Healthcare It News - February 2008 - (Page 53)

www.HealthcareITNews.com February 2008 ■ Healthcare IT News 53 NEWSBRIEFS MINNESOTA TO REQUIRE ELECTRONIC TRANSACTIONS Minnesota has became the first state in the nation to adopt rules aimed at helping healthcare providers quickly and accurately verify their patients’ insurance coverage and the medical benefits or services for which they are eligible. The rules require that beginning in 2009, “eligibility inquiry and response” transactions between healthcare providers and insurance companies and other payers must be exchanged electronically, using a single standard format. Gov. Tim Pawlenty proposed the legislation authorizing the rules in collaboration with healthcare providers and health plans. e-prescribing network appeals to payers Efficiency, quality initiatives, and P4P drive growth ST. PAUL, MN gives authenticated and authorized clinicians real-time, By PaTTy ENrado, Contributing Editor – In 2007, RxHub’s National Patient Health Information Network payer base grew from eight to 17 payers, representing a growth of more than 50 million new patient records for those patients who have opted in. The network’s growth – which “e-prescribing is becoming a required component to stay in consideration for the business.” – John Beardsley secured access to decision support data for more than 200 P4P PROGRAM IN TWO WASHINGTON HOSPITALS Aetna has announced that it will launch a pay-for-performance program for two hospitals in Spokane and Puget Sound, Wash. Aetna has licensed the Leapfrog Hospital Rewards Program, a national model for P4P programs, from the Washington, D.C.based Leapfrog Group. The Leapfrog Group said its LHRP measures the quality of care and the efficiency with which hospitals use resources in clinical areas that represent a significant portion of hospital admissions and expenditures among the commercially insured population. Iowa health system, payer join forces for P4P project By PaTTy ENrado, Contributing Editor DES MOINES, IA – Long-time million patient records at the RxHub’s senior vice president of point of care – speaks to growing business development. payer acceptance of e-prescribRecent programs such as the ing’s value. Big Three automakers’ Across the board, paySoutheast Michigan eers are implementing ePrescribing Initiative prescribing to improve have demonstrated ROI. patient safety, quality “Saving lives and savand efficiency and proing dollars is a compelmote best practices. ling argument,” said JP Early adopters rec- JP Little Little, RxHub’s COO. ognized the value of increased Tony Schueth, managing partpatient safety and cost savings on ner at Point-of-Care Partners, drug spending, said Tom Groom, rxHuB see page 56 Amid standards work, PHRs serve purpose By PaTTy ENrado, Contributing Editor DETERMINING PAyMENT RESPONSIBILITy AT POC The SSI Group has joined in partnership with nTelagent Inc. in order to help healthcare providers more accurately determine a patient’s responsibility at the point of care. The partnership allows SSI’s ClickON PREVENT customers to access nTelagent’s proprietary front-end business solution, the Self Pay Management System. This will enable healthcare service providers to determine patient responsibility for both uninsured and insured patients including insurance verification, co-pays and deductibles, at the point of care. collaborators Iowa Health System and Wellmark Blue Cross Blue Shield of Iowa – respectively, the state’s largest healthcare system and payer – are implementing a pay-for-performance (P4P) pilot that aligns payer incentives with quality and safety improvements. Peter Roberts, group vice president for provider relations and health management for Wellmark, said “the financial vehicle and the healthcare delivery organization must come together” in order for the P4P to succeed. The Iowa Health System launched an evidence-based care initiative to standardize order sets, developed using Zynx Health’s Web-based knowledge management system, across its hospital system. “The payer St. Luke’s Hospital in Grand Lakes, Iowa, will be the pilot site in a pay-for-performance project run by the Iowa Health System and Wellmark BCBS of Iowa. stepped forward to build a reward system that would reinforce the use of the order sets,” said Sal Bognanni, the system’s director of clinical performance improvement. Wellmark wanted to financially support the Iowa Health System’s system-wide commitment to evidence-based protocols for care, which Roberts believes could be a role model for other regions, because the payer supports evidence-based care for its members. Iowa see page 54 – Several industr y organizations, including Health Level Seven (HL7), America’s Health Insurance Plans (AHIP), the Blue Cross and Blue Shield Association (BCBSA), Blues plans, UnitedHealth Group and X12, are working toward portability standards for personal health records. In the meantime, nextgeneration PHR tools, such as OptumHealth’s recently announced lifetime portable PHR, which is integrated with health tools and services such as health risk assessments, serve a vital role today and beyond. “It is still important that we do all we can to give individuals convenient, ongoing access to their own health information and history,” said Steve Heimes, senior MINNEAPOLIS oPTum see page 58 PROACTIvE CARE MANAGEMENT FOR MEDICARE MEMBERS TriZetto Group executives say its new module for the proactive care management of Medicare members will be available for limited release. According to TriZetto, the CareAdvance Medicare module was designed to address the needs of senior populations and is the first product to successfully automate the full spectrum of care management for both commercial and Medicare members. CareAdvance Medicare automates case and disease management activities, and provides case management support for Medicare beneficiaries. More at HealthcareITNews.com e Connect: PaYerS 0208 Online tools healthcare consumers use “Which, if any, of the following online tools have you ever used?” Physician or facility finder Health plan selection tool Health risk assessment Drug cost comparison tool Drug quality comparison tool 12% 23% 19% 18% 41% Healthcare It a critical piece to Mo HealthNet By PaTTy ENrado, Contributing Editor Base: 3,402 US online non-elderly, commercially insured consumers who use online healthcare tools (multiple responses accepted). e ● Connect: GraPHS 0208 SOURCE: FORRESTER RESEARCH’S NORTH AMERICAN TECHNOGRAPHICS HEALTHCARE ONLINE SURVEy 2007 ● – On the heels of a positive progress report on Missouri’s new Medicaid program, Governor Matt Blunt is recommending an increase of $15 million for the Healthcare Technology Fund in his budget to support MO HealthNet projects. The move signals Blunt’s acknowledgement of the importance of technology in enhancJEFFERSON CITY, MO ing healthcare services delivery for Missouri residents. “Before, we were a payer for services rendered,” said George Oestrich, MD, deputy director of the Missouri Dept. of Social Services. “With MO HealthNet, we are taking a different approach and focusing on wellness, health and prevention.” Oestrich said healthcare IT is “absolutely” a critical piece HEalTHNET see page 60 http://www.HealthcareITNews.com http://www.HealthcareITNews.com http://www.healthcareitnews.com/story.cms?id=8631

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Healthcare It News - February 2008 Contents Hot Potato Wal-Mart Focus CIO Role Wasteland Linking Docs Katrina Work P4P Team Fire Sale? Emergency Systems Beyond Business

Healthcare It News - February 2008

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