Managed Care - December 2008 - (Page 8)

NEWS AND COMMENTARY Interoperable PHRs Offer Best Value for Insurers f the four models of personal health records (PHRs) that payers, providers, and health systems might be tempted to purchase, interoperable PHRs (i.e., those that are populated with data from all regional data sources via standards-based automated data exchange), may be the type that provides the best value for health plans and insurers. That’s the finding of a report from the Center for Information Technology Leadership (CITL), a research organization based at Partners Healthcare System in Boston. The organization estimates that PHRs could save the United States health system $21 billion a year. PHRs are defined as Web-based systems that allow patients to maintain their medical data and use that data to better manage their health care. “The interoperable model enables the exchange of standardized health information across platforms. This model allows different systems to talk to one another. Right now, systems can only talk to each other with the help of very skilled people who create the interfaces and standardize the data so that it can be exchanged and shared,” says Doug Johnston, executive director of CITL and one of the authors of the report. The other three models reviewed were the provider-tethered, payertethered, and third party models. • Provider-tethered PHRs are connected internally to the database of the provider’s electronic health records. Patients can communicate with other providers and payers via manual communication channels but are unable to directly integrate external data. • Payer-tethered PHRs connect members to health insurers’ administrative databases. Patients can communicate with providers and other payers via manual communication channels such as secure e-mail, but are unable to directly integrate external data. • Third-party PHRs aggregate data through manual data exchanges, which import data from external sources but are unable to feed the data into clinical or administrative systems. O says Blaine Bos, a Mercer partner. “Raising the deductible has become the fallback for employers faced with cost increases they can’t handle. It’s the easiest way to reduce cost without taking more out of every employee’s paycheck.” And although employers were able to hold benefit cost increases to about 6 percent in 2008, it has meant shifting more cost to employees. Headlines On Deadline The top 10 health plans were announced by U.S. News & World Report and the NCQA. The report identified the top commercial, Medicare, and Medicaid plans. Coming in at number 1 again this year among commercial plans was Harvard Pilgrim Health Care of Maine and Massachusetts, with Tufts Associated Health Maintenance Organization, Harvard Pilgrim Health Care of New England, Grand Valley Health Plan, and Geisinger Health Plan rounding out the top five Pricewaterhouse-Coopers projects that President-elect Obama’s proposed reform of the U.S. health system would cost the federal government $75 billion in 2009 dollars, the equivalent of $2,500 per newly insured person. The research is presented in “Healthcare Policy in an Obama Administration: Delivering on the Promise of Universal Coverage.”. . . Two Kaiser Permanente plans received four-star ratings, the highest rating possible, from the California Office of the Patient Advocate. The score card rates the state’s largest HMOs based on measures for nine health conditions including asthma, back pain, diabetes, and heart care. — Tony Berberabe PPO Deductible Jumps 100% The median deductible required by employers for individual coverage in PPO plans jumped to $1,000 in 2008 from $500 last year, according to the “National Survey of EmployerSponsored Health Plans” issued by Mercer. Back in 2000, only about half of employers imposed a deductible for PPO coverage, and the average deductible at that time was just $250. Surprisingly, this jump was recorded in traditional PPOs — not the high-deductible health plans where a deductible of at least $1,100 is required in order to deposit taxfree money in a health savings account (HSA). “The introduction of the HSA may have changed employers’ thinking on just how high a deductible can go without causing employees to revolt,” 8 MANAGED CARE / DECEMBER 2008

Table of Contents Feed for the Digital Edition of Managed Care - December 2008

Managed Care - December 2008 Editor's Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor ICD-10 Offers Huge Opportunity, Challenge Part D at a Crossroads Plans Can Weather the Financial Crisis DM vs. Medical Home? Tackle Prediabetes Reasonable Approach to Morning Sickness Formulary Files Tomorrow's Medicine Outlook

Managed Care - December 2008

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