Managed Care Executive Group (MCEG) released 2010 top 10 managed care challenges

May 17, 2010

At the Managed Care Executive Group?s (MCEG) recent annual forum, the group released its annual top 10 issues list. This year the Top Ten is dominated by the role of government.

At the Managed Care Executive Group’s (MCEG) recent annual forum, the group released its annual top 10 issues list. This year the Top Ten is dominated by the role of government. In fact, the top three spots all have to do with government initiatives.

“Not suprisingly perhaps, leading the list are the role of state and federal government and healthcare reform,” says Alan Abramson, CIO and senior vice president of IS/IT at HealthPartners. Abramson is also chairperson of the Board of Directors for MCEG. “In pushing these to the top of the list, members of MCEG see government as both an innovator and a regulator in relationship to health plans. Third on the list, and also related to government involvement, this time as a standards setter, is the impact of ICD-10.”

Abramson says using ICD-10 for medical record coding and billing is a "sleeper" requirement.

“There is potential to impact not just claims processing, but provider contracting, disease management, coordination of care, and essentially all health plan administration processes,” he says. “Plans that approach adoption of ICD-10 through algorithms to ‘cross-walk’ version 10 claims into existing version 9 claims processing systems may regret taking that approach. Plans that take on the difficult task of installing a true ICD-10 system with its several hundred thousand new codes may come out ahead in the long run as they mine the data from the more finely detailed ICD-10 version and use it to adjust provider reimbursement.”

Abramson says forum attendees heard from a panel of national thought leaders who interpreted the direction of health reform legislation and provided suggested courses for action. Among these were:

• Plans should engage in the process of drafting new regulations, since it will be through regulation, not the initial legislation, that the impact of health reform will be realized.
• The combination of the American Recovery and Reinvestment Act, Health Information Technology for Economic and Clinical Health Act, Health Reform, and ICD-10 will require process and information technology changes that are as extensive as any industry has experienced in recent times. Plans will need to carefully prioritize work, identify what work can be shared through partnerships, and find new resources for others.
• There is no stimulus funding for health plans, unlike those for providers. Plans will have to find operational cost savings to offset expenditures to meet the new requirements.
• business process change will comprise about 80% of the new requirements work, IT change about 20%. This is a reversal in resource consumption from that of most large projects in recent years.

The complete 2010 list MCEG top 10 issues are:
1. The role of state and federal government in healthcare
2. Healthcare reform
3. ICD-10
4. Data analytics and informatics
5. HIPAA 5010
6. Consumer response to healthcare changes
7. Health data exchanges
8. Automated member acquisition and retention
9. Providing transparency to health plan data and operations
10. Collaboration with providers as a business partnership