system is largely unwired and disjointed with variables all along with the procedures and outcomes. Hence, such major disparities increase the expenses regardless of the efforts of enhancing quality, cost, and the incorporation of information technology. Moreover, given that Medicare/Medicaid will classify healthcare providers concerning the resultant outcomes and patient satisfaction as the basis for pay on performance, there is no modality to compare UnitedHealthcare performance facilities to effectively conduct improvements under the initiative (Champy & Greenspun, 2010).
To fulfill their patient satisfaction and to be ready to deal with the health care needs of citizens in the next decade, UnitedHealthCare needs to train its healthcare professionals to spot breakdowns along with its system. It also needs to come up with innovative interventions (Masonson, 1993). Furthermore, UnitedHealthCare requires the services of an outside healthcare consultant specializing in patient satisfaction to assess its level of client satisfaction. For instance, quarterly surveys are required to define, review, and advance the quality of service functions. These surveys should be conducted under an empowered client service personnel as a solitary point of contact. Secondly, multiple versions of similar processes should be eliminated and replaced with five major behaviors of initiatives, joint efforts, empathy, courteousness, and communication as the drivers of patient satisfaction. Thirdly, the organization needs to align its network facilities’ quality with LEAN departments to ease the quality and operational improvement measures (Chaplin, 1996). In such a process, the external provider works in coordination with the facility liaison marketer to clarify and initiate groundwork negotiations of provisional commitments.
One of the key outcomes of healthcare reengineering is to allow the staff to make decisions even as jobs are merged into single departments. This calls for a renewed assurance to quality enhancement, nursing excellence, along staff engagement. Firstly, best practices for valuable nursing recruitment should be implemented to assure the hiring and advancement of exceptional nursing personnel. Therefore, UnitedHealthCare needs to encourage the nurses to get specialty certification or institute professional portfolios by offering incentives like compensations and bonuses every year they renew their certification (Masonson, 1993). Secondly, there is the need to reduce the duration when a position is declared vacant to the moment of hire for a typical two months. Thirdly, it is essential to develop a methodology for determining the efficacy of the orientation of new nurses and deliberate recognition programs. Hence, a nursing resource center will provide the nurses some space to pursue professional certification and to research current evidence-based practices. Furthermore, the nurses should come up with a departmental vision statement. This will balance the proportion of full-time nursing staff and their part-time counterparts to guarantee continuity and dedication (Bigelow & Arndt, 2005).
To attain improved outcomes under cost reduction measures, it will be crucial for UnitedHealthCare to shift to specialization. In particular, procedure specialization will lead to an accelerated knowledge curve arising from the economies of scale (Chaplin, 1996). However, such outcomes should be maximized via recurrent improvement processes. Moreover, the available technology will facilitate its national network sharing of information across its providers. Therefore, permitting every patient to get a data-driven assessment, prognosis, and treatment plans from another facility while staying in a single location will eliminate the excess use of resources from one facility to another auxiliary facility. An example is providing home health care provisions, through telehealth applications. It is also crucial to consolidate flows by arranging operations and facilities spaces based on experiences while installing resources to the spot of utilization to reduce patient movements (Champy & Greenspun, 2010).
The focus should be made on IT-enabled businesses within the wider health care marketplace to ensure efficient and resourceful network growth. This calls for active intelligence, outsourcing solutions, and consulting services across the network facility’s decision-making processes. Initial engagement should be on market analysis through geographic information systems to locate regional facilities along with key transportation and residential systems. Secondly, there should be an increase of physician and nurses’ workplace locations through capacity models that are based on estimated production, operation management, seasonality, and output (Bigelow & Arndt, 2005).
This case study reveals the effective and hollow management approaches of UnitedHealthCare where the entire procedure is just a single process that operates under a chain of the primary workflow model. However, UnitedHealthcare needs to come up with an effective evaluation program that will determine the level of satisfaction of its clients. This will greatly improve its performance in the short run and the long run, hence enabling the healthcare facility to meet its short-term and long-term goals and objectives.
Bigelow, B., & Arndt, M. (2005). Transformational Change in Health Care: Changing the Question. Hosp Health Serv Adm , 83 (2), 19-26.
Champy, J., & Greenspun, H. (2010). Reengineering Health Care: A Manifesto for Radically Rethinking Health Care Delivery. Philadelphia, Los Angeles: FT Press.
Chaplin, E. (1996). Reengineerig in Health Care: Chain Hand-offs and the Four-Phase Work Cycle. Quality Progress , 29 (10), 105-06.
Masonson, L. N. (1993). Reengineering is here to stay. Healthcare Financial Management , 47 (11), 84-85
UnitedHealthCare Group. (2013). Strategic Alliances. Web.