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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 (i.e., costs). The IT department should design, implement, and operate the systems that run the MCO. Efficiency is the hallmark of a good system.

 

 

Work:

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.

 

  • Describe the key elements of an information system for an MCO. Four key elements: processes, data, tools, and organization, which are all needed to manage a system efficiently and effectively. Processes deal with how to perform the task. Data refers to the information required to perform the process. Tools are the equipment needed to perform the processes. Organization refers to the people that support the process and how they are set up to do so.  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/medical records (EH/MR) program that is 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.

 

 

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