They picked a picturesque locale to talk about some serious health care issues.
At its Annual Forum, held recently in Key West, Fla., members of the Managed Care Executive Group (MCEG) discussed a number of topics and technologies in support of President Bush’s “Four Cornerstones,” a value-driven approach to health care.
During forum sessions, members determined the top ten issues impacting the health care industry in 2008, noting a significant shift toward priorities that give members the tools and support they need to manage their health care.
The ten issues are:
1. Consumer-directed products. New IT investments will focus on the engaged consumer. A greater degree of direct consumer involvement—in everything from the sales cycle to treatment decisions—will shape plan design, service delivery, and administrative operations, ultimately resulting in radically different products. Web-based service will be a dominant feature in these new products. However, transition to a Web-service model likely will be slower than in other industries as millions of members choose to remain in traditional plans.
2. Web enablement. Health plan Web sites will include sales automation, self-service, and information transparency, resulting in competitive advantage and improved member wellness. Health plan Web sites will become essential as the health care resource for plan members. Mashups, Wikis, personalization, and custom portlets will become part of the working vocabulary of health plan IT departments.
3. Speed-to-market solutions. Fast, focused, and results-driven projects will address rapidly changing product portfolios. IT projects will combine existing standards and architectures with new technologies.
4. Business and IT collaboration. The market for business process analysts, project managers, and IT auditors is on the rise as organizations move beyond back room automation to business process redesign and service automation.
5. Data analytics and informatics. Disease registries, scorecards, member outreach, case management, and customer segmentation will continue to drive investment in analytics. As clinical information becomes more readily available through personal health records and electronic health records, data-mining and advanced decision support tools will improve the practice of real-time medicine.
6. Collaboration with providers as business partners. Authorization and utilization reviews are on the way out, replaced by a more collaborative model based on access, quality, safety, effectiveness, and patient centeredness. “Pay for Performance” is holding providers accountable and stressing excellence.
7. The role of state and federal government in health care. The 2008 election will feature health care reform in response to voter demands. Government support, intervention, and regulation will have a growing impact on payer’s operations, costs, and marketplace strategies. Mandates, increased regulation, oversight, and compliance audits will affect IT budgets, operations, and project planning.
8. Value-driven health care. HIPAA led the way through standardization of electronic transactions and portability of certain plan features. President Bush demanded it in his Four Cornerstones plan. Transparency in other health plan functions, such as simplified adjudication, provider payment/contracting, employer/purchaser reporting, and member account management, is enabled by emerging new standards. Buyer’s coalitions, government purchasers, provider trade groups, and consumer advocates will power the push for plans to adopt simplified and common administrative formats, performance metrics, and portable member data exchange.
9. Database/warehousing expansion. The enormous database expansion required for a consumer-centric health plan requires planning, strategic investment, and improvements in knowledge management. The data warehouse will support multiple functions throughout the health plan, feed internal decision-support data marts, and become the source for data extracts to external organizations.
10. Electronic health records. Health plan-based EHRs gather data from disparate electronic medical records and claims to create a composite. Personal health records (PHRs) give individuals access and control over their own medical information. With new offerings from companies like Google, Microsoft, and Intel, issues of privacy, security, and standardization of patient data will become even more challenging
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