Supporting businesses for managed care organization (MCO) is one of the vital functions of information technology (IT) and how the department of IT aligns with the operational dynamics of the MCO is a very important consideration in regards to management. Risk reduction in the MCO, for example cost reduction can be addressed by an IT department that functions well. Systems that run the MCO should be designed, implemented and operated by the department of IT. This will ensure efficiency, which is one of the symbols of a good system. Managed care organization (MCO) is a physician or entity of healthcare service practitioners that is instrumental in managing care health plans (Hillblom, Schueth, Robertson, Topor, & Low, 2014). The head of the Department of Consumer and Business Services (DCBS) should authenticate the organizations. It is very significant to explore the components of managed health care organization so that before the IT aspect can be incorporated efficiently and enhance the MCO section of the health care entity. The goal of MCO practitioners is to provide proper and inexpensive medication to all.
Describe the key elements of an information system for an MCO. What elements are different than for a physician office or group?
Delegate your assignment to our experts and they will do the rest.
In the present times, it is significant for the IT department to be involved in all the sections of the health care organization. The most critical aspect of the information system is the exchange of information. Consequently, there is the patient enrollment data as a key element of an information system (Kimuyi, 2018). The information includes admitting notes, patients’ history, and medical histories of the clients. Secondly, there is the health provider’s data that entails their description, certification, information of locations, hospital rights, expertise, and contact address.
Another key element is the authorization to services data. This comprises information of diagnosis, category of services, date of medication, referrals, physician’s identity, patient’s name and the number of authorization (Hillblom et al., 2014). Moreover, the accounting department has claims processing data. These entail Medicare, insurance records, Medicaid information and medical history indicating the diagnosis, tests, and medication process of the patients. With an information system fitted in an MCO, there can be a quick and effective approach in executing the process in various departments.
For a physician's officer or group, the utilization of technology can allow quick and convenient sharing of information. This may including sending, retrieving and receiving information from various practitioners within the institution. Software programs help doctors to assess and monitor statistics that can facilitate the diagnosis process. Therefore, the physician will need the software programs to facilitate billing processes and trace procedures so that the past records of treatments of the patient are received. The data may include the prescriptions that have been made and the common symptoms that the patient has demonstrated which may help the process of diagnosis and medication (Kimuyi, 2018). The new technology demands that the doctors have advanced skills and keenness to deliver quality healthcare. Even older physicians may need to train and update their skills to handle the new technology in healthcare.
Describe the technology that you think the MCO would need to operate fully
The MCO can adopt an electronic way of recording keeping as a health information technology. Electronic Health Records (EHRs) gives health information regarding a specific patient or population to allow for easy retrieval of such data by any authorized health practitioner. The information that could be gathered in EHRs comprises billing information, personal data, signs and symptoms, lab tests, medical history and any demographics that could be relevant (Hillblom et al., 2014). EHR will facilitate precise capturing of a patient’s health status and access comprehensive, proper as well as accurate patient’s information every time.
Another important aspect of EHR technology that MCO can capitalize on is that it ensures a paperless environment. This implies reduced medical errors, repetition of tests, and the chance of losing medical data pertaining to the student is reduced. Medical information could be misplaced, stolen or succumb to calamities such as fire or flood. The MCO should only be cognizant of ensuring that only authorized persons hold the medical information for the patients, and do not leak them to anyone else without the patient’s consent (Aldosari, 2017) . Ultimately, productivity will be enhanced, the safety and confidentiality of the patient’s data will be assured and reduced paperwork brings down the costs of printing and acquiring papers. The EHR also gives room for enhanced workflow by giving the chance for health care employees caring for the same client to retrieve data about them in real time concurrently. They cannot communicate from different points of work. Thus, practitioners can come up with better decisions in a more fast way and accurately.
Propose a specific electronic health record (EHR) or electronic medical record (EMR) program that is the Health Insurance Portability and Accountability Act (HIPAA) compliant. Describe the essential functions, costs, and projected savings for the MCO
MCO should utilize DrChrono, an EHR that is coherent with what is required of them by the Health Insurance Portability and Accountability Act (HIPAA). It has components like patient reminders, scheduling, as well as billing for the patient. The major function of DrChrono is to enable easy distribution of accurate and appropriate free data remotely. Aldosari (2017) aligns with the advantage of EHR of eliminating cumbersome papers of using charts and fill forms. The technology is cloud-based making it be paperless so that the authorized personnel can access information. Moreover, the program gives the practitioner the chance to retrieve the information of the patient way before they engage on a face-to-face basis. This enables the practitioner to slot an appointment with the client, who is the patient in this case. The patients can be assured of the security of their communication and information, also giving room for the refilling of prescriptions.
Moreover, the program has security and confidentiality characteristics that eliminate all the unauthorized persons not to get in touch with the information of the patient. The program is also cost-effective in the sense that there is a free trial of service to explore the software instead of just a demo (Aldosari, 2017) . The software has automated systems like medical billing and records of patient checks (Hillblom et al., 2014). This explains its efficiency since all the parties that are to use it can access needed data and services at a reduced cost. The tailored services for the customers enable the MCO to acquire more proceeds for the institutions yearly if they utilize the program.
Evaluate the strengths and weaknesses of insourcing versus outsourcing your IT needs, and make a final recommendation based on that evaluation.
One of the strengths of insourcing is that it is possible to save costs. This could be done by recruiting an internal committed IT specialist who is paid on an agreed basis as opposed to sourcing for the expertise of a third party. Another advantage is that insourcing allows the manager to monitor and give guidance on the specialists working under their watch. Nonetheless, insourcing has weakness also. It is time-consuming to recruit and hire employees. This time could be channeled to meet other objectives and developmental process of the health care organization (Raza, 2018). Another disadvantage is that the organization may lack top talent because they cannot afford them. As such, outsourcing the needs of information technology in the institution can be significant at this point. Insourcing can be challenging when one is unable to retain their workers. The workers could resign or leave the organization when they find greener pastures.
On the other hand, outsourcing can be preferable in some point. To begin with, the management can have skilled IT specialists that are the top talent in the present IT systems infrastructure. Having competent and knowledgeable IT experts make the organization have quality delivery of care and be able to compete maximally above the rest. Another advantage is that through outsourcing the organization can engage a team of IT specialists as opposed to insourcing someone who is committed to all the IT needs of the organization (Raza, 2018). With outsourcing, the organization can utilize more of their time in other income generating avenues because of the comfort that the IT specialists will deal with all the IT needs successfully. The disadvantage of outsourcing is that it may not be possible to control the operations of the expert maximally.
As a recommendation, outsourcing is the best compared to insourcing. Even in terms of cost saving, outsourcing seems to be the best since the organization is only committed to making payment of the expert whenever the IT needs of the organization are to be met. The MCO should incorporate outsourcing approach to fulfill the IT needs of the organizations because the benefits definitely overshadow the cons.
Conclusion
The IT department is very instrumental in an MCO because of the assurance of delivery of timely, precise and significant data. The data can be quickly facilitated through IT programs include claim processing, provider’s information, patient records, and many more. Thus, the employment of a comprehensive EHR system like DrChrono by a health organization is critical to reducing the tasks of using charts and filling forms, thus enhancing quality and quick delivery. It is more beneficial to outsource IT services rather than insourcing as it offers a higher value, giving the organization a competitive edge over its competitors.
References
Aldosari, B. (2017). Patients' safety in the era of EMR/EHR automation. Informatics in Medicine Unlocked , 9 , 230-233.
Hillblom, D., Schueth, A., Robertson, S. M., Topor, L., & Low, G. (2014). The impact of information technology on managed care pharmacy: today and tomorrow . Journal of Managed Care Pharmacy , 20 (11), 1074. (Hillblom, Schueth, Robertson, Topor, & Low, 2014)
Kimuyu, P. (2018). The Role of Managed Care Organizations within the Healthcare Industry.
Raza, B. (2018). Understanding the transition process in a public-private partnership outsourcing context: An information systems case study (Doctoral dissertation, Auckland University of Technology).
