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Engaging Health Care Consumers Online is Top Priority
Date:4/25/2008

Managed Care Executives cite cost and complexity

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.


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SOURCE Managed Care Executive Group
Copyright©2008 PR Newswire.
All rights reserved

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