Formed in 1998, the Managed Care Executive Group (MCEG) is a national organization of U.S. senior health executives who provide an open exchange of shared resources by discussing issues which are currently faced by health care organizations. In the fall of 2011, 61 organizations, which represented 90 responders, ranked the top ten strategic issues for 2012. Although the issues were ranked according to their priority, this report discusses the top three issues which I believe to be the most significant due to the need for competitive and inter-related products, quality care and cost containment. The Managed Care Executive Group (MCEG) The objective of the MCEG is to provide channels to exchange information between managed care/health plan information systems executives and to provide opportunity for personal networking. MCEG provides a forum to develop policy which relates to the use of information technology and healthcare. MCEG provides feedback to vendor sponsors and other vendors on the trends and types of technology needed to ensure that their products and strategies meet their customer’s present and future managed care needs. Additionally, their objective is to “educate executives on clinical and administrative trends in health care, new and emerging technologies, and other pertinent information to assist in achieving the key goals of cost containment, effective service and high quality health care.” (Why We Matter, 2011) Administrative Mandates (Compliance HIPAA 5010, ICDE-10) Administrative Mandates, including the Health Information Technology for Economic and Clinical Health (HITECH) Act, ICD-10 and HIPAA 5010, are all part of administrative simplification and the need for systems optimiza... ... middle of paper ... ...ntial in ACOs. Retrieved January 16, 2012 from http://www.healthmgttech.com/index.php/solutions/payers/eight-reasons-payer-interoperability-and-data-sharing-are-essential-in-acos.html Wise, N., & Taylor, F. (n.d.) Moving Forward With Reform: The Health Plan Pulse for 2012 and Beyond. Retrieved January 16, 2012 from http://www.htms.com/pdfs/MovingForwardWtihReform2012_HTMS_MCEG_Whitepaper.pdf Payer/Provider Inoperability. (2011). Retrieved January 13, 2012 from http://www.mceg.net/top-10/payer/ The Managed Care Executive Group. (2011). Retrieved January 13, 2012 from http://www.mceg.net/ Top 10 issues for health plans in 2011. (2011, April 5) Healthcare IT News. Retrieved January 13, 2011 from http://www.healthcareitnews.com/print/24881 Why We Matter. (2011). Retrieved January 13, 2012 from http://www.mceg.net/about-us/why-we-matter/
Jha, A. K., Burke, M. F., DesRoches, C., Joshi M. S., Kralovec P. D., Campbell E. G., & Buntin M. B. (2011). Progress Toward Meaningful Use: Hospitals’ Adoption of Electronic Health Records. The American Journal of Managed Care, 17, 117-123
The health information networks factor into the enhancement of the patient-centered management system, in that they help with the implementation of the Electronic health record. The HITECH Act for example allocated “18 billion through the Medicare and Medicaid reimbursement systems as incentives for hospitals and physicians who are meaningful users of EHR systems”(About the HITECH, n.d.). This is a beneficial way to promote the use of electronic health records and have them become universally utilized across the nation. NHIN is also an excellent network that is more widespread and contains policies as well as standards that help with the safe trade of data. NHIN is the biggest network that all other health information networks hope to achieve. The NHIN is a contributor to the expansion of the EHR and it also further improves the patient-centered management system by having the policies they have. These policies assist with keeping the information in the system safe and also helping many different entities to become a part of its use. Some of the entities involved are the Center for Disease Control and prevention, Social Security Administration, Department of Defense and Kaiser Permanente among others. Both CHIN and RHINO implement the use of electronic health record, which makes it more widespread,
Where the states stand on Medicaid Expansion. (2014, March 28). Retrieved April 20, 2014, from http://www.advisory.com/daily-briefing/resources/primers/medicaidmap
"The Pros and Cons of ObamaCare." UPMC. N.p., 6 Nov 2013. Web. 14 Apr 2014.
When one examines managed health care and the hospitals that provide the care, a degree of variation is found in the treatment and care of their patients. This variation can be between hospitals or even between physicians within a health care network. For managed care companies the variation may be beneficial. This may provide them with opportunities to save money when it comes to paying for their policy holder’s care, however this large variation may also be detrimental to the insurance company. This would fall into the category of management of utilization, if hospitals and managed care organizations can control treatment utilization, they can control premium costs for both themselves and their customers (Rodwin 1996). If health care organizations can implement prevention as a way to warrant good health with their consumers, insurance companies can also illuminate unnecessary health care. These are just a few examples of how the health care industry can help benefit their patients, but that does not mean every issue involving physician over utilization or quality of care is erased because there is a management mechanism set in place.
In 2009 President Obama, through the American Reinvestment and Recovery Act, pledged to provide incentives to the nation’s physicians and hospitals to convert to an electronic healthcare system in attempt to improve the quality of care and reduce cost (Freudenheim, 2010). By converting to an electronic system, we have the opportunity for improved communication between all healthcare providers and decreased cost to our healthcare system. The goal is to improve communication across all aspects of the service chain (Horan, Botts & Burkhard, 2010). Almost two years later, the conversion progress continues to be slow. Only one in four physician’s offices, mostly large groups, have implemented the electronic record system (Freudenheim, 2010).
“An electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users.” (healthit.gov) The EHR mandate was created “to share information with other health care providers and organizations – such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics – so they contain information from all clinicians involved in a patient’s care.” ("Providers & Professionals | HealthIT.gov", n.d., p. 1) The process has proved to be quite challenging for providers. As an incentive, the government began issuing payments to those providers who “meaningfully use certified electronic health record (EHR) technology.” (hhs.gov) There are three stages that providers must progress through in order to receive theses financial incentives. Stage one is the initial stage and is met with the creation and implementation of the HER in the business. Stage two “increases health information exchange between providers.” ("United States Department of Health and Human Services | HHS.gov", n.d., p. 1) Stage three will be the continuation and expansion of the “meaningful use objectives.” ("United States Department of Health and Human Services | HHS.gov", n.d., p. 1) The hospital, where I work, initiated the HER mandate many years ago. In this paper, I will discuss the progression and the challenges that my hospital encountered while implementing the EHR mandate.
McDonough, John E., and Eli Y. Adashi. "Realizing the Promise of the Affordable Care Act--January 1, 2014." JAMA: The Journal Of The American Medical Association 311.6 (2014): 569-70. Print.
Health reform at a glance: the health insurance exchange. (2009). Retrieved November 5, 2009, from waysandmeans.house.gov/media/pdf/111/exchange.pdf
In the mid-1960s President Lyndon B. Johnson signed into law Medicare and Medicaid, two federally funded programs that guaranteed health insurance benefits to the elderly and the poor (Shortliffe et al., 2006). The focus of the health insurance benefits was cost-based reimbursement. With the increase in patient visits hospitals realized the need for information systems in order to automate the billing process. One of the challenges of these information systems was the cost. Due to the cost of these large, mainframe, financially-focused information systems, they were mainly found in large hospitals that were affiliated with academic medical centers (Shortliffe et al., 2006). Smaller hospitals just could not afford these information systems.
Unfortunately, the quality of health care in America is flawed. Information technology (IT) offers the potential to address the industry’s most pressing dilemmas: care fragmentation, medical errors, and rising costs. The leading example of this is the electronic health record (EHR). An EHR, as explained by HealthIT.gov (n.d.), is a digital version of a patient’s paper chart. It includes, but is not limited to, medical history, diagnoses, medications, and treatment plans. The EHR, then, serves as a resource that aids clinicians in decision-making by providing comprehensive patient information.
The present environments for healthcare organizations contain many forces demanding unprecedented levels of change. These forces include changing demographics, increased customer outlook, increased competition, and strengthen governmental pressure. Meeting these challenges will require healthcare organizations to go through fundamental changes and to continuously inquire about new behavior to produce future value. Healthcare is an information-intensive process. Pressures for management in information technology are increasing as healthcare organizations feature to lower costs, improve quality, and increase access to care. Healthcare organizations have developed better and more complex. Information technology must keep up with the dual effects of organizational complication and continuous progress in medical technology. The literature review will discuss how health care organizations can provide effective care by the intellectual use of information.
To date, there have been multiple studies on the different aspects of the Health IT infrastructure. These studies have shown many challenges ahead as well as some positive outcomes. One study quoted within the Article of “A Robust Health Data Infrastructure” stipulates, “180,000 outpatients and 800 clinicians in communities that had adopted EHRs from multiple vendors found that, over a multi-year period, the overall cost of outpatient care was reduced by 3.1% relative to the control group.” (Jason 14). The outcomes of this study have proven success with the implementation of EHR systems and the outlook is
The influx of information technology has been widespread and the possibilities of advancement are limitless. With the complex structure of the healthcare industry, it is necessary that the technology will be leveraged to support quality standards, management processes and performance improvement efforts.
Technology has changed the way Nursing homes (NH) document their patients plan of care, medical records, and outside doctor visits (Podiatrist). Health Information technology (HIT) applies the use of information systems for the administration, the operations management of the Nursing home, and direct clinical functions (Nauert & Fields, 2012). Policymakers have decided that electronic communication will make improvements on the quality, safety, and efficiency of care to Medicaid and Medicare clients. Health Information Technology for Economic and Clinical Health Act (HITECH) mission is to provide a virtual network to all health care providers, but long term care (LTC) facilities was not incorporated in the legislation. Nevertheless, Nauert