Unlikely Allies

Les Masterson, for HealthLeaders Media , July 15, 2010
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Eyeing a portion of the stimulus law's $19 billion meaningful use incentives, many physicians and hospitals are working to meet the federal government's guidelines before they take effect later this year and in 2011. These healthcare providers may have an ally in what often is seen as an adversary: the health plan.

Meeting meaningful use requirements will result in major capital investments for many providers, especially those who don't already have an EHR and other technologies in place. Though largely seen as an issue for providers and hospitals, innovative health insurers are viewing meaningful use guidelines as an opportunity. They understand that meaningful use should lead to better data sharing with providers and ultimately better quality.

There's another benefit for health plans. Through outreach efforts to help providers and hospitals meet the looming requirements, a health plan could distance itself from the competition.

Health plans have an opportunity to become a "partner of choice" by offering providers collaboration and clinical tools. This could be as inexpensive as providing technology for "lightweight EMRs" and patient registries or even partially or fully subsidizing the underwriting of providers' software costs with the understanding that the health plan will benefit from the meaningful use incentive dollars, says Matias Klein, vice president and general manager of the tools and collaboration division at Portico Systems, a Blue Bell, PA-based technology company that works with health plans to use technology to reduce costs.

Klein says the federal government and health plans have similar goals. The feds are incentivizing providers via meaningful use requirements in hopes of having more provider information about the quality of care, which could lead to cost and redundancy reductions, he says.

Vince Kuraitis, JD, MBA, principal and founder of Better Health Technologies, a Boise-ID-based consultancy that works with many different healthcare stakeholders on technology, says there are parallels to HITECH in that meaningful use should lead to collaborative and multipayer models. Health plans should work together as well as with states to develop systems so they can share information across networks rather than build competitive systems around different care management processes, he says.

"There are a lot of ways health plans could help. It's around having certain types of data and data analytics that help hospitals and doctors meet meaningful use, and I think will become even more important in phases two and three in HITECH," says Kuraitis. "I think the insurers' model of control over the system is not going to be a tenable business model of the future. There needs to be more collaboration," he says.

Charles Kennedy, MD, vice president of health information technology for WellPoint, the Indianapolis-based health insurer with approximately 34 million members, says three potential roles for health insurers within the meaningful use requirements are in the areas of data source, incentive aligner, and innovator.

"Health plans have a tremendous amount of claims data. There are challenges using claims data in clinical care," says Kennedy, such as the promptness of claims filing and limited information in the claims.

Collaborating with providers, health plans will be able to provide a larger breadth of patient information to multiple stakeholders. Kennedy says WellPoint created a data warehouse composed of information for its 34 million members. Having greater information sharing via computer networks will allow WellPoint and providers a more rounded view of their members/patients and their health status and needs.

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