7-9. Summarize the purpose and intended benefits of a healthcare exchange. 7-10.

Question

7-9. Summarize the purpose and intended benefits of a healthcare exchange. 7-10. Explain why a healthcare exchange requires an inter-organizational information system. 7-11. Using knowledge from this chapter, summarize the difficulties and challenges of developing inter-organizational information systems. 7-12. Healthcare exchange must utilize personal and confidential data about their users. Write one-paragraph policy that stipulates responsible processing and storage of these data. 7-13. Explain what you believe are the reasons for the Access CT success. 7-14. Read the Executive Summary of the First Data report located at www.oregan.gov/DAS/docs/co-assessment.pdf. Summarize those findings. 7-15. Using the facts described in this case and your answer to question 7-14,list five key learnings you can take from the Access CT and Cover Oregon projects.

Explanation / Answer

IT SOLUTION-IS THE CURRENT SOLUTION THE RIGHT APPROACH LONG TERM?

VENDOR APPROACH-SHOULD COVER ORGEON CONTRACT WITH A SYSTEM INTEGRATOR OR CONTINUE WITH THE CURRENT APPROACH?

SUSTAINABILITY OF ENROLLMENT AND FINANCES - IS FIANCIAL MODEL SUSTAINABLE BASED ON THE CURRENT COST AND ENROLLMENT PROJECTIONS?

HEALTH CARE EXCHANGE The new health care law makes Health insurance available to most uninsured low and middle income individuals through a health insurance exchange also known as a health insurance marketplace. The exchanges are state or federally run online marketplaces where customers can shop for affordable quality health insurance The Affordable Care Act requires that all Americans, purchase a Private Health Care plan, get an exemption or pay a tax penalty on their federal income taxes Americans who cannot afford health insurance will most likely either qualify for Medicare, Medicaid, CHIP or get assistance in the form of tax credits or assistance with up-front costs through their state’s Health Insurance Exchanges, if insurance is still unaffordable after assistance they may be exempt from the Individual Mandate. Healthcare exchange requires an inter-organizational information system. A. Changing business practices, customers needs and market dynamics have driven many organizations to implement interorganizational systems (IOSs). IOSs have been successfully implemented in the banking, cotton, airline and consumer-goods industries, and recently attention has turned to the healthcare industry B. unlike intraorganizational implementations and prior IOS studies, competition, economic dimensions, political issues and a group of enablers are the primary determinants of success C. Interorganizational systems using information technology(ies) and telecommunications to store, transmit, and transform clinical and financial information. This information can be shared among cooperative and competitive participants, such as payors, hospitals, alternative delivery systems, clinics, physicians, and home health agencies Problems The primary problemhealth management information systems( CHMISs)faced was a lack of affordable and effective technology. CHMISs occurred prior to the advent of cheap, reliable, high speed internet access; a CHMIS required costly network connections, hardware, and software in organizations where these types of technology had not previously existed. Also, CHMIS efforts discovered the newfound challenge of integrating data sources that had never before been combined Personal and confidential data The prospects of a fully integrated healthcare system are truly exciting. While patients’ expectations and HIE capabilities may truly never completely align, the exchange of a patient’s health data within a health organization, or regionally, among aligned providers, have tremendous potential to improve patient care and satisfaction. Now that the majority of innovative healthcare organizations have invested the capital, time and effort to install electronic medical records, many are looking to fully leverage the technology and meet Meaningful Use requirements by connecting to an HIE Clinical Data Repository Centralized HIEs have a CDR that houses a redacted version of the complete patient medical record, which is easily accessible by all member organizations. X Communication Backbone The method by which data is transmitted within an HIE. Communication methods include secured email, secured FTP, secured Web services, and TCP/IP via VPN connection In Federated and Hybrid HIEs, all patient data is maintained by and “lives” in the member’s CDR (not in a centralized location). When the RLS receives a patient query, it must relay all participant organizations, rank the responses, and then return the information to the original requester. ACCESS CT SUCCESS Access Health CT is not the only successful state exchange, of course, and the federal government’s HealthCare.gov has made great strides since its troubled debut. What truly sets the Connecticut effort apart—and what earned it the Editor’s Choice Award—was the way the exchange was built with re-use and revision in mind. Access Health CT has addressed back-end needs as well as citizen expectations. The security and privacy controls, data standards and flexible reporting functions all help to ensure the system can help Connecticut deliver on this critical mission Access Health CT has continued to build on that initial success—streamlining the process for consumers and steadily adding new functionality. The goal was not simply to maintain a functional government-run exchange, but to deliver an customer experience that exceeds the citizen expectations shaped by private-sector apps and online services. LEARNING Analysis address the following three AREAS from cover orgeon

IT SOLUTION-IS THE CURRENT SOLUTION THE RIGHT APPROACH LONG TERM?

VENDOR APPROACH-SHOULD COVER ORGEON CONTRACT WITH A SYSTEM INTEGRATOR OR CONTINUE WITH THE CURRENT APPROACH?

SUSTAINABILITY OF ENROLLMENT AND FINANCES - IS FIANCIAL MODEL SUSTAINABLE BASED ON THE CURRENT COST AND ENROLLMENT PROJECTIONS?

Analysis address the following three AREAS from CT SUCCESS streamlining the process for consumers and steadily adding new functionality. deliver an customer experience that exceeds the citizen expectations shaped by private-sector apps and online services

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