Managed Care Organizations and Information Technology
The most important function of information technology (IT) for the managed care organization (MCO) is to support the business of the MCO. How the IT department aligns with the operational dynamics of the MCO is a vital management consideration. A well-functioning IT department will help the MCO reduce risk (e.g., costs). The IT department should design, implement, and operate the systems that run the MCO. Efficiency is the hallmark of a good system.
Your task as the manager of the MCO is to determine what the IT department in your organization should consist of, what its function will be, and what critical elements will be turned over to the IT department. Complete the following:
- Describe the key elements of an information system for an MCO. What elements are different than for a physician office or group?
- Describe the technology that you think the MCO would need to operate fully.
- Propose a specific electronic health record (EHR) or electronic medical record (EMR) program that is Health Insurance Portability and Accountability Act (HIPAA) compliant. Describe the essential functions, costs, and projected savings for the MCO.
- Evaluate the strengths and weaknesses of insourcing versus outsourcing your IT needs, and make a final recommendation based on that evaluation.
Expert Solution Preview
Introduction:
In the healthcare industry, the use of Information Technology (IT) has become a vital aspect of the operation, especially for Managed Care Organizations (MCOs). As a medical professor responsible for designing assignments for medical college students, I will provide answers to the questions related to IT and MCOs.
1. Describe the key elements of an information system for an MCO. What elements are different than for a physician office or group?
Answer: An information system for an MCO must have specific key elements such as a health information management system, patient management system, utilization management system, care management system, and financial management system. These elements connect all the departments of the MCO and provide a comprehensive platform for data analysis and evaluation. The major difference between an MCO and a physician office or group is that an MCO manages the healthcare needs of a larger population. Therefore, the information system for an MCO must be able to manage large sets of data and information.
2. Describe the technology that you think the MCO would need to operate fully.
Answer: To operate fully, an MCO must have various IT technologies such as cloud computing, data analytics, telemedicine, security solutions, and mobile applications. Additionally, the MCO should also integrate a reliable network infrastructure for data sharing across departments and with external stakeholders.
3. Propose a specific electronic health record (EHR) or electronic medical record (EMR) program that is Health Insurance Portability and Accountability Act (HIPAA) compliant. Describe the essential functions, costs, and projected savings for the MCO.
Answer: One recommended EHR/EMR program for an MCO is the EpicCare. EpicCare is HIPAA compliant and has essential features such as health information exchange, clinical documentation, reporting, and data analytics. The cost of implementing EpicCare is dependent on the size of the MCO and the specific modules needed, but the projected savings may include cost reductions, improved patient outcomes, and increased revenue.
4. Evaluate the strengths and weaknesses of insourcing versus outsourcing your IT needs and make a final recommendation based on that evaluation.
Answer: Insourcing allows an MCO to have more control and direct supervision over their IT needs. However, it may require additional in-house resources and skill sets, which can increase overall costs. On the other hand, outsourcing can offer cost savings and access to a wider pool of skilled IT professionals. However, the MCO may lose some control over their IT processes. Considering the pros and cons, I would recommend a combination of insourcing and outsourcing for an MCO’s IT needs. This will allow the MCO to have direct supervision over critical IT functions while outsourcing less essential operations to reduce costs.
