Managed Healthcare Executive - January 2009 - (Page 8)

NEWS ANALYSIS Deliver value, create trust, adapt to change in 2009 TRACEY WALKER SENIOR EDITOR NATIONAL REPORTS — In 2009, man- The conversion to ICD-10 will increase the number of code sets used for billing and clinical classi cations from 17,000 to 150,000. “This conversion, likely to be costly and disruptive, will impact all major provider and payer processes,” Veronneau says. “In addition to clinical process changes, the entire healthcare system . . . will have to be adapted.” When the conversion process is complete, ICD-10 will provide payers and ECONOMIC HITS providers more information about the As unemployment rises, the number of peo- care process, such as increased accuracy of ple in employee-sponsored plans is declin- reimbursement and quality management, ing, according to Ben Isgur, director, PwC’s says Veronneau. Health Research Institute. As a result, comAccording to PwC, in view of the three mercial payers may see a drop in enrollment health industry issues described above, manand premium revenue this year. aged care executives should: The consumers’ role in managing Place greater emphasis on deliver8 JANUARY 2009 aged care executives will need to respond quickly to the signi cant changes ahead for the health system, according to experts. “New consumer expectations and disruptive market forces are quickly changing the way that healthcare is nanced and delivered,” says Paul Veronneau, partner, PricewaterhouseCoopers (PwC) Healthcare Advisory, leader of payer performance practice. “Healthcare organizations that thrive will be those that continue to look for and deliver on the enormous opportunities to add value and improve health and productivity. Like every other industry, healthcare will become more consumer centered and will need to demonstrate real value for the money.” MCOs can accelerate their e orts to become trusted healthcare partners to consumers by di erentiating themselves through a new role. “By doing so, they can rise above their traditional administrative gatekeeper role and shift their focus to being a health and wellness facilitator,” he says. PwC’s Health Research Institute recently identi ed health industry issues for 2009 that are the most signi cant for managed care executives: the impact of the nancial crisis and growing number of underinsured; wellness program participation; and conversion to ICD-10. VERONNEAU ISGUR their own health and wellness has reached a tipping point, and wellness programs will receive greater attention in 2009. Large and small employers say that wellness programs are important to them, but only 15% of eligible employees actually participate. “The success of wellness programs is linked to participation levels, and participation, in turn, is connected to incentives,” Isgur says. “The study found that workers are two to four times more likely to enroll in wellness programs if they receive gift cards or other incentives.” ICD-10: INVESTMENT REQUIRED ing value and service to employers and members. Payers should work more collaboratively with employers to help them execute their health strategy, and focus on delivering value. “For example, health plan services that rank higher in importance, but lower in satisfaction, such as wellness programs, deserve immediate attention,” Veronneau says. “Services that are low in importance and satisfaction may need re-invention.” Become the trusted advisor of employers. “Payers should recommend programs that have been e ective at other organizations in terms of gaining participating members and showing positive outcomes,” Isgur says. “Insurers are in an excellent position to promote wellness and related incentives by playing a more active role in plan design and development of tools and education. Health plans can distinguish themselves from competitors if they are able to integrate the most relevant wellness incentives for an employer population into bene t speci cations.” MCOs need to begin the long-term process of implementing ICD-10. Some organizations will put this o hoping for a regulatory delay, say the PwC experts. But agile organizations will begin to develop a strategic approach to ICD-10 conversion. “This strategic approach should include everything from awareness building to impact assessment and execution,” Veronneau says. “The earlier MCOs begin the process, the more time they have to adapt to change. And those that align this regulatory requirement with such strategic goals as revenue growth, operating e ciency, and quality improvement, the less they will spend, the more coordinated they will be, and the more competitive they will become.” In addition, managed care companies that embrace ICD-10 conversion as a catalyst to increase patient safety and quality will be turning a regulatory requirement into a strategic opportunity, says Isgur. MHE

Table of Contents Feed for the Digital Edition of Managed Healthcare Executive - January 2009

Managed Healthcare Executive - January 2009 Contents Editorial Advisors For Your Benefit News Analysis Politics & Policy Letter of the Law Managed Care Outlook New Day 5 New Realities of Disease Management Pharmacy Best Practices Health Management Technology State Report: Hawaii MHE Resource Ad/Edit Index

Managed Healthcare Executive - January 2009

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