Health Care Systems

Developing Relationships with Internal and External Stakeholders

  • 1.  Developing Relationships with Internal and External Stakeholders

    Posted 01-18-2021 07:34 PM

    Formed from The Balanced Budget Act of 1997, Medicare Advantage organizations are private health insurance plans that offer Medicare-eligible beneficiaries coverage. "As of 2020, there were more than 24 million Americans enrolled in Medicare Advantage plans, accounting for about 36 percent of all Medicare beneficiaries ("Medicare Advantage (part C) Private Health Plans," 1994-2021). The goal of establishing MAO plans was to reduce healthcare costs, improve the quality of care, and provide consumers with health coverage choices.    Many individuals and groups involved in or whose interests may positively or negatively affect how Medicare Advantage plans perform.  

    For Medicare Advantage organizations, the stakeholders are a vast group. Stakeholders include patients, physicians, employers, insurance companies, pharmaceutical firms, and government agencies.  Each of these individuals/groups has a vested interest in the cost and quality of healthcare being provided.  Internal stakeholders are committed to serving the organization as board members, staff, volunteers, and donors. External stakeholders are impacted by the work or performance of the Medicare Advantage plans.

     Each stakeholder may have a different level of interest, accountability, and authority. The impact stakeholders can have dependent on their relationship to either the Medicare Advantage plans. When developing a relationship with stakeholders, there should be a plan for how stakeholders' input will be solicited, gathered, and meaningfully incorporated into measure development and maintenance processes.  (Centers for Medicare & Medicaid Services, n.d.)  When developing relationships with both internal and external stakeholders, it is essential to understand their level of interest and influence.  A straightforward approach is often the most effective approach. One should acknowledge and actively monitor the concerns of all legitimate stakeholders and should take their interests appropriately into account in decision-making and operations("Identifying And Managing Internal And External Stakeholder Interests," 2020).

    References

     Centers for Medicare & Medicaid Services. (n.d.).  Stakeholder Engagementhttps://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Stakeholder-Engagement

    Identifying and managing internal and external stakeholder interests(2020). https://www.healthknowledge.org.uk/public-health-textbook/organisation-management/5b-understanding-ofs/managing-internal-external-stakeholders

    Medicare Advantage (Part C) private health plans(1994-2021). https://www.medicareresources.org/medicare-benefits/medicare-advantage/





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    Monique Akins
    Compliance Manager
    Anthem
    TAMPA,FL
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    ComplianceLines