Widespread adoption of electronic medical record (EMR) systems in the future is a noble objective, however it has distracted policy makers from enabling true Health Information Technology (HIT) reform now. While others continue to champion EMR systems as former U.S. Department of Health and Human Services National HIT Coordinator David Brailer, MD, did, many in the health sphere confuse the advancement of EMRs with overall HIT reform. As industry pundits debate potential clinical benefits and cost reductions that EMR systems could deliver, there is too little discussion about how HIT can improve the single largest payer of medical claims—Medicaid.
Healthcare executives face an uphill struggle to reduce costs, grow revenues within a shifting payment landscape and ensure that patients receive quality, life-saving care. A tough assignment, especially when a critical shortage of workers sabotages those efforts.
According to Robert Taketomo, president and CEO of Ventegra, an example of a three-tier injectable benefit design (all tiers subject to a standard deductible and out-of-pocket maximum) would be:
Plans take initiative in disaster planning through partnerships (More from Disease Management, July 2006)
Some health plans are partnering with public health departments and statewide services to develop disaster plan to help avert the potential catastrophic effects of a flu pandemic. As an integrated delivery system, SelectHealth in Salt Lake City is working with the Utah Department of Health, which developed the Utah Pandemic Influenza Response, a preparedness plan in coordination with efforts by WHO and the U.S. Department of Health & Human Services. The state's primary goals are to minimize serious illness and deaths, societal disruption and economic loss.
Care management and P4P programs face the same challenge: getting physicians to trust and use payer data
Care management and pay-for-performance (P4P) programs couldn't be more popular in the industry. Although often thought of and managed separately, their goals are really the same: to focus attention and dollars where they will have the greatest impact on patient care. With care management, the focus is on finding and providing specialized services to those who either have chronic illnesses or who might be heading down the path toward them. P4P merely casts the net wider with its assumption that tying physician payments to standards of care will deliver optimal care along the healthcare continuum.
With its first phase of certification rolling, the Certification
Commission for Healthcare Information Technology (CCHIT) will
concentrate on maintaining its momentum while moving to the realm
of inpatient electronic health records (EHRs) in its second
certification phase, followed by the evolving EHR network
infrastructure in phase three.
According to the Centers for Disease Control, chronic diseases have
become the leading cause of death and disability in the United
States, account for 7 out of every 10 deaths and affect the quality
of life of 90 million Americans. In 2002, direct medical costs
reached $92 billion and indirect costs (including disability, work
loss and premature mortality) totaled $40 billion. Perhaps the most
confounding fact is that although chronic diseases are among the
most common and costly health problems, they also are among the
Insurance companies are constantly on the lookout for innovative
ways to reduce risk and reduce costs. From underwriting continuing
education for insured physicians to providing discounts to
hospitals that have implemented risk reduction measures,
forward-thinking insurers know that small investments in safety
today can reap significant future rewards.
Although any change in moving newly released over-the-counter (OTC)
medications to benefit designs or formularies is currently being
driven by health plans, other emerging market factors will
influence how plans and employer groups think about coverage for
OTCs. For example, Blue Cross and Blue Shield of Minnesota has had
numerous inquiries about OTC coverage, usually from employer groups
that know Medicaid and some Part D plans can cover OTCs. In
addition, some states are evaluating their pharmacy practice
guidelines to determine how to revise them to accommodate changes
in dispensing OTCs. This change is driven by the addition of OTCs
to formularies and by the move to put pseudoephedrines behind the
counter. Another industry trend in some states, including
Minnesota, allows pharmacists to prescribe OTC products for public
With the nation focused on pandemic flu preparations, federal
government officials are calling for a nationwide biosurveillance
network to help identify a public health threat in real time. While
few doubt biosurveillance can play a critical role in an outbreak,
emergency departments are underfunded and overcrowded, pushing
biosurveillance to the bottom of the technology wish list. But a
closer look reveals that biosurveillance technology can make an
immediate impact on public health, patient care, wait times and the