Transcript organizational change - DR

MARKETING & INSURANCE
Strategic Management in Healthcare
24 MARCH 2009
MARKETING
• ESSENTIAL TO IMPLEMENTING
STRATEGY AND FULFILLING MISSION
MARKETING
• “MARKETING IS AN INTEGRAL PART OF
STRATEGIC PLANNING”
• DO YOU AGREE?
CENTRAL CONCEPT OF
MARKETING
• VOLUNTARY EXCHANGE OF
SOMETHING OF VALUE CONSIDERATION
• DETERMINE WANTS, NEEDS,
EXPECTATIONS, DEMANDS
• DELIVER GOODS OR SERVICES
ELEMENTS OF MARKETING
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PRODUCT
PRICE
PLACE
PROMOTION
SERVICE
CONSIDERATION
ACCESS
PROMOTION
TARGET MARKET
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PHYSICIANS
PATIENTS
INSURERS
EMPLOYERS
GOVERNMENT
CHARITY GROUPS
EPIDEMIOLOGIC PLANNING
MODEL
• DEMAND = POPULATION x INCIDENCE
x USE x MARKET SHARE
• INCIDENCE
– NUMBER OF NEW CASE OVER A PERIOD
OF TIME
• PREVALENCE
– NUMBER OF CURENT CASES AT A POINT
IN TIME
SOCIAL MARKETING
• USE THE TOOLS OF MARKETING TO
INFLUENCE VOLUNTARY BEHAVIOR
FOR SOCIAL BENEFIT INSTEAD OF
PROFIT
• HEALTH CARE ORGANIZATIONS?
• GOVERNMENTS & CHARITIES?
PAYORS
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FEDERAL GOVERNMENT
STATE GOVERNMENT
EMPLOYERS
CHARITIES
INDIVIDUALS
INSURANCE
• ARE THEY PAYORS?
• SINGLE PARTY PAYOR
• NATIONAL HEALTH
INSURANCE IS A CONTRACT
• PARTIES TO THE CONTRACT
– THE PATIENT AND THE INSURANCE
COMPANY
• HOW IS THE DOCTOR INVOLVED?
• HOW IS THE EMPLOYER INVOLVED?
INDEMNIFICATION
INSURANCE
• WHAT MOST OF US THINK OF AS
INSURANCE
• YOU HAVE A LOSS - THE INSURANCE
COMPANY FIXES IT OR PAYS FOR IT
SELF INSURANCE
• GENERALLY INVOLVES THIRD PARTY
ADMINISTRATORS
• LOOKS JUST LIKE INSURANCE
• USUALLY INCLUDES SOME TYPE OF
CATASTROPHIC REINSURANCE
DIRECT CONTRACTING
• TAKES OUT THE INSURANCE
COMPANY
• SAVES MONEY
• CREATES ISSUES FOR FOLLOW-UP
GOVERNMENT MANDATES
• PREGNANCY
• SCREENING PROGRAMS
• DIALYSIS
MANAGED CARE
ORGANIZATIONS
• INTEGRATION OF FINANCING AND
SERVICE DELIVERY
• INSURANCE COMPANIES WITH
CAPTIVE PROVIDERS
• USE SOME SYSTEM OF GATEKEEPING
TYPES OF MCO
• HMO - HEALTH MAINTENANCE
ORGANIZATIONS
• PPO - PREFERRED PROVIDER
ORGANIZATIONS
• POS - POINT OF SERVICE PLANS
COST CONTAINMENT
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THE PURPOSE OF MANAGED CARE
HAS IT WORKED?
ACCESS TO CARE
CONTROL OF PHYSICIANS
PREVENTION
MEDICARE
• SINGLE PARTY PAYOR
• VERY EFFICIENT AND EFFECTIVE
MEDICARE COST
CONTAINMENT
• DRGs
• PAY FOR QUALITY
• INCREASING NUMBER OF LIVES
• INCREASING SERVICES
NATIONAL HEALTH
DO YOU WANT HEALTH CARE THAT
RUNS LIKE THE POSTOFFICE?
Takes a note from my hand in New York on
Monday and puts it in my sister’s hand in
California on Wednesday for 42 cents.
CASE STUDY # 3
• GEORGE – pharmacist in rural Alabama
for 40 years – lunch counter & sundries
• Mrs Murden – expensive arthritis medicine
• Options
– Stay with her pharmacy
– Local drug discount card
– $4 plan at Wal-Mart or Walgreens
– Mail-order