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 optimization to improve the quality of health care and cost. The new HIPAA requirements will bring about major changes in the contents of data submitted with claims and the information available in response to electronic inquiries. This implementation will require changes to software and systems and possible changes in procedures used for billing Medicare and Medicaid.
Following HIPAA 5010 will be an impact for health care systems to change to ICD-10 for their medical record coding and billing. “Administrative simplification, speed to market, more automated processes and streamlined project delivery will be strategically important and necessarily balanced with maintaining and enhancing current systems and gaining consumer confidence in health plans.” (Administrative Mandates, 2011)
Care Management, Data Analytics, and Informatics
Healthcare organizations will be driven to invest more in data and analytics due to new technologies. This includes Electronic Medical Records (EMR’s), Computerized Physician Order Entry (CPOE), e-prescribing, on-line reporting and appointment scheduling. Furthermore, important programs such as “wellness, disease management, mental/behavioral health support systems, real-time decision...