Why The MCEG Top 10 Healthcare Reform Issues Matter

TOP TEN Healthcare Reform Issues

This summer the Managed Care Executive Group (MCEG) met in Florida, and released a “TOP TEN”  list of relevant healthcare reform issues.  Here is a copy of that list fresh off of the internet presses.  Over the course of the month we will look into some of these issues in more detail, including encounter data and claims changes, HITECH Act, HIPAA 5010, and other healthcare compliance issues which will be front and center moving forward.

The 2010 MCEG Top Ten Issues:

1. The  Role  of  State  and  Federal  Government  in  Health  Care:  Government  support, intervention and regulation are having increasing impact on payer’s operations, costs and even marketplace strategies. In 2010 MCEG will look closer at Legislative and Compliance Demands from the Government. The implementation of the  HITECH Act, ICD-10, HIPAA 5010, and Health Care Reform will be among the top investments in 2010.
2. Health  Care  Reform:  Reform  legislation,  whether  comprehensive  or  piece-meal,  and whether at the Federal level or State level, will result in dozens of new agencies and grant programs, in addition to adjustments to the insurance market and payment.
3. ICD-10:  The  impact  of  changing  to  ICD-10  for  medical  record  coding  and  billing  is underestimated.  It will likely be as significant a project across the industry as Y2K or HIPAA 5010 and when undertaken, will push many other HIT projects to lower priority.
4. Data  analytics  and  informatics:  Disease  management,  real-time  decision  support,  case management,  customer  segmentation  and  protocol  development  will  continue  to  drive investment in analytics. Clinical information will be broad and deep, enabling caregivers to more precisely identify diagnoses and target treatment.
5. HIPAA 5010:  New HIPAA requirements will present substantial changes in the content of the data submitted with claims as well as the data available in response to electronic inquiries. The implementation will require changes to the  software, systems, and perhaps procedures that are used for billing Medicare and other payers.
6. Consumer Response to Health Care Changes:   In 2010 we will see a wave of consumers voicing their opinion on product offerings, costs, networks and reform.  Consumers will demand integration between Web-based technology and administrative services to improve their customer experience.
7. Health Data Exchanges: HIOs (Health Information Organizations) are a key component of the HITECH Act.   States level HIE efforts are addressing 5 critical domains identified by the office  of  the  national  coordinator  (ONC):  governance,  finance,  legal/privacy,  technical infrastructure and business /technical operations. Finding the sustainable financial model is a core issue.
8. Automated Member Acquisition and Retention:  As participation in employer-sponsored plans decrease and the need for individual and family health insurance grows, health plans are looking to connect directly with potential members to enable them to search and select plans right for them and then purchase them on-line. Health plans will need enterprise application integration  techniques  and  processes  to  connect  their  Web  portal  to  their  underwriting systems, their enrollment systems, their sales  systems, their customer service systems and their billing and payment systems.
9. Providing transparency to health plan data and operations:  The ability to allow providers and health plans to utilize secure shared-data continues to expand. The need to improve patient outcomes and operational efficiency is leading to investments in quality measurement, peer grouping, provider report cards and predictive modeling.
10. Collaboration  with  Providers  as  a  Business  Partnership:  Prior  authorization  and utilization reviews are fading and in their place, is a more collaborative model based on real- time  eligibility,  benefit  verification,  access,   quality,  safety,  effectiveness  and  patient centeredness. P4P is holding providers accountable, as stressed by Bridges To Excellence (BTE), Leapfrog and other initiatives.

We would love to know what you think of this list, and look forward to discussing it with you more in our upcoming August posts.  In the meantime please feel free to contact us at results@bhmpc.com with any questions.