Reference no: EM133723508

Assignment: Health and Medical Anthem Blue Cross Blue Shield Worksheet

Select one of the following cases from one of the organizations listed below as the basis for each of your assignments. Note: The assignments in this course build upon each other, so you are required to use the same case and organization throughout.

A. UPMC Children's Hospital of Pittsburgh: Hospital-Acquired Conditions. Imagine you are the director of risk management.

B. CVS Pharmacy: US Labor Department's OSHA Proposes $89,000 in Fines to CVS Pharmacy for Exit, Storage and Other Hazards at Orange, Conn., Store. Imagine you are the new safety officer for CVS Health.

C. Anthem Blue Cross Blue Shield: Anthem Pays $16 million in Record HIPAA Settlement for Data Breach. Imagine you are the risk officer for Anthem Blue Cross Blue Shield.Assume that you have taken on a new role as the chief operating officer of a healthcare organization and are charged with leading system-wide risk management efforts to identify risks and minimize hospital acquired conditions (HACs). Your organization's financial viability depends on receiving proper reimbursement for services delivered. As the chief operating officer, you must create an executive summary table that describes your organization's compliance with the regulatory requirement, to promptly identify conditions that are POAs and proactively assess and manage risk.Select a risk management issue within a specific healthcare setting or organization. You will use this issue as a starting point for your work on this assessment. Use the Executive Summary Table

I. Current organization and background. Present your organization and background.

II. Present the organization's philosophy or culture statement: Include mission, vision, and values

III. Prepare a SWOT analysis for your organization. Assess the internal versus external environment relative to the risks associated with your chosen risk management issue.

IV. Regulatory requirements: Compile a list of the applicable regulatory requirements and an explanation of what they mean to your organization. How do you anticipate these regulations to change in the future? Is your organization prepared?

V. Risk management implications: Identify the associated risk management implications. For example, HACs result in no reimbursement and poor quality ratings. Where is your selected organization experiencing risk by not meeting a regulation or not providing services as efficiently as they could?

VI. DMAIC lens: Assess your risk management concern. What is causing this problem to occur?

VII. Recommendations: What recommendations do you have for this scenario? What challenges will you face when implementing this change?

VIII. Measuring and monitoring:

1. Identify metrics for measuring or monitoring the risk management issue and your recommendations.

2. Propose how you will make use of the outcome data for organizational improvement.

IX. Ethics considerations: Describe legal and ethical implications related to the handling of this risk management issue.

X. In your executive summary table and SWOT analysis, be sure you:

1. Conduct a proactive assessment based on the existing regulations and requirements.

2. Describe strategies to influence, impact, and monitor the needed changes for quality improvement.

3. Develop a value proposition for change management that incorporates quality and risk management concepts.

4. Prepare a SWOT analysis for your organization assessing the internal versus external environment relative to the risks associated with your chosen risk management issue.

5. Integrate legal and ethical principles and also organizational mission, vision, and values into the decision-making process.