MEDecision published an e-book Tuesday, Medical Loss Ratios: Important Implications for Care Management, which examines the impact new Health and Human Services mandates will have on care delivery models - and explores the critical role of health IT as health plans work to meet the new requirements.
Medical Loss Ratio (MLR) is defined by the 2010 Patient Protection and Affordable Care Act as the minimum percentage of premiums health plans must devote to clinical services and quality improvement efforts. Starting this year, health plans must meet the new MLR ratios or refund the difference to policyholders beginning in 2012.
MEDecision's e-book outlines what the HHS considers to be medical and quality-related activities for health plans within the MLR parameters. Investments in health IT qualify as such and the authors say they should be considered an important part of the equation to not only help health plans work to meet the MLR requirements but also to improve the overall quality and cost of care for their members.
"The MLR mandates are designed to reduce waste and costs and therefore strongly encourage investments in health IT," said Eric Demers, senior vice president, health and life science for MEDecision. "We launched this book to shed light on the important role health IT can play in delivering actionable information closer to the point of care and in the coordination of care among payers, providers and members."
He added that "these are key considerations for health plans as they prepare for patient-centered medical home models, accountable care organizations and all the implications health reform has for the way care will be managed, administered and received."
Medical Loss Ratios: Important Implications for Care Management can be downloaded at MEDecision.com.