Strategic Decision-Making for Community Memorial – Healthcare Market Challenges

Strategic Decision-Making for Community Memorial – Healthcare Market Challenges

What to Do

I would tackle the situation as the hospital’s chief financial officer in an impartial and calculated manner. The ultimate choice I make will take into account the opinions of Dr. John Evans, Katrina Eaton (CEO), Linda Freed (Business Office Manager), and Nancy Stritmatter (CNO). While establishing a partnership, upholding a positive reputation, and keeping patients are critical, it is as important to safeguard the hospital’s financial interests (Grønkjær et al., 2022). I will put some effort into coming up with a counterproposal to MegaPlan’s proposal that is reasonable but still guarantees the hospital’s financial viability. In addition to stressing the potential detrimental effects on patient care and employee morale if they cannot get healthcare locally, I will underscore the hospital’s value to the community, its employees, and their families. I will also stress the value of a fair contract that enables the hospital to keep offering high-quality care while taking care of the requirements of Commercial Inter tech’s staff members and families. Finding a mutually advantageous deal with MegaPlan will depend on open dialogue and negotiation, and it is ready to look into alternative network possibilities if necessary to ensure the hospital’s survival and patient happiness.

Advice That Makes the Most Sense

In this case, I would follow Dr. John Evans’ recommendation. His suggestion that the hospital craft a realistic counterproposal for MegaPlan while highlighting its negotiation position, the potential impact on patient care, and employee morale demonstrates his methodical and strategic thinking. Dr. Evans’ counsel demonstrates a thoughtful and practical viewpoint that seeks to reach a mutually beneficial agreement with MegaPlan, ensuring the hospital’s sustainability and upholding positive relationships with its patients and staff. This is done by considering the hospital’s financial interests and the community’s healthcare needs.

How to Proceed

I shall proceed as the hospital CFO by considering Dr. John Evans’s suggestions and creating a well-organized counterproposal for MegaPlan. This proposal will highlight the hospital’s special contribution to the neighborhood and its importance to the families and coworkers of Commercial Inter tech. Carefully assessing the financial ramifications and service preauthorization requirements ensures the hospital can continue operating profitably without sacrificing the standard of patient care (Diana van Riet-Nales & Sinclair, 2023). To encourage a fruitful negotiation process concurrently, I will start an open and transparent line of communication with MegaPlan’s representatives. I will approach the negotiations with professionalism and aggressiveness, highlighting the hospital’s dedication to offering the community high-quality treatment while keeping in mind that MegaPlan is a sizable player in the neighborhood healthcare market.

To keep patients and provide access to care for Commercial Inter tech’s staff and families, I will, if necessary, look into alternative network possibilities. My goal will be to come to a fair and equitable deal that benefits both sides, protects the hospital’s financial stability, and keeps patients satisfied. To ensure a coordinated approach in resolving this serious managed care issue, I will always keep the hospital’s CEO, Katrina Eaton, and other significant stakeholders informed. As I prepare the counterproposal, I will also consider how joining MegaPlan’s preferred provider network (PPN) would affect the hospital’s operations and financial results. Using this approach, I can decide whether joining the PPN is advantageous enough to overcome any potential drawbacks of MegaPlan’s negotiation strategies and payment procedures. To further fortify our position, I will work with other regional healthcare providers dealing with MegaPlan-related difficulties to investigate the potential for presenting a unified front during talks to win reasonable and long-term contracts for all parties concerned.

References

Diana van Riet-Nales, & Sinclair, A. (2023). Product Care & Daily Practise. 931–955. https://doi.org/10.1007/978-3-031-20298-8_40

Grønkjær, M., Voldbjerg, S. L., Jørgensen, L., Kusk, K. H., & Laugesen, B. (2022). Establishing and leading a cross‐institutional partnership to integrate fundamentals of care into clinical practice, nursing education, and research. Journal of Advanced Nursing. https://doi.org/10.1111/jan.15366

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The local healthcare market’s dynamics are changing and evolving due to the increased competition between healthcare providers and systems. Things are looking up for Community Memorial as it tries to transition to a value-based care delivery system! But one day, just before lunch, you get a call from Bill Jacobs, the human resource director at Commercial Inter tech (CI), the largest employer in the community. Bill says, “I wanted you to hear it from me first. We signed a contract yesterday with Mega Plan Health. It will be the managed care organization for all 4,500 of our employees and their families. About 9,000 patients total. I’m sure that you will want to get a contract with Mega Plan as soon as possible. I noticed that your hospital is not in its preferred provider network (PPN), and I am pretty sure that you will want to be so that our employees can continue using the facility.” By the time you thank Bill for the heads up, the acid is already churning in your stomach. In the hospital world, Mega Plan is known for cutthroat tactics, negotiating steep discounts with hospitals, and fighting every claim the hospital makes. Commercial Inter tech has every right to contract with any health insurance provider it likes, but now you have a problem. If you cannot get a decent contract with Mega Plan and become part of its PPN, many local patients may bypass your hospital and go to the closest PPN facility. Delivered to your office this afternoon, by no coincidence, is a contract proposal from Mega Plan. It calls for the hospital to provide a 35% discount on charges to Mega Plan and all of its members. It also includes service preauthorization requirements that will make life very difficult for your business office. You know from experience that the hospital loses money whenever the discount from charges exceeds 20%.

Assignment:
So what will you do? Whose advice makes the most sense to you in this situation, and how will you proceed?

Present your comments in a one- to two-page paper, explaining how you will proceed.