Engaging Health Care Consumers Online is Top Priority

Managed Care Executives cite cost and complexity



25 Apr, 2008, 01:00 ET from Managed Care Executive Group

    CLEVELAND, April 25 /PRNewswire/ -- In its Annual Forum, held this year
 in Key West, Florida, the Managed Care Executive Group (MCEG) met to
 discuss a variety of topics and technologies in support of the President's
 Four Cornerstones, which focuses on value-driven healthcare. During these
 sessions, the MCEG members determined the 2008 Top 10 issues impacting our
 industry and noted a significant shift towards priorities that give members
 the necessary tools and support to manage their healthcare needs:
 
 
1. Consumer Directed Products: The engaged consumer will be the focal point of significant new IT investment. A greater degree of direct consumer involvement in everything from the sales cycle to treatment decisions will impact plan design, service delivery and administrative operations, ultimately resulting in radically different products. Web-based service will be a dominant feature in these new products, but the transition to a Web-service model will likely be slower than in other industries as millions of members choose to remain in traditional plans. This will prove to be a challenge in cost and complexity for both administrative and IT departments. 2. Web Enablement: As healthcare follows the path of other consumer-intensive industries, health plan websites will include sales automation, self-service and information transparency. Competitive advantage and improved member wellness will result. Health plan websites as THE health care resource for their membership will be essential. Mashups, Wikis, personalization and custom portlets will become part of the working vocabulary of health plan IT departments. 3. Nimble, speed-to-market solutions: Fast, focused and results-driven projects will address rapidly evolving product portfolios. These IT projects will combine existing standards and architectures with new technologies to produce innovative solutions. These solutions must develop at the speed of the marketplace. 4. Business and IT Collaboration: As organizations move beyond back room automation to business process redesign and service automation, the importance of a strong business/IT partnership is heightened. The market for business process analysts, project managers, and IT auditors is on the rise. 5. Data Analytics and Informatics: Disease Registries, scorecards, member outreach, case management and customer segmentation will continue to drive investment in analytics. As clinical information becomes more readily available through PHRs and EHRs, data-mining and advanced decision support tools will improve the practice of real-time medicine. 6. Collaboration with Providers as a Business Partnership: Prior authorization and utilization reviews are fading, and in their place is a more collaborative model based on access, quality, safety, effectiveness and patient centeredness. P4P is holding providers accountable, stressing bridges to excellence. 7. The Role of State and Federal Government in Health Care: Government support, intervention and regulation are having increasing impact on payer's operations, costs and even marketplace strategies. The importance of electronic health information technology in reforming the U.S. healthcare system is evident in the President's Four Cornerstones initiative. The 2008 election will feature healthcare reform in response to voter demands. Mandates, increased regulation, oversight and compliance audits will impact IT budgets, operations and project planning. 8. Value-Driven Health Care: HIPAA led the way through standardization of electronic transactions and portability of certain plan features. The President demanded it in his 4-cornerstone plan. Transparency in other health plan functions, such as simplified adjudication, provider payment/contracting, employer/purchaser reporting, and member account management is enabled by emerging new standards. Buyer's coalitions, government purchasers, provider trade groups, and consumer advocates will power the push for plans to adopt simplified and common administrative formats, performance metrics and portable member data exchange. 9. Database/Warehousing Expansion: Dealing with the enormous database expansion required for a true consumer-centric health plan of the future requires planning, strategic investment, and advances in knowledge management. The Data Warehouse will support multiple functions throughout the health plan, feed internal decision-support data marts, and become the source for data extracts to external organizations. 10. Electronic Health Records: Health Plan-based EHRs bring together data from disparate electronic medical records and claims to create a composite from across the health system. Personal Health Records (PHR's) give individuals access and control over their own medical information. With the entry of new offerings from companies like Google, Microsoft, Intel and others, issues of privacy, security, and standardization of patient data will become even more challenging.

SOURCE Managed Care Executive Group
    CLEVELAND, April 25 /PRNewswire/ -- In its Annual Forum, held this year
 in Key West, Florida, the Managed Care Executive Group (MCEG) met to
 discuss a variety of topics and technologies in support of the President's
 Four Cornerstones, which focuses on value-driven healthcare. During these
 sessions, the MCEG members determined the 2008 Top 10 issues impacting our
 industry and noted a significant shift towards priorities that give members
 the necessary tools and support to manage their healthcare needs:
 
 
1. Consumer Directed Products: The engaged consumer will be the focal point of significant new IT investment. A greater degree of direct consumer involvement in everything from the sales cycle to treatment decisions will impact plan design, service delivery and administrative operations, ultimately resulting in radically different products. Web-based service will be a dominant feature in these new products, but the transition to a Web-service model will likely be slower than in other industries as millions of members choose to remain in traditional plans. This will prove to be a challenge in cost and complexity for both administrative and IT departments. 2. Web Enablement: As healthcare follows the path of other consumer-intensive industries, health plan websites will include sales automation, self-service and information transparency. Competitive advantage and improved member wellness will result. Health plan websites as THE health care resource for their membership will be essential. Mashups, Wikis, personalization and custom portlets will become part of the working vocabulary of health plan IT departments. 3. Nimble, speed-to-market solutions: Fast, focused and results-driven projects will address rapidly evolving product portfolios. These IT projects will combine existing standards and architectures with new technologies to produce innovative solutions. These solutions must develop at the speed of the marketplace. 4. Business and IT Collaboration: As organizations move beyond back room automation to business process redesign and service automation, the importance of a strong business/IT partnership is heightened. The market for business process analysts, project managers, and IT auditors is on the rise. 5. Data Analytics and Informatics: Disease Registries, scorecards, member outreach, case management and customer segmentation will continue to drive investment in analytics. As clinical information becomes more readily available through PHRs and EHRs, data-mining and advanced decision support tools will improve the practice of real-time medicine. 6. Collaboration with Providers as a Business Partnership: Prior authorization and utilization reviews are fading, and in their place is a more collaborative model based on access, quality, safety, effectiveness and patient centeredness. P4P is holding providers accountable, stressing bridges to excellence. 7. The Role of State and Federal Government in Health Care: Government support, intervention and regulation are having increasing impact on payer's operations, costs and even marketplace strategies. The importance of electronic health information technology in reforming the U.S. healthcare system is evident in the President's Four Cornerstones initiative. The 2008 election will feature healthcare reform in response to voter demands. Mandates, increased regulation, oversight and compliance audits will impact IT budgets, operations and project planning. 8. Value-Driven Health Care: HIPAA led the way through standardization of electronic transactions and portability of certain plan features. The President demanded it in his 4-cornerstone plan. Transparency in other health plan functions, such as simplified adjudication, provider payment/contracting, employer/purchaser reporting, and member account management is enabled by emerging new standards. Buyer's coalitions, government purchasers, provider trade groups, and consumer advocates will power the push for plans to adopt simplified and common administrative formats, performance metrics and portable member data exchange. 9. Database/Warehousing Expansion: Dealing with the enormous database expansion required for a true consumer-centric health plan of the future requires planning, strategic investment, and advances in knowledge management. The Data Warehouse will support multiple functions throughout the health plan, feed internal decision-support data marts, and become the source for data extracts to external organizations. 10. Electronic Health Records: Health Plan-based EHRs bring together data from disparate electronic medical records and claims to create a composite from across the health system. Personal Health Records (PHR's) give individuals access and control over their own medical information. With the entry of new offerings from companies like Google, Microsoft, Intel and others, issues of privacy, security, and standardization of patient data will become even more challenging. SOURCE Managed Care Executive Group