Integrating IT into Managed Care Organizations

Integrating IT into Managed Care Organizations

Technology has greatly changed the medical and health care services provided to patients in the country. To provide better healthcare services to patients, managed care organizations need to incorporate information technology into their systems to improve their quality of services. Managed care can be described as healthcare services tasked with ensuring that patients receive better and proper health care services. Meanwhile, managed care organizations are a group of medical services providers who facilitate managed care health plans. The health plan is made up of hospitals, doctors, and other medical providers whose chief obligation is to give covered medicinal care as provided by the managed care guidelines. The primary aim of MCOs is to ensure patients receive health care services at an effective cost that is affordable. Information Technology plays a significant role in improving the dynamics of the operations of MCOs. The IT department in MCOs help reduce risks in designing, implementing, and the operation of the MCOs system. Thus, as a manager of the Managed Care Organization, it would be vital to establish an IT department’s composition, elements, and functions that are needed to improve the department as well as the MCO.

Elements of an MCO’s information system would include the technology, IT agents, members, and the employer. Technology plays a crucial part in the MCO because it ensures the organization’s ability to provide effective services to their customers. Technology such as software and web portals can be used to help determine the billing of patients, their history, and their eligibility for an insurance cover. Technology also assists in keeping track of the performance of the members of the MCO. According to an article by Hiblom and his colleagues, the use of technology will allow, “an entire patient history to be viewed without the need to track down the patient’s previous medical records” (2014 p 2) The members of the MCO include the physicians and all the supporting staff working in the organization. These members are tasked with providing services to patients visiting the facility, ensuring that the duties expected of a managed care organization are being done, and help customers to receive quality medical care. The IT agents are an element of information systems that are tasked with helping ensure that the technology used by the organization is working.

Also, they provide means for the information cycle within the institution to continue thus, improving different services such as patient services and sales. Lastly, the employer of the MCO ensures that services are delivered and that the patients receive quality health care services at an affordable rate. In addition to this, they are mandated to enroll new members in the organization as well as oversee the care of patient needs.

The use of smart cards by both the members of the MCO as well as the patients is a form of technology that I believe will help the MCO operate fully. Smart cards offer the MCO a chance to become digitized because all the information concerning the members of the MCO and the patients will be present in the smart card. A member’s smart card will contain the role of the member at the organization and also their personal details such as social security numbers. To the patient, their smart card will contain their medical information such as medical history, allergies, and insurance cover. The smart cards could also be used to validate and verify a patient’s insurance. According to Baltzi (3), “the cards can bring the keys and the certificates that are used for the encryption and the digital signature.” I believe that smart cards will improve the way services are administered to the customers of the MCO because it is easy to use the form of technology. Also, it will save the doctors time spent on going through medical records of patients because all their medical information will be recorded on their smart cards. As a manager, I recommend the use of smart cards because I believe it will revolutionize the provision of services, and an influx of new customers might be experienced since it reduces the time spent on looking for the patient information manually. Thus, reducing the consultation time and allow the physician to serve as many patients as possible.

            As a manager of the MCO, I would propose that the organization use Care Cloud as their electronic health record program because of it easy to use and secure. Electronic health record programs offer an electronic method of a patient’s medical history as well as information. I recommend the Care Cloud program because I believe that the program can ensure that the patient’s medical information is secure from hackers and people with malicious intent towards the MCO’s patients. Care Cloud offers a variety of functions that benefit both the organization and the patient. For starters, the software is easy to use, and value for its price is amazing since it is effective. According to an article by Uzialko (2019), “It is not the cheapest, nor the most expensive, but the value per dollar is quite good.” Also, the program has a smartphone application that will help doctors keep track of their patient’s well-being, no matter where they are in the world. Through the app, scheduling can be done to make it easier for the physician to keep track of their patients’ schedules for the day. I believe that the MCO will improve its services through the use of the program, thus attracting an even larger clientele that will lead to greater revenue at the end of the financial year.

Insourcing and outsourcing of IT need and activities have been a subject of concern for most people. Insourcing is the ability to hire staff on behalf of the organization and giving out the duties internally instead of providing the work to an outside company. On the other side of the coin, outsourcing is the technique of distributing work to another organization instead of handing out the work to an in-house department or employee. One of the benefits of insourcing IT work is that it gives the employees a chance to improve work quality. Another strength is that it helps build up the reputation of a brand or organization because it promotes loyalty. However, it may lead to inefficiency if the workers are incompetent. Outsourcing is cheaper as compared to insourcing and allows the company to find skilled and trained expertise. According to an article by Taveras, outsourcing is beneficial to the organization because “transferring the risk to a third party that can give guarantees of experience and professionalism in the area” (2015 p 3). However, it opens up the organization to the risk of losing confidential material to outside parties, which could harm the company’s reputation. Thus, I support insourcing since it promotes loyalty, which will lead to the better treatment of patients and their ability to return to the organization. In addition to this, outsourcing may lead to legal issues with the patients if their personal and confidential information is leaked or exposed.

As a manager of a Managed Care Organization, I believe that establishing an information technology department is important and beneficial. An IT department would improve the services provided by the MCO because it will improve the way patients receive treatment or interact with their physicians. Through the elements of the information systems of the MCO, I believe that the interrelation of these elements will improve the way patients are cared for and treated by the member of the MCO. Also, I believe that incorporating the use of technology to an MCO will help monitor the progress of patients. Hence, I propose the use of an electronic health records program named Care Cloud because it will help the doctors monitor their patients’ health through their services such as smartphone applications. The proposal to use in-house employees of the MCO to take up IT work will help improve loyalty and the organization’s brand because it will help reduce the risk of leaking of patient confidential files to the public. Overall, I embrace the use of technology and welcome the idea of an IT department to help integrate technology with the MCO.

 

References

Baltzi, E. Health Care Smart Cards: a Critical Review. The Scientific Journal of the Hellenic Regulatory Body of Nurses.

Hillblom, D. et al. (2014). The impact of information technology on managed care pharmacy: today and tomorrow. Journal of Managed Care Pharmacy, 20(11), 1073-1079.

Taveras, Pedro. (2015). OUTSOURCING VS. IN-SOURCING DECISION FACTORS. 10.13140/RG.2.1.2746.5445.

Uzialko, A. C. (2019). CareCloud Review 2019 | Electronic Medical Record Software Reviews. Business.com. https://www.business.com/reviews/carecloud-ehr/