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/
"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.
External and internal influences are relevant in health care. These influences continue to affect the total operations of a health care facility. I will summarize the insights I have gained into the external influences of the new health care reform policy and quality initiatives. The recent health care reform legislation was passed in the house and senate this year. The senior vice president, that I have interviewed, states that health care reform is an “unknown” for organizations. In addition, I will research the quality improvement initiatives and how these external influences include implications for organizations and health care administrators.
As I began watching Reinventing Healthcare-A Fred Friendly Seminar (2008), I thought to myself, “man, things have changed since 2008.” And as the discussion progressed, I started to become irritated by how little had changed. The issues discussed were far-reaching, and the necessity for urgent change was a repeated theme. And yet, eight years later, health care has made changes, but many of its crucial problems still exist.
Yong, Pierre L., Robert Samuel Saunders, and LeighAnne Olsen. The Healthcare Imperative: Lowering Costs and Improving Outcomes : Workshop Series Summary. Washington, D.C.: National Academies, 2010. Print.
The Certification Commission for Healthcare Information Technology (CCHIT) is a private, non-profit organization formed to certify EHRs against a minimum set of requirements based on functionality, interoperability, and security. It was founded in 2004 by three industry associations: the healthcare Information and Management Systems Society, the American Health Information Management Association, and The Alliance for Health Policy and Systems Research. In 2005 CCHIT was awarded a three-year, $7.5M government contract to assist with developing certification criteria and inspection processes for EHR systems. The U.S. Department of Health and Human Services has partnered with the CCHIT to certify EHR pr...
An HIE (health information exchange) allows medical professionals at multiple levels access and share medical information electronically, and within the confines of HIPAA privacy laws. HIE is meant to improve efficiency, speed, quality, and cost of patient care. It is thought by some in the industry that HIE is not able to address recurring challenges associated with rapid technological advancements. The initiative for HIE is being driven by meaningful use requirements, coordination needs for new payment approaches, and federal financial incentives.
The Henry J. Kaiser Family Foundation, (March 2010). Focus on Health Reform, Summary of New Health Reform Law, Retrieved on Feb. 1, 2011, from http://www.kff.org/healthreform/upload/8061.pdf
Saldin, Robert. "Wonder Drug Or Bad Medicine? A Short History Of Healthcare Reform And A Prognosis For Its Future." Juniata Voices 11.(2011): 83-91. Academic Search Premier. Web. 11 May 2014.
Kimbuende, E., Ranji, U., Lundy, J., & Salganicoff, A. (2010). U.S. health care costs. Retrieved from Kaiser EDU website: http://www.kaiseredu.org/Issue-Modules/US-Health-Care-Costs/Background-Brief.aspx
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.
Competitive advantage matters greatly to those responsible for the management of healthcare institutions. Together with rapidly escalating healthcare costs, increasingly complex medical technologies, and growing regulatory and legal pressures, healthcare organizations face a critical need to improve the quality of care at reduced costs (Cu...
The Health Information Technology Economic and Clinical Health Act also known as The HITECH Act, is Title 13 of the American Recovery and Reinvestment Act (ARRA) that was signed into law February 17, 2009 and enacted September 23, 2009 (Rouse). This piece of legislation was designed to stimulate the adoption of electronic health records (EHR). HITECH regulations were designed to reduce healthcare costs, provide safer practices, and improve the quality of services provided to the patient. In addition, HITECH encourages access for patients through the EHR systems to their personal ePHI (electronic protected health information) for patient-centered care. HITECH also promotes health information exchanges across the country, state, and/or healthcare
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