Three quarters of health plan attendees at Portico System’s third Annual Integrated Provider Management Symposium said provider reimbursement and network access would be affected by industry reforms.
“Shifts in healthcare industry trends, mounting pressures from the government and increased employer pressures are driving changes in health plans’ technology investment behavior,” said Mike Flanagan, vice president of product management and marketing for the Philadelphia-based vendor of provider management solutions for health plans.
Health plans and others in the healthcare industry are implementing strategies to deliver increased value to members, providers and employers, Portico officials said. Value is now based on the health plan’s ability to create targeted products for its members based on provider networks that take into account provider performance and quality care.
Of the 28 healthcare organizations attending the Portico event, 62 percent of the health plan attendees said they would further invest in provider management and care management solutions for 2010 and 60 percent indicated they are decoupling their provider management systems from their claims systems.
“In today’s highly competitive environment, there is a competition for revenue and it is based on the customer segmentation, product innovation, competitive benefit structure and network design,” said Sam Muppalla, COO of Portico Systems. “The network essentially becomes the product differentiator and a plan’s number one asset.”
“We’re seeing an increased interest in the importance of modernizing provider management systems in an effort to respond to the changes that are currently within the healthcare industry and also to be better prepared for potential changes in the future,” said Flanagan.
Integrated Provider Management is a key enabler to improved access, cost and quality, he said.