Reimbursement

Key changes to physician quality reporting and e-prescribing incentives are being proposed by the Centers for Medicare and Medicaid.

Thanks to almost $100 million in settlement proceeds from health insurers, a new reimbursement database for out-of-network healthcare charges is being developed in New York.

A regional not-for-profit health insurer serving New York, Vermont and New Hampshire will reimburse physicians for online consults.

Horizon Blue Cross Blue Shield of New Jersey has deployed a new Web-based portal to use as its health information exchange platform. The new multi-layer Web portal, developed by Cambridge, Mass.-based NaviNet, will be used to assist Horizon BCBSNJ in reducing paperwork, simplifying administrative processes and reducing expenses with electronic exchange of health data.

Ezekiel Emanuel, a White House adviser on healthcare policy, says high-touch is the way to fix the nation's failing – and costly – healthcare system.

A new initiative launched in Ohio plans to improve the flow of information between health plans and physicians' offices using a multi-payer Web portal.

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.