Reimbursement

Traditional disease management has historically been treated and tracked by condition with separate departmental IT systems. The rise in co-morbidities – with obesity being one of the main drivers – is requiring payers to implement fully integrated, patient-centric IT systems to determine which multiple management programs best meet a patient's needs, said Lynn Dunbrack, program director for Health Industry Insights.

Prior to the 2008 passage of the Long-Term Care Community Choices Act, Tennessee was spending 99 percent of its Medicaid long-term care dollars on nursing homes instead of home-based services. One of the largest TennCare managed care organizations in the state is replacing its care management software to enable its transition to full implementation of the program by March 2010.

CareFirst BlueCross BlueShield's $100 million integrated claims system and supporting software implementation was completed last August on budget and within a year of rollout. "It was one of the smoothest, quickest implementations we've had," said Etta Maguire, senior director at CareFirst BCBS.

Independence Blue Cross (IBC) plans to increase the type and sophistication of clinical alerts that it has been delivering to its network physicians since April. The regional Blues plan is moving to the next phase amid positive feedback it has been getting from physicians that the alerts are valuable. Lansdale, Pa.-based Green and Seidner Family Practice has focused on gaps in colon cancer screenings, pap smears and mammograms, said Barry Green, MD.

ICD-10 implementation and compliance issues associated with the HITECH Act are on the minds of medical billing companies, according to a speaker at the 2009 Fall National Conference of the Healthcare Billing and Management Association.

Three out of every four insurance claims from healthcare providers are being submitted electronically to AmeriHealth New Jersey – an increase of 50 percent over the past three years, according to the New Jersey-based insurer.

Shared Health is slated to begin rolling out in December a solution that would give Mississippi Medicaid providers a Web-based electronic health record system and e-prescribing capability.

America's Health Insurance Plans has contracted with MedAssurant, Inc., a Bowie, Md.-based data solutions provider, to provide data analytics services.

One Beacon Professional Partners, a member of the OneBeacon Insurance Group, is collaborating with Medversant Technologies to provide clients with an electronic credentialing verification and management system.

 Health insurers' focus on administrative cost reduction has been intensified by the economic recession and Washington's healthcare reform agenda. More focused spending for healthcare IT solutions that demonstrate the ability to take cost out has spiked as a result – at least for NaviNet.