Integrating Efficiency to Managed Care Organizations through IT Solutions



Most observers and healthcare practitioners have had recent debates on whether managed care organizations can negate costs and remain to be efficient through adoption of information technology departments within the organization. Information technology continues to improve the healthcare infrastructure not just in the United States, but other parts of the world, considering the complexity of the business and care procedures associated with care givers. More healthcare providers continue to include information technology systems to their businesses, including any analytics, database and system management tools that would aid the swift operation of care management organizations. 

This paper intends to critically analyze the various elements required in an Information Technology System for a care management organization, examine the required technological specifics that would befit such organization, propose a specific healthcare record that is compliant with the Health Insurance Portability  and Accountability Act (HIPAA), examine the costs that the care management organization would save as a result of the system and analyze the pros and cons of in sourcing against outsourcing of IT services and finally make recommendations as to the best approach to take in ensuring an information technological capable organization for healthcare services (Chaikind, 2004). 

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Salient Elements of an Information System for Managed Care Organizations

Care providers in healthcare organizations have over time recognized the critical role played by informational technology solutions, which provide a myriad of support systems for the acre giving business. The information system required for a managed care organization ought to have specific capabilities which do not affect other care givers such as physicians. The system should, first and foremost, have the ability to coordinate care. Practically, the system should be able to provide accessibility of information on patients across the relevant departments of the organization, so that care is given on an updated and informed point. This will be helpful in ensuring that care managers are able to transit from one phrase of the care provision to another, and monitor any available care gaps there may be. The system, on the other ambit, ought to facilitate any assessment and general risk stratification. This is to mean that care providers should be empowered to access the status of health for every patient they are dealing for, and they should be able to analyze such patient’s developments and proceeding procedures to be administered to them. This will aid the care managers to evaluate and know which among their patients are at higher risk compared to the rest, and hence need specialized attention or benefit from care management that is intensive (Lundy & Janes, 2009). 

The system also needs to be able to sustain cohort management. The system needs to adopt tools which will assist care managers to approach care-giving according to a certain formula, especially for high-risk patients who need particular attention. The tools should enable creation of schedules, target reminders on a routine basis and provide notifications especially for emergency requirements or preventive care analysis. To be specific, a system specifically designed for a managed care organization needs a care plan sharing platform for individual patients, care givers and certain people in the organization’s management, so that a common source of information can be shared among different parties as the need may be. The system also needs to encompass support tools for clinical support, which can be installed to assist newbies and learning care givers to assist even in the absence of the responsible parties due to databases with previous care procedures available within the system (Saxton & Leaman, 2009). 

The technology can also be designed to allow for the engagement of care-givers and patients, especially those who are self-administering medication from their homes and hence need updating and guidelines from their caregivers. This will assist with self-activation of patients and also ensure self-management hence cutting of exorbitant travel expenses for check-ups. The technology should have capacity to generate patient information such as medication outcomes and other outcomes from their health care, information which shall be capable of satisfying caregivers to make decisions. Lastly, the system should be capable of generating reports for compliance need, when managed care organizations need to automatically channel any information to governmental authorities regarding quality of care given and financial metrics. This is critical due to the various governmental incentives to propagate accountable healthcare to patients. Electronically generated reports are cost-effective and greatly reduce the burden of the organization’s administration personnel (Lundy & Janes, 2009).   

Specific Electronic Health Record (EHR)

Due to the nature of managed care organizations and their proneness to storage and sharing vital and often confidential patient information, they are bound by the provisions in the Health Insurance Portability and Accountability Act of 1996. The Act was signed to law by President Bill Clinton with the aim of improvising national standards in the entire United States for the safeguard of electronic healthcare transacting and data sharing. Information exchange tools in for any organization’s information technology department needs to possess the ability to maintain a shared platform of information in form of patient records. This is among the most guarded technological solutions due to the potential vulnerability to leaking patient data to 3rd parties (Rosenbaum, et. al., 1998). 

Information exchange systems can take different forms such as implementing repository health records for patients which enables directional exchange among two different parties with interfaces. However the best model of health records for a managed care organization is one that encompasses three major benefits including; have locator records for patient information, which is enabled by maintaining a patient index and integration engine for easy accessibility of the patient’s data, a notification system that automatically notifies the relevant parties in the even data is accessed, input or retrieved through downloads from the patient database, and the care manager’s directory services to ensure that patients can access the contacts and profiles of their caregivers at anytime, in the event they need to (Saxton & Leaman, 1998).

Costs Savings due to Integration of above Information Systems

Managed care continues to get great attention because it creates a solution for America’s growing vulnerability to healthcare crisis. Contemporary technological advancements and the best features of the old practices ought to be merged to create care services that are of quality, but cost-effective. There is debate as to whether information systems and integration of IT solutions do control the cost trend for the organization or assist in a one-time reduction as the organizations manual systems are refined. Measured results have however proven that technology can greatly reduce the expenses of an organization and definitely save the patient’s costs too. With technology and digital migration from manual systems, the organization will save on transportation costs, human resource need and purchasing of office infrastructure costs. This cost-efficiency twirls around accessibility and exchange of information (Rosenbaum, et. al., 1998).

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Insourcing versus Outsourcing – The Greater Good

Whether to outsource or retain in-house IT practitioners depends on the available finances within the Managed Care Organization. However, there are many other factors which determine the direction to take. The advantages of outsourcing services will include the organization’s ability to focus on their core business, evasion of risks connected to inferior operations, the organization enjoys flexibility of resources and expenses such as periodic salaries to IT personnel is evaded. The disadvantages include loss of management control and negative publicity. Insourcing, to the contrary, has the advantage of high levels of control from the organization and ensures increased engagement with technological tools. The disadvantages revolve around high investment thresholds, and possibilities of dedicated technology tools failing to be used frequently by caregivers. From this analysis, the Managed Care Organizations are better with outsourcing of services, as this is a more cost-realistic option (Warner, 2014). 

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  1. Chaikind, H. (2004). The Health Insurance Portability and Accountability Act (HIPAA): Overview and Analyses. New York: Nova Publishers.
  2. Lundy, K. & Janes, S. (2009). Community Health Nursing. New Jersey: Jones & Bartlett Learning Publishers. 
  3. Saxton, J. & Leaman, T. (1998). Managed Care Success: Reducing Risk While Increasing Patient Satisfaction.  New Jersey: Jones & Bartlett Learning Publishers.
  4. Rosenbaum, S., Silver, K. & Wehr, E. (1998). An Evaluation of Contracts between Managed Care Organizations and Community Mental Health and Substance Abuse Treatment Agencies. New York: DIANE Publications.
  5. Warner, M. (2014). Insourcing versus Outsourcing in the United States or Reversed Privatization in the Heartland of Capitalism. New York: Department of City and Regional Planning Publications. 
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