Understanding the Industry: Revealing the Hidden Sphere
Finally, the fourth and last installment of this series.
In this article, the final 3 sectors will be explained and expounded upon (so exciting!). Just like the other sectors, I will also provide examples for each one so that you can get a better idea of what it looks like in the real world.
For most people, this is information that you learn along the way as you grow in your Healthcare Administration career.
So when I say that this newsletter works hard to provide hacks - so that you can understand the things that your professors, your peers, and even your mentors might not think to explain to you - I mean that. ;)
And to my fellow colleagues in the field, let’s continue saying the quiet part out loud so that everyone can be on the same page, with the same understanding, knowledge, and contextual information.
(Finally) revealing and explaining the sectors within the “hidden sphere”.
In this diagram, the middle sphere is the hidden sphere. It contains the sectors: Supporters, Educators, and Researchers.
Let’s dive into each of them, shall we?
Researchers and Educators
Most people interact with this sector through a university or academic medical center (or sometimes both). These institutions are responsible for disseminating the most up-to-date information to students, clinical providers, and other working professionals. One could expect to learn the “best practices” of the industry from them.
This sector is much more wide and vast than most people realize. This can include research institutions, foundations, associations, coalitions and collaboratives, universities, colleges, hospitals, academic medical centers, physician associations, health agencies (state, federal, and global), and more! This sector is the fuel behind our healthcare industry, because many are trained and taught through education while others find innovation, amplification of important issues, and novelty through emerging research and studies.
Often, organizations and institutions that belong in these sectors also belong in other sectors. For example, I would consider the Institute for Healthcare Improvement (IHI) to be both a Researcher and Educator. Whereas, the Center for Medicare and Medicaid Services (CMS) is better well-known as a Payor but also acts as a Researcher.
Some other examples include:
Universities and colleges, such as University of Southern California (USC)
Academic Medical Centers (AMCs), such as Children’s Hospital Los Angeles
Research institutions, such as Kaiser Family Foundation (KFF)
Supporters
The “Public Health” sector refers to public health departments (city, county, or state), some public utility services (water), and health education. It also represents community-based organizations (or CBOs) that meet the health-related social needs of people in a specific geographic area. This area coined the term “social determinants of health” (SDOH).
The large reason why we even have a “sick” care system in the United States is because the environment and living situation for many people in this country is subpar, and if persistently unaddressed, leads to the increased occurrence and prevalence of chronic care conditions in the American population.
Choosing to neglect the quality of our water will lead to more health issues in an area. Long ago, when I watched a viral Netflix documentary on why you should become a vegan, the most touching and heartbreaking part was seeing people living in rural areas acquire the worst diseases and health complications simply because they live in the midst of industrial waste, runoff, and pollution. So, public health must be empowered and elevated so that leaders in this space can have authority, not just in educating the masses but also in regulating and enforcing appropriate standards for corporations and businesses.
Some organizations in the “Provider” sector attempt to contribute to this cause by assessing and meeting the needs of their local population (i.e. Community Needs Assessment, local events, health fairs, etc). This is only a fraction of all the ways that public health organizations support the healthcare industry.
Some examples include:
California Department of Public Health (CDPH)
Community Relations departments of local hospitals & health care systems
Public Health Institute (PHI)
Centers of Disease Control and Prevention (CDC)
World Health Organization (WHO)
Let’s not forget about the Purchasers!
As I’ve been posting about my Industry Dynamics diagram on LinkedIn, I received the comment below:
In my response, I really meant to say “I’m not sure where they fit into the current diagram.”
And then I realized that I had forgotten a vital part of the industry. Although (and I’ve stated this before), it’s very common for an organization to mingle and switch between multiple sectors depending upon its ultimate mission and vision.
So, let’s discuss where Purchasers could sit within the diagram….
Purchasers
So, if you weren’t aware, the system that the American country uses for people to get their healthcare services paid for is quite complicated.
In a previous post, we discussed the role of Payors - typically, this sector refers to insurance companies that front most, if not all, of the money for covering the healthcare services that you receive.
Purchasers sit on the other side of that process, and this sector typically refers to employers (the companies and organizations that you work for). So, most commonly, your employer purchases plans from health insurance companies so that you can have adequate options for your health insurance coverage while you are employed. The Healthcare Payment Glossary also has an amazing definition and brief explanation for this group of organizations here.
“In traditional health insurance arrangements, the purchaser is the individual or organization that pays premiums for a health insurance policy, and the payer is the health insurance company that pays claims under the policy.”
— from the Healthcare Payment Glossary
Other Purchasers include state marketplace exchanges (i.e. Covered California, Maryland Health Connection, Access Health CT for Connecticut), employers, associations, unions, and trust funds. You can find other state-based exchanges here if you’re curious!
(I was today years old when I learned this) but it is also commonplace for some of these organizations to band together in coalitions or collaboratives in order to have more power and leverage. Ultimately, this is meant to push the health insurance companies to provide higher quality, more affordable health plan options.
Below are some examples:
National Alliance of Healthcare Purchaser Coalitions
Purchaser Business Group on Health
California Healthcare Coalition
Some of its members include:
Coalition of Kaiser Permanente Unions
SEIU Fund (the SEIU is a large union inclusive of many employee groups in California)
California Purchasers Health Care Coalition (originally known as the California Public Employers-Employees Trust Fund Group which enabled collaborative efforts of the various Jointly Managed Trusts serving public school districts and other private sector employees in California
To conclude, I believe that the only appropriate position would be to put them in between Payors and Providers - like so:
And yes, I did mean it when I said that this would be the last installment of this “Understanding the Industry” series. I’m sad to see it go because I loved brainstorming examples for the sectors and creating the diagram - but all good things must come to an end.
Now that you understand the healthcare industry with more depth and context, you may be wondering “Where do I fit into all of this?”
Well, that’s the exact reason why I created this quiz:
This is a revamped version of a quiz that I originally created in Google Docs.
This quiz will:
Identify your “most compatible” sector of the Healthcare industry based on your responses
Provide foundational knowledge about these sectors
Unlock access to a Post-Quiz PDF, including detailed examples on the Industry Dynamics Diagram AND other tools & resources (so that you can know what to do next!)
Click »HERE« to take the quiz (and don’t forget to come back and let me know what you think ;)
This is only the first version of this resource, so pleaseeeee let me know what I should change or add to improve its usefulness and effectiveness.
If this series has left you with any questions, please leave them in the comment section below. ALSO - If you have any suggestions for what I should cover next, let me know!