Health Care Systems 235
University of Phoenix 2011
The name of the agency of my selected provider is Blue Cross Blue Shield of South Carolina. I researched different websites to obtain my information about Blue Cross Blue Shield. I researched Blue Cross Blue Shield of South Carolina, which was updated in 2011, Manta Media which was updated in 2011, Blue Cross Blue Shield Association updated in 2011, Blue Cross Blue Shield updated in 2011 and Wikipedia updated in 2011.
Based on my research, the delivery of services that are provided are different, extensive types of health plans, discounts, added values, and online services which means more choices for members, with plans to fit every budget and lifestyle. Blue Cross Blue Shield of South Carolina offers the largest provider networks in the state, offering members the greatest choices in doctors, hospitals, and other health care providers. Blue Cross Blue Shield of South Carolina are one of South Carolina’s largest employers with offices throughout the state, and has a large family of subsidiary companies, in which some companies offer insurance products, such as property, life, mental health, and substance abuse benefits. They also have subsidiaries that administer contracts for the federal government, and some focus on technology. The data center is ranked in the top percent worldwide by IBM. At all Blue Cross Blue Shield locations, Blue Cross Blue Shield is major supporters of community and charitable causes, support health care related research, education, and services through the Blue Cross Blue Shield of South Carolina Foundation. (2011, Blue Cross Blue Shield of South Carolina)
Blue Cross Blue Shield of South Carolina and their services fit in the continuum of care by contracting with a Complex Case Management provider by the name of Franklin Health, to provide treatment to the most critically ill of Blue Cross Blue Shield clientele. The mission of Complex Case Management is to provide patients with the services they need and want. The result from Complex Case Management’s work is tending to save money by avoiding hospitalization, and emergency room costs, which is a secondary goal. Franklin Health offers to deliver patient information, and options such as advance directives, and goals for symptom management. Franklin Health has numerous nurses trained to work with the sickest patients. If the family agrees to be served by a nurse from Franklin Health, in cooperation with one of the case managers from Blue Cross Blue Shield of South Carolina, Blue Cross contracts that case for service with Franklin Health. Any client of Blue Cross Blue Shield is available for the program, ranging from the youngest to the oldest. The program tries to move individuals out of the hospital, as long as everyone agrees that the course of action will not be to the detriment of the patient. Almost every service is covered, and the company will consider anything to keep patients at home. Any expenditures, from medical equipment to an air conditioner may be found appropriate if it can be shown that it will be more cost effective than a hospital stay. The only dollar limits are those dictated by the patient’s policy limit, or the plan’s limit. The options for types of coverage are unlimited and can be made to fit into various models. If a client exceeds the allowance for hospice or home health care, they are placed in alternative treatment plans, provided the patient chooses to stay at home, which is more cost effective.
Outcome measures consist of pain and other symptoms, patient and family satisfaction, communication about treatment wishes, acceptability and feasibility to nursing, medical staff, and the industry, and utilization measures. Utilization measures...