More Interaction Between Health Care Providers and Payers Called for in List of Top Ten Issues Facing Managed Care Executives

The ability to allow health care providers and insurance companies to share data is at the top of the Managed Care Executive Group’s (MCEG) 2006 list of issues facing managed care executives in America.

The list was developed at MCEG’s annual meeting held in Naples, Florida. Tommy Thompson, former U.S. Secretary of Health and Human Services, provided the keynote address, where he focused on prevention as a way of reducing health care expenses and improving the overall health of Americans. While major points from last year remained hot priorities, MCEG members saw a shift toward tightening the interaction between providers and payers.

1. Providing transparency to health plan data and operations. The ability to allow providers and health plans to utilize shared data is at the top of this year’s list. Improved patient outcomes and operational efficiency is leading to initiatives including shared electronic medical records and predictive modeling.

2. Investment in real-time infrastructure. Innovation in business process continues to yield returns in customer satisfaction and increased revenue. CIOs know that business process fusion requires a robust and scalable real-time infrastructure, and are investing accordingly.

3. Collaboration with Providers. Prior authorization and utilization reviews are fading, and in their place is a more collaborative model based on access, quality, safety, effectiveness and patient centeredness.

4. Consumer-Focus. Health plan products featuring choice, customization, flexibility, and direct involvement by individual members will drive IT investment toward support for personalized processes and away from “one size fits all” processes of the past. Interest on the part of national players like Intuit and Ingenix will fuel new partnerships.

5. Nimble, speed-to-market solutions. Fast, focused and results-driven projects will be required to address the rapidly changing product portfolios and changing demands of the market. These IT projects will need to fit within overall standards and architectures to avoid rework and too-early replacement later.

6. Retention and use of clinical information as it impacts:
   • Predictive modeling
   • Diseases management
   • Health outcomes

7. Managing all the health information needed by members, employers, providers and other stakeholders to maintain and improve health. Further development of regional health initiatives may come into conflict with payer and provider offerings of patient accessible records.

8. Impacts and movement to services oriented architecture (SOA). While technical in nature, this IT trend will be one of several enablers that will allow solutions to be implemented and tuned in a timely fashion.

9. Rapid product development to meet changing demands of members. Members, in addition to payers and providers, are adjusting to new paradigms. Education and discernment of their needs are equally important.

10. Impact of Medicare Reform Legislation. Recent Medicare reform will require all players to adjust from their initial entry positions, as the government responds to criticisms of “too many choices” from the public.