Care management technology acquisitions require strategy

March 1, 2005

CONFUSION ABOUNDS as healthcare payers attempt to make decisions about technology acquisitions for care management. It is not surprising, given the enthusiasm for "new technology" that Gartner analysts hear questions from clients like, "Should my organization invest in an e-prescribing solution, an e-visit solution or a personal health record?" and the list of technologies goes on.

CONFUSION ABOUNDS as healthcare payers attempt to make decisions about technology acquisitions for care management. It is not surprising, given the enthusiasm for "new technology" that Gartner analysts hear questions from clients like, "Should my organization invest in an e-prescribing solution, an e-visit solution or a personal health record?" and the list of technologies goes on. There is no single right answer. The questions we ask back are, "What are your strategies?"; "How can technology enable those strategies?"; and "Are there opportunities for a single technology investment to support multiple programs?"

There are three major drivers for care management strategies and technology decisions, 1) those that result from analyzing the requirements of the population or membership enrolled in benefit plan, 2) those made because of a significant expense category (e.g., prescription drug costs) or 3) those made as a result of corporate initiative (e.g., we want to improve customer satisfaction and believe that deploying e-visit technology will accomplish that goal). Creating a map of care management strategies and technologies will help healthcare insurance companies prioritize investment decisions.

ANALYTICALLY DRIVEN DECISIONS Healthcare payers analyze the demographics and the clinical requirements (e.g., care management programs) of the members they must manage. From those results the medical management staff designs strategies and interventions that may or may not require the use of technology. For example, multichannel communication between the payer and the member and between the patient and the provider may be a critical component of several programs. Therefore, an investment in secure messaging technology that can be made available to network providers to communicate with their patients-perhaps in the form of e-visits-makes sense. Likewise, investment in telephony as another channel for communications may well be a required technology. Conversely, unless the population includes a significant number of home-bound, chronically ill patients (such as the Veterans' population or a Medicare population) then the investment in remote biometric devices would not be on the high-priority list.

CORPORATE-DRIVEN DECISIONS Healthcare payers establish strategies or initiatives that are likely to require technology affecting care management. For example, access to a member portal for personal health management including a Personal Health Record may be included as part of a consumer-defined product offering. That technology must be acquired to meet contractual requirements and thus becomes a priority.

Identifying the various types of care management technology that could be required is the first step toward prioritizing acquisition. Healthcare payers must recognize that the next 24 to 30 months will be a time of pilot testing of many applications of technology, such as telephony and secure messaging.

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Cynthia Burghard is research director with Gartner's Healthcare Industry Research & Advisory Services.