Stakeholders

Strategy and Tactical Plan

Managing and dealing with numerous stakeholders requires patience, knowledge and understanding of various processes that many healthcare businesses lack.

Government

The US Government is at the top of the pyramid and sets the tone for the entire system. The most influential entities include the U.S. Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS), the Food and Drug Administration (FDA), and the Centers for Disease Control and Prevention (CDC).

Payors

Public payors include Medicare/Medicaid. There are numerous private payors requiring premiums from recipients. Both types of payors wield considerable sway either through policy making (CMS) or through lobbying (insurance companies).

Managed Care

By contracting with Managed Care Organizations (MCOs), providers are expected to reduce costs and better manage the utilization of healthcare resources in order to improve care for patients with chronic and complex conditions along with aligning payment incentives with performance, quality and outcomes.

Providers

Providers in most instances are unable to predict accurate payments for their services. Therefore, reducing AR days and projecting for cash-flow sometimes could pose a serious challenge.

Patients

Most patients are dependent upon the advice of their physician in making a health services “consumption” decision. In most instances the patient is unaware of the full costs of care including deductible and out-of-pocket expenses.

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