Managed care organizations (MCO) have increasingly gained attention as a solution to the health crisis particularly in the US. At its core, MCO’s require practitioners to transition from traditional care towards more synchronized care to achieve the desired goal. As such, IT is a key enabler of this change supporting more effective data management, evaluation and exchange. Therefore, with the appropriate resources and technical capacity, it is possible to boost patient engagement and provide enhanced experiences for all individuals in healthcare delivery.
Key Elements of an Information System for an MCO
It is imperative that MCOs understand the value of determining how elements of information systems relate with each other to generate better information for effective decisions and outcomes. The key elements include data acquisition procedures and user interface. Data is available to managed care systems by means such as direct entry and retrieval from paper records. As such, information systems provide unique documentation of the patient, precision of information captured and interoperability with various medical systems. On the other hand, user interface allows collaborative data entry and handles distribution and implementation of data. Furthermore, the system should have digital sources of evidence (undp.org, 2018). They are vital for evidence-based practice as they have practicability when it comes to managing client safety and quality care. Moreover, there is healthcare data standards. This are the basis of any accountable system. Illustration of terms pertaining patient safety in computer networks in a way that renders them viable for reuse for patient safety is essential in integrated information systems.
Elements that differ include decision support systems which allow care givers to access healthcare information as they advance through the care continuum. To illustrate, encoded clinical data regarding the significance of lab trials would allow a system to provide alerts unlike the passive data recovery function. Furthermore, MCOs have restricted access to services by enrollees (Kimuyu, 2018). In retrospect, they run under an inclusive network that allows them to assume responsibility of establishing a network of care providers. This model of operation makes them distinct from that of an office physician.
Technology Needed By MCO to Operate Fully
The same cognitive technologies people rely on in their day to day lives and across health setting can be employed in MCOs assisting them to enhance patient care and cut costs. Now more than ever MCOs need a radical technology for long term improved health outcomes and system adequacy in managed care. I believe cloud computing will assist MCOs operate at their full potential. As MCOs continue to upgrade to interoperable and integrated platforms, some are shifting towards cloud. Cloud computing allows states to employ budget solutions like machine learning from public providers like google. This aids in data generation that informs patient care and detection of important patterns for improved customer service (Aziz and Guled, 2016). Nevertheless, there is reduced data storage costs. Cloud solutions are beneficial in that when moving data, one need not maintain the data sets as it can be costly. By managing the structure and maintenance of data storage, cloud computing allows practitioners to channel their efforts towards caring for the clients. Additionally, it allows enhanced medical research. Similar to how cloud computing allows healthcare facilities to capitalize on their data, digitizing healthcare info through cloud benefits clinical researchers. Case in point, Microsoft Azure is being used for precision treatment through the stored data. Besides, cloud offers back up as a service. With the infusion of client information, health facilities are outgrowing their legacy storage backup, finding themselves in financial crisis as they purchase pricey upgrades. Therefore, through cloud computing MCOs will be linked with public, private and hybrid cloud which is controlled by the provider and ensures the organization has sufficient space.
EHR Program That is HIPAA Compliant
iPatientCare is an electronic health record (EHR) web based or on-site database that backs up single practices as well as facilities that have a large staff base. The program backs up processes conducted in various locations with different specialties allowing physicians to check patient eligibility, evaluate laboratory results and convey appointment prompts to patients. It is convenient for practitioners as they can access it on their mobile devices and make notes at any location. To add on, the program is equipped with ‘miGlass’, a service that records a client visit to the facility and allows them to take a home video so they can master necessary care procedures such as prescription schedules and dressing steps offered by the care organization.
In regards, to costs and projected savings, the current medical setting for MCOs is in need of deliberate restructuring for cost-effective and continuous quality improvement. Redesigning calls for specialized equipment and tools such as the iPatientCare. Quality improvement procedures tend to be budget neutral as ensuing costs of project failure, errors and poor outcomes are evaded. Therefore, the fact that processes are streamlined makes it more affordable to sustain (ipatientcare.com, 2016). In addition, the software aids in cutting down the amount of provisions that an MCO will need. By reducing use of paper records, the organization will greatly cut the budget for non-clinical provisions. Digital storage is space efficient and facilities are able to do more without the need for large, manual filing systems. Research indicates care establishments waste a great percentage of resources on unnecessary expenditure particularly on ineffective claims processing. Utilizing EHR programs such as iPatientCare will automate the procedures substantially cutting down the costs.
Strengths and Weaknesses
Some organizations opt to hire one expert who serves as the main person in charge of IT operations. Reasons why care organizations may opt to take the insourcing route include possible cost savings. Depending on the proficiency of the expert, it can be somewhat less expensive than outsourcing third party services. Moreover, it is easier to monitor the employees. Insourcing means management can monitor the staff and manage them based on the current technical methods. Regarding the weaknesses, insourcing may lack skilled specialists (medirest.co.uk, 2018). A small facility may not have ample capacity to attract top expertise, which can be provided by a professional IT firm through outsourcing. Nevertheless, insourcing fosters internal upgrading but does not offer insights on organizational performance. This may pose problems when allocating resources to meet set objectives.
One of the most outsourced areas in healthcare is IT. International healthcare outsourcing market is projected to be worth billions of dollars which infers that it has a number of pros. They include widening provider skill pool. It can be difficult finding proficient talent particularly in rural areas, but through outsourcing MCOs can bridge that gap. Outsourcing allows management to rid themselves of their tedious administrative responsibilities so they can concentrate on enhancing patient care (Roberts et al, 2013). Besides, outsourcing cuts costs. Some services such as diagnostic imaging allows care facilities to offer advanced services without needless investments in in-house tools. However, outsourcing has its drawbacks which include data breaches which affect patient confidentiality. Breaches pose a risk for entities that outsource making it essential to assimilate risk management agendas. Moreover, outsourcing may foster quality issues originating from misinterpretations from the scope of services being provided and costs.
Both insourcing and outsourcing IT needs have their strengths and weaknesses. It comes down to the preference and what works best for the facility. When managed properly both outsourcing and insourcing can be harnessed as a competitive advantage to capitalize on the staff and enhance patient care.
References
Aziz, H. A., & Guled, A. (2016). Cloud computing and healthcare services.
ipatientcare.com (2016). Why quality improvement in healthcare is important. Retrieved 6th Dec 2020 from https://ipatientcare.com/blog/why-quality-improvement-in-healthcare-is-important/
Jeremy G. Roberts, John G. Henderson, Larry A. Olive and Daniel Obaka (2013), “A Review of Outsourcing of Services in Health Care Organizations,” Journal of Outsourcing & Organizational Information Management, Vol. 2013 (2013), Article ID 985197, DOI: 10.5171/2013.985197
Kimuyu, P. (2018). The role of managed care organizations within the healthcare industry.
Medirest.co.uk. (2018). How insourcing expertise can improve healthcare in private hospitals
Undp.org (2018). Key elements of a health information system. Retrieved 6th Dec 2020 from https://www.undp-capacitydevelopment-health.org/en/capacities/focus/health-information-systems/key-elements-of-a-health-information-system/
