United Healthcare

United Healthcare




United Healthcare

The Centers for Medicare and Medicaid Services anticipates enhancing service delivery to its clients in relation the National Quality Strategy. The focus is on delivery of enhanced care, ensuring the presence of health communities and delivery of affordable care to the public. In response to the Affordable Care Act, the entity has instituted a variety of reforms in terms of adoption of new policies, standards, and regulations aimed at meeting the expectations of customers, governmental agencies, financial institutions and the healthcare facilities in the country. The United States can be termed as a global leader in the field of healthcare due to the presence of rigid institutions, healthcare professionals and an extensive variety of healthcare providers.

In recent years, the United States has witnessed an increase in healthcare expenditure than any other economy around the world (Centers for Medicare and Medicaid Services, 2013). It is estimated that by the year 2020, the healthcare expenditure in the United States will reach an estimated $4.6trillion and account for nearly 20% of the country’s Gross Domestic Product (Centers for Medicare and Medicaid Services, 2013). The healthcare costs of any country are usually an underlying reflection of the overall health of a population. The institution of the Affordable Care has been effective in enhancing the functionality of private health insurance and extending access to healthcare services for low income Americans. This has altered the means that services are paid through programs such as Medicaid and Medicare.

Improving access and delivery of quality, reduction of costs and coordination of care are primary strategic objectives of Centers for Medicare and Medicaid Services (CMS) as well as the Affordable Care Act (ACA). polices adopted through the ACA such the establishment of Accountable Care Organizations has enhanced value based purchases and coordination of care for individuals utilizing services provided in both Medicaid and Medicare. The Centers for Medicare and Medicaid Services (CMS) plays a critical role in the delivery of healthcare services by ensuring access to quality care. This has been made possible by new regulations and policies by expanding the responsibilities and duties beyond the traditional role of administration of CHIP, Medicaid, and Medicare programs (Flower, 2012).

The Affordable Care Act demands the CMS coordinates with the states towards establishment of Health Insurance Marketplaces, expansion of services such as Medicaid and regulating the private health insurance plans availed (Muennig & Glied, 2010). The entity anticipates that the expanded role and responsibility provided by the ACA will place CMS at the forefront of leading the delivery of high quality care and enhancing healthcare delivery at affordable costs for all Americans. The expansion of the duties and responsibilities will affect CMS’ growth in its traditional base and provide emphasis on continued efforts towards enchained innovation, reduction of disparities in access to healthcare and enhancing integrity of the program. In addition, this is anticipated to expand the networks and confer additional responsibilities for healthcare professionals such as nursing staff and physicians.

Integration of Insurance Oversight and Center for Consumer Information into CMS will increase the duties and responsibilities of the entity towards consumer protection concerning private healthcare insurance and enabling market reforms (Vincent & Velkoff, 2010). The entity also shares a critical responsibility with other state agencies in promotion of use and adoption of health information technology as a means of enabling optimal delivery of quality care for all Americans in the country. The entity will continue in leveraging its internal resources and its external relations with partners to remain steadfast towards achieving its mission of being an efficacious steward of public funds and resources.

The entity envisions success in the future as relative to ensuring the presence of high quality healthcare system in the country that provides for enhanced care and access to improved health through coverage. The focus is primarily on improving care and the health of the American population through transformation of the United States healthcare system. This is anticipated to move the system towards a system that is inherently accountable and integrated for continuous improvement of care, reduction, and elimination of unnecessary costs and providing preventive care for health promotion (Vincent & Velkoff, 2010).

CMS has identified four critical strategic goals, which it anticipates to utilize to achieve its vision and mission for the healthcare system in the United States. The identified strategic goals are applicable to all functions and programs in the organization. These strategic goals are provided as:

  1. Better care and reduced costs of access
  2. Prevention care and optimal population health
  • Expansion of healthcare coverage
  1. Achievement of enterprise excellence through development of its workforce and utilization of innovative tools processes and strategies for efficient and effective collaboration with agents and partners

As the entity moves towards developing capacity and capabilities for strategic planning and performance management, it is expected to enrich its operational and policy decisions to achieve such goals (Flower, 2012). The entity notes of the need to undertake continuous improvement in its processes as a means of achieving the strategic goals and objectives, the mission and vision. Additionally, this will also cover the alignment of internal operations to respond to new challenges and demands. Furthermore, this will enable the entity to leverage its resources as a means of reduction of incidences of redundancy and wastage. Other anticipated goals include improvement and management of client information and promotion of diversity and a culture of multifunction collaboration and cooperation in the organization.

Improvement in preventive health benefits will focus on the utilization of evidence base practice in preventive services as well as delivery of primary care (Flower, 2012). This will affirm the importance of utilization of evidence based practice for both physicians and nursing practitioners in American healthcare settings. In addition, the emphasis on preventive care will demand that healthcare professionals focusing on improving their skills, knowledge and capacities for delivering care and familiarizing themselves with new rules, policies and regulations provided under the Affordable Care Act.

Healthcare professionals, stakeholders in the healthcare sector will also be mandated to ensure that they contribute towards reduction of disparities in access and utilization of preventive and primary care benefits, enhancing outreach, and access and quality of community based services (Flower, 2012). Enhancing protectionist measures for consumers in the country will focus on the need to develop sustainable partnerships with consumers, issuers, communities, and state based agencies tasked with oversight of the insurance segment. Protectionist measures will play a critical role in the private marketplace towards enhancing transparency on the business operations of insurance providers and enhancing accountability for cost savings for the users. Moreover, this is anticipated to contribute towards high levels of integrity in the program through adoption of appropriate ethical and corporate governance measures. Integrity will be affirmed through appropriate enrollment practices, allocation, and utilization of resources in the organization for optimal delivery of care to all Americans irrespective of race, gender, ethnicity, social status, and sexual orientation.


Centers for Medicare and Medicaid Services. (2013). CMS Strategy: The Road Froward 2013-2017. New York: Centers for Medicare and Medicaid Services.

Flower, J. (2012). Healthcare beyond reform: Doing it right for half the cost. Boca Raton, FL: CRC Press/Taylor & Francis.

Muennig, P.A., & Glied, S.A. (2010). What changes in survival rates tell us about US health care. Health Affairs, 29(11):2105-2113.

Vincent, G.K. & Velkoff, V.A., (2010). The Next Four Decades: The Older Population in the United States: 2010 to 2050. Washington D.C: Census Bureau.





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