Health Organization Evaluation
docx
keyboard_arrow_up
School
Grand Canyon University *
*We aren’t endorsed by this school
Course
451
Subject
Health Science
Date
Dec 6, 2023
Type
docx
Pages
7
Uploaded by stephaniemkocsis
Health Organization Evaluation: United Healthcare
Stephanie Kocsis
Grand Canyon University
NRS 451: Nursing Leadership and Management
Dr. Candida Constantine Castillo
August 27, 2023
1
Health Organization Evaluation: United Healthcare
United Healthcare is one of the nation's largest, best-known insurance companies. United Healthcare prides themselves on helping people live healthier lives while creating a healthcare system that works better for everyone (United Healthcare, 2023a). UHC believes in empowering health while focusing on the community and social determinants of health of its members (United Healthcare, 2023b). United Healthcare provides insurance plans for all types of people, including individual and family plans for people of all ages and lifestyles (United Healthcare, 2023a). They have more than 1.3 million healthcare providers within their network from over 6,700 hospitals and care facilities across the nation (United Healthcare, 2023a). The company also offers global services in South America and Europe at UHC owned and operated facilities (United Healthcare, 2023a).
Organizational Readiness
United Healthcare expresses its dedication to constantly enhancing the value of their performance for consumers, customers, care providers, and their shareholders (United Healthcare, 2023a). “UnitedHealthcare is the health benefits business of UnitedHealth Group, a health care and well-being company working to help build a modern, high-performing health system through improved access, affordability, outcomes and experiences” (United Healthcare, 2023a, para 13).
In order to understand health equity and the challenges individuals encounter, UHC works with organizations, leaders, and members across the nation, listening and learning to what they say and formulating solutions to help support and provide quality coverage and care (United
Healthcare, 2023a). Some examples of what UHC has done to increase health equity for its members include creating jobs and opening health centers (United Healthcare, 2023a).
2
The company also released a report stating that in Q2, they experienced a 13 percent increase in revenue due to an increase in member enrollment (Waddill, 2023). Andrew Witty, chief executive office of United Health Group states “
Our diverse health care capabilities and dedicated colleagues are enabling us to meet the needs of more people in more ways, driving substantial growth and expanding our opportunities to serve well into the future” (Waddill, 2023,
para 2). The company had to work past many challenged in order to get to this point, including provider workforce shortages, drug costs, and the coronavirus pandemic (Waddill, 2023).
Strategic Planning
United Healthcare is a large health insurance company who constantly views issues within the company and formulates solutions in order to implement change and benefit the company and its members. However, there is always room for improvement within any company
or organization. Strategic planning can assist organizations in reaching goals and achieving the vision they have for their company.
Network Growth
United Healthcare has a network of over 1.3 million healthcare providers (United Healthcare, 2023a). In order to continue to provide quality insurance to its members, the company should focus on expanding their network to more providers, hospitals, and other healthcare organizations. UHC can create a team of representatives who will be responsible for getting out to other organizations and help expand the United Healthcare network. Sending representatives to these organizations will not only get United Healthcare’s name out, but it also allow the companies and provider to ask questions and receive information regarding coverage and other insurance needs. In doing so, this will expand their network, allowing members to have
3
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
more choices when it comes to their healthcare and what providers, hospitals, and offices they can visit.
Nursing Staff
In order to provide quality services to its members, UHC employs nurses to assist with clinical tasks such as case management, prior authorization, member services, claims, referrals, etc. (United Healthcare, 2023b). UHC should continue to offer its employees training and education in order to assist in staying up to date on the latest practices, technology, and research. In doing so, this will allow nurses and other employees at UHC to provide quality care and services to the members they serve.
Resource Management
United Healthcare takes pride in its vision and mission statement, holding employees to high standards. In order to continue to uphold these standards, they must be evaluated and monitored. A human resource office can implement a team dedicated to these tasks. They will be responsible for evaluating and monitoring staff, providing resources and education to those who may be falling behind on the standards. This team can also determine ways to improve overall staff morale and satisfaction, which will create positive work ethics. This satisfaction will be reflected by the increase in workflow and patient/member satisfaction.
Patient Satisfaction
Patient satisfaction is a key element in the success of an insurance company. Individuals rely on the opinions and experiences of others. UHC should continue to strive to provide quality service to its members by going above and beyond with each encounter. Patient satisfaction surveys can be given out after each encounter in order to collect data on areas that could be improved. Also, the company can provide education on customer service to its employees to aid 4
in the quality of the services provided. In turn, members will experience better care, thus recommending UHC to their family and friends.
Issues and Impact
According to customer complaints on the Better Business Bureau, many complaints are against customer service and how issues are handled (BBB, 2023). Customers also had complaints regarding claims, referrals, and prior authorization. This can have an impact on patient satisfaction ratings as well as employment within the company. Individuals will share their negative experiences with family, friends, and other individuals. If members continue to have issues with the company, they may also reach out to companies such as the Better Business Bureau to express their concerns. These complaints and concerns may sway others, affecting their view of the company, causing them to either choose another insurance company or leave UHC. Individuals will also share their negative experiences with others. If there are many negatives within the company, this may also take a toll on employment rates. Individuals seeking employment may choose another company based on the satisfaction of its consumers. Those currently employed may begin to feel “burned out” causing them to seek employment elsewhere. If the company loses employees, this may affect staffing causing shortages, thus affecting the quality of service provided to its members. This will create a cycle of dissatisfaction among both employees as well as consumers, which will then affect the reputation of United Healthcare. Theory/Model Support Plan
United Healthcare would benefit from following a feedback loop theory while implementing the strategic plan. Within a feedback loop, both positive and negative feedback is utilized to determine the effectiveness of changes implemented (Helbig, 2022). This theory also 5
allows an organization to understand how their systems are performing and if they are efficient (Helbig, 2022). If there is a positive loop, this allows the organization to ensure things are working how they should (Helbig, 2022). In a negative loop, this alerts the organization that there is an issue which needs to be addressed in order to create a solution for positive change (Helbig, 2022). This theory works best for United Healthcare as they are an organization which works closely with the public. The opinions and experiences of their members have a major influence on the future success of the company. This theory also allows managers and leaders to determine satisfaction of their staff, allowing them to make changes as needed to ensure that they
do not have a shortage of staff which can affect their patients/members.
Summary
To conclude, United Healthcare is a well-known insurance provider in the nation as well as worldwide. The company appreciates its members and prides themselves on empowering their
health and well-being. In order to continue to expand their network, implementation of a strategic plan would be beneficial. This would allow for more providers and organizations to choose UHC, creating more access for their members. The organization should also focus on staff and patient/member satisfaction in order to increase the number of subscribers and to allow staff to enjoy their job and remain with the company. United Healthcare can utilize a feedback loop theory when implementing the strategic plan to allow them to make changes and adjustments as needed.
6
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
References
Better Business Bureau. (2023). UnitedHealth Group: complaints: Better Business Bureau® profile
. BBB. https://www.bbb.org/us/mn/minnetonka/profile/health-
insurance/unitedhealth-group-0704-21000358/complaints Helbig, J. (2022). Chapter 5: Reengineering Health Care Management. In Nursing leadership and management: leading and serving
(pp. 127-176). Grand Canyon University. https://bibliu.com/app/#/view/books/1000000000587/epub/Chapter5.html
United Healthcare. (2023a). About us
. United Healthcare. https://www.uhc.com/about-us United Healthcare. (2023b). Care management and clinical programs
. United Healthcare. https://www.uhc.com/broker-consultant/products-solutions/care-management-clinical-
programs United Healthcare. (2023c). Cultural competency
. United Healthcare. https://www.uhcprovider.com/en/resource-library/patient-health-safety/cultural-
competency.html United Healthcare. (2023d). Our vision for empowering health
. United Healthcare. https://www.uhc.com/about-us/community-impact/empowering-health Waddill, K. (2023). UHC reports 13% revenue growth in Q2 2023 due to rising enrollment
. Health Payer Intelligence. https://healthpayerintelligence.com/news/uhc-reports-13-
revenue-growth-in-q2-2023-due-to-rising-enrollment 7