Healthcare IT News - March 2009 - (Page 27) www.HealthcareITNews.com March 2009 ■ Healthcare IT News 27 NEWSBRIEFS AMA FIlES lAWSuIt AgAINSt AEtNA, CIgNA ovER dAtA Two physician-class-action lawsuits have been filed against Aetna Health, Inc. and the Cigna Corp. The lawsuits, filed last month in New Jersey federal court by the American Medical Association, several state medical associations and individual physicians, claim the companies used skewed data provided by UnitedHealth Group subsidiary Ingenix to under-reimburse physicians. The suits contend that for more than a decade the two health insurance companies used a corrupt system to underpay physicians for out-of-network medical services and forced patients to pay an excessive portion of the costs. CDS proves to be money-saver Real-time decision support key to best outcomes. By PaTTy ENrado, Contributing Editor SAN DIEGO – Health plans can save as much as $250 per member per year using clinical decision support, or CDS, according to an internal study conducted by Anvita Health, the healthcare analytics company formerly known as SafeMed. By using good intelligence to push clinical messaging to members and providers, health plans will not only reduce healthcare cost but also improve Richard the health and Noffsinger quality of life for their members, said CEO Richard Noffsinger. Because of their access to claims data and both network providers Cds see page 28 Annual savings for members using CdS Calculations based on the existing medical literature show that the potential cost saving due to decreased medical costs from using advanced CDS is more than $250 per member per year. Guideline compliance Medication adherence Drug safety Imaging e ● Connect: GraPHS 0309 $120 $100 $40 $35 SoURCe: ANVITA HeAlTH uNItEdHEAltH gRoup updAtES Id CARdS ACRoSS All plANS UnitedHealth Group has adopted new standards for healthcare ID cards across all its health plans. The cards will provide patient eligibility information and access to a personal health record, and process healthcare transactions. The new national standards require healthcare ID cards to include a magnetic stripe that can be read through a standard card-reader machine and also be designed with a standard layout to increase readability and be compliant with the National Council for Prescription Programs. Wisconsin HMo harnesses data Medicaid Security Health manages quality for effectiveness. By PaTTy ENrado, Contributing Editor MARSHFIELD, WI tENNESSEE BluES EARNS uRAC AppRovAl FoR WEB SItE BlueCross BlueShield of Tennessee has attained full Health Web Site accreditation for bcbst.com from URAC, a Washington, DC-based health care accrediting organization that establishes quality standards for the healthcare industry. The accreditation review evaluated several key areas of the company’s health information technology under Health Web Site, Version 2.0 standards including accountability, health content quality and service delivery, privacy and security and disclosure. – Security Health Plan of Wisconsin relied on traditional methods of member and provider communication for preventive care and Healthcare Effectiveness Data and Information Set, or HEDIS, measures, respectively. With the implementation of ikaSystems’ ikaProHEDIS+, the physician-sponsored HMO can now evaluate clinical outcomes on a timely basis and communicate with members and providers in multiple channels, said Jane Wolf, health serJane Wolf vices director. The application “fits very nicely” with its strategic direction of being member centric and delivering quality information for members and providers, she said. The push for quality of care and supporting data is coming from three areas – the Centers for Medicare and Medicaid Services (CMS), State Medicaid Programs and commercial health plans, which are providing data back to their self-funded groups, said Ravi Ika, president and CEO of ikaSystems.Historically, quality of care data is delivered portal offers self-service offering expected to reduce admin burden for Kansas. By PaTTy ENrado, Contributing Editor Security Health Plan executives in Marshfield, Wis., say they are focused on managing quality as well as reporting quality. retrospectively, which impedes a physician’s ability to improve his or her scores for HEDIS or payfor-performance programs because the data is not immediately accessible, said Cynthia Burghard, senior vice president of market intelligence at ikaSystems. Data needs to be delivered in real time because, she said, “you need to use data to manage quality, not just report on quality.” Janice Young, program director for Health Industry Insights, agreed. Retrospective data and reporting have long been complaints of physicians because of the lag time in being able to impact or adjust patient care, she said. Prospective tools, such as ikaProHEDIS+, howqualITy see page 28 pREMERA oFFERS pAtIENtS REAl-tIME CoSt EStIMAtoR Premera Blue Cross, which operates in Washington and Alaska, has introduced an online tool enabling patients to make clearer financial decisions about their healthcare. Premera’s new real-time cost-estimator and claims-adjudication tool makes it possible for providers to produce nearly instantaneous out-of-pocket expense estimates for patients, say Premera executives. Patients will also have the option of using the Webbased program to submit their claims to Premera for processing in real time, cutting paperwork and postage and shortening the period for reimbursement by days. More at HealthcareITNews.com e Connect: PaYerS 0309 Alabama Medicaid puts IT to work on better care By Molly MErrIll, Associate Editor MONTGOMERY, AL – The Alabama ● Medicaid Agency is developing an electronic health information exchange and clinical support tool to link Medicaid, state health agencies, providers and private payers. The clinical support tool is called QTool and is based on technology developed by Affiliated Computer Services, Inc. The initiative is being funded by a $7.6 million federal Medicaid transformation grant, part of a three-phase effort to improve patient health outcomes while Five hundred Medicaid-enrolled physicians are pilot testing the Qtool. reducing service duplication. “ACS is a leading force in the area of electronic health records and health information exchange,” said Christopher T. Deelsnyder, senior vice president and managing director of ACS Government Healthcare Solutions. F i v e - h u n d r e d Me d i c a i d enrolled physicians in nine counties are pilot testing the QTool, which provides claims-based data for physicians and rules-based alerts for management of asthma and diabetes patients. “By creating this electronic health information exchange where physicians can securely access their patients’ lab test results, medical claims, drug and other data, we are confident that providers will be better able to make more informed patient care decisions,” said Alabama Medicaid Commissioner Carol H. Steckel. ■ More at HealthcareITNews.com e Connect: aLaBaMa 0309 TOPEKA, KN – When the Kansas Health Policy Authority issued permanent plastic ID cards to its Medicaid beneficiaries, making information readily available became a necessity. The Member Web Service Portal went live in late January, g i v i n g K H PA an oppor tunity to expand the amount of information dispersed and Tripp Fulton level of electronic interaction between provider and beneficiary, said Andy Allison, MD, Medicaid director. In the brief time the system has been up, thousands of hits have been recorded, he said. Provider directory searches, confirmation of eligibility in real time and tracking of spending in real time are areas of high usage, Allison said. The portal provides self-service for the insurance business component, but next steps will incorporate reporting and communications. In the future, the portal will evolve to connect to personal health records and electronic medical records, he said. EDS, which developed and kaNsas see page 29 ● http://www.HealthcareITNews.com http://www.bcbst.com http://www.HealthcareITNews.com http://www.HealthcareITNews.com http://www.healthcareitnews.com/news/alabama-medicaid-puts-it-work-better-care
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