Case: Ledina Lushko

The case of Ledina Lushko, a patient enrolled in a Blue Cross and Blue Shield of Illinois individual plan, highlights many of the issues that have plagued the United States healthcare system for some time. As an insurance plan provider, BCBS of Illinois takes pride in the health outcomes of our members and has a responsibility to contribute positively to their care. The fractured, ineffective care Mrs. Lushko received is disappointing, however, this case provides strong support for a shift in focus towards managed care and specifically, the Accountable Care Organization structure. The following details several aspects of Mrs. Lushko’s experience and how her care could have been improved by enrollment in BCBS of …show more content…

This team would have insured that Mrs. Lushko received expert opinions immediately, without need to travel far distances or take action on her own. In an ACO structure, the burden to coordinate patient care falls on the primary care physician who has the knowledge and contacts to reach out to others in specialty fields when required. This physician advocates on behalf of the patient and helps to translate specialty opinions into language that can be understood by the patient. The coordinating primary care physician reduces waste and confusion that can be harmful to a patient's’ immediate health outcomes and long term health and costly for all involved. In addition, all providers who are part of the private ACO structure must consider cost of care for the patient as a factor in all decisions. On several occasions, Mrs. Lusko was subjected to repeat examinations by professionals who offered no valuable addition to her care. The ACO structure empowers the primary care physician to build a team of providers in an efficient manner that provides the patient with the best, most cost-efficient care rather than forcing the patient seek further care.

3. Issue: Nosocomial Infection

After several major surgical procedures, Mrs. Lushko was placed in the surgical ICU for recovery that required the use of a ventilator. During this recovery Mrs.