Plans play central role in expanding IT systems

June 1, 2006

Washington, D.C.-As the nation moves forward with initiativesto build an electronic healthcare information system, MCOs willplay a central role, said former National Coordinator for HealthInformation Technology David J. Brailer, MD, at a press conferencefollowing his resignation in April.

WASHINGTON, D.C.-As the nation moves forward with initiatives to build an electronic healthcare information system, MCOs will play a central role, said former National Coordinator for Health Information Technology David J. Brailer, MD, at a press conference following his resignation in April.

"Every government program struggles for funding, and it is our concern that Dr. Brailer's resignation will negatively impact the funding for healthcare IT in America," Tom Skelton, CEO of Misys Healthcare Systems, a healthcare IT company in Raleigh, N.C., says. "We look toward the president to renew his call for a National Health Record and a timely appointment of Dr. Brailer's replacement."

At the press conference in April, Dr. Brailer noted a need for MCOs to support the education, dissemination and financing of health IT adoption. "There will have to be more partnerships between managed care organizations and providers across the board," Dr. Brailer said. "Purchasers need to communicate to the health plans their expectations and use their own portal capabilities and other tools to advance health IT breakthroughs."

PAYER REVIEW

One innovation will include the adoption of healthcare IT requirements in health plan performance reviews. Dr. Brailer noted that the Office of Personnel Management (OPM), the federal government's human resources agency, plans to include adoption of health IT as an element of performance review for its contracted plans within two to four years. According to OPM's recently released annual Federal Employee Health Benefits (FEHB) Program Carrier Letter, the agency will feature those health plans that have health IT capabilities during the next open-enrollment period for federal employees later this year. OPM is looking for plans to work toward enhancing consumer education, offering personal health records (PHRs) and encouraging e-prescribing.

This is an important development, says Henry Loubet, senior vice president for Keenan & Associates, an insurance brokerage firm in Torrance, Calif. He considers the appropriate use of PHRs, online claims adjudication, e-prescribing, administration simplification and consumer-facing tools important for achieving improved performance, high satisfaction, better quality and ultimately lower costs. "The increasing reliance on healthcare IT and the number of new applications being developed demonstrates the value it is bringing to the market," Loubet says.

"While virtually all of the key FEHB initiatives are in various stages of development at the individual insurer level, the breadth and scope of the federal requirement-coupled with huge financial stakes-will undoubtedly have a profound market impact," says John Farrell, president and CEO of Urix LLC, a healthcare analytics and reporting company based in Cheshire, Conn. "The federal government has essentially sent the message to health insurers that it is time to 'walk the walk.'"