As the U.S. healthcare industry continues its evolution from paper toward electronic medical record-keeping, a trend is emerging: The payers are leading the way, but the consumer ultimately will benefit from -- and actively participate in -- the shift toward industrywide computer-based medical-record databases.
As the U.S. healthcare industry continues its evolution from paper toward electronic medical record-keeping, a trend is emerging: The payers are leading the way, but the consumer ultimately will benefit from-and actively participate in-the shift toward industrywide computer-based medical-record databases.
What's happening in the area of computerized patient health records is an indicator of this trend. Briefly stated, this technology takes disparate patient medical records and organizes them into an easily and instantly accessible databank. This includes all pertinent information accumulated over an individual's medical interactions with caregivers: treatments, procedures, medical tests and results, pharmaceutical prescriptions and so forth.
The industry is at the early adoption phase of this medical-information technology concept, and forward-thinking health plans are leading the way. In terms of adopting patient health record technology, the universe of payers can be divided into three groups.
The Principal Financial Group, a Des Moines, Iowa-based financial services firm whose health segment covers more than 1.5 million members, falls into the first group. According to executives of the health segment of The Principal, their focus is on maintaining wellness and preventing illnesses, not just covering those who must be treated when a medical problem occurs. It has implemented a health services program based on a consolidated patient health records databank that's helping the health segment of The Principal focus on preventive medicine while improving quality of care and cutting administrative costs.
"We think in terms of health insurance, as opposed to healthcare insurance," says Ray Webster, MD, MPH, chief medical director of The Principal. "We're trying to get across a change in attitude, to go beyond being a payer and get to our members before they reach a stage where their medical situation gets serious and, as a result, more costly."
In order to reach this goal, more than a change in attitude was needed.
SICK CARE VS. HEALTHCARE
"Four or five years ago, we wanted a way to efficiently track patients before they got a serious illness," says Raedean VanDenover, RN, senior medical management consultant at The Principal. "We realized we were focusing on assisting members with providing their 'sick' care needs rather than promoting healthcare."
There were other concerns. The Principal realized that referrals were being sent to case managers who had no prior knowledge of experience with that particular case, and that there had been a significant increase in referrals to case management.
"We needed the capability of taking claims-shown data and putting it in one specific place, in order to provide a picture of what's going on with patients," Dr. Webster says. "We needed our case managers to be able to focus on clinical aspects, not on finding information from disparate sources and pulling it all together."
OPTIMIZE THE VALUE
Three years ago, The Principal identified five main changes needed in its existing IT system to optimize the value of members' patient health records and to make the data in them instantly accessible to case managers. In short, they wanted to: