Healthcare IT News - April 2008 - (Page 28)

28 Healthcare IT News April 2008 ■ www.HealthcareITNews.com NEWSBRIEFS HumaNa BEEFS up oNlINE oFFERINg FoR mIlItaRy Humana Military Healthcare Services is adding a series of educational briefings accessible online for its National Guard and Reserve members. The briefings explain TRICARE benefits for the activated members and their families. Topics include an overview of TRICARE, inactive duty status, benefits during pre-activation and activation periods, TRICARE for family members, TRICARE Reserve Select, and behavioral healthcare services. HMHS is headquartered in Louisville, KY. Medicaid program expands EHR ACS to add more applications to its integrated system. By PaTTy Enrado, Contributing Editor JEFFERSON CITY, MO aEtNa, HEaltHlINE INtRoducE NEW SEaRcH ENgINE Aetna and Healthline Networks launched Aetna SmartSource, a personalized search engine that mines information from Aetna’s data to deliver personalized health and health benefits information to Aetna members. Powered by Healthline Networks’ search technology, Aetna SmartSource is an intelligent online search tool that connects members to health information and Aetna programs and resources specific to their needs. Aetna SmartSource pulls information from a variety of Aetna Web resources based on a member’s insurance plan, zip code, and overall health. – MO HealthNet, Missouri’s Medicaid program, is expanding its electronic health record system, implemented in April 2006, by extending its contract with Affiliated Computer Services. “ T his contrac t rene wal means the division can con- tinue forward with progressive clinical rules development and deployment of secure resources for patients and providers,” said George Oestrich, director of pharmacy. “It will also allow better surveillance and management of cases leading to better service for MO HealthNet participants.” “The original contract had grown significantly over the past five years via contract amendments, and therefore the new contract was built upon those successes,” said Jennifer Cornelius, ACS’s “EHRs are the best source for information.” – George Oestrich account manager for MO HealthNet. With CyberAccess, providers could view paid claim data, as well as prior authorization rules implemented by MO HealthNet, which enabled prior authorizations to be granted electronically. MO HealthNet added a provider intervention portal and a participant Web portal. With the integrated system already in place, Cornelius said ACS can build additional applications. The contract calls for optional EHR services, which includes interoperability with provider MIssourI see page 29 System will also serve payer’s long-term strategic vision. By PaTTy Enrado, Contributing Editor SEATTLE Regence automates contracts – Regence, the largest not-for-profit payer in the Pacific Northwest and Mountain State regions, recently implemented Kryptiq’s Choreo Contract Management to manage its contracts more efficiently. More importantly, according to Mark Ganz, CEO of Regence, Choreo will serve as a transformational platform as the health plan continues to Kryptiq headquarters in Portland, Ore. “Kryptiq’s system enhances our ability to create move from a transaction model to a retail model. “This is a required shift for the entire industry,” a smooth and transparent relationship between patient and provider,” Ganz said. he said. Health plans must drive “this is a required Luis Machuca, president and value to individuals by empowerCEO of Kryptiq, noted that a ing members with tools that will shift for the entire payer’s core value and product help them navigate through both industry.” is in their provider network and illness and wellness, he said. – Mark Ganz requires an innovative system Minimizing interactions and hassles with physicians by eliminating “clunky” that will optimize that network. Through contract automation and management systems mired in rules and procedures will enable Regence to innovate and look for ways to and data sharing within the enterprise, the payer create transparency for members and transform will be able to easily and proactively address such the healthcare system to one that is focused on things as incentives for wellness program goals. Machuca said that while automated contract the community and real-time continuum of care, he said. rEGEnCE see page 29 Aetna launches multi-payer physician portal By PaTTy Enrado, Contributing Editor HARTFORD, CT – Aetna is shutter- HoRIzoN NJ tapS HEaltHtRaNS FoR pHaRmacy claImS Horizon NJ Health has contracted with HealthTrans, a national pharmacy benefits administrator, to provide pharmacy claims management and reporting services for its more than 300,000 members. HealthTrans expects to process nearly three million claims annually. Horizon NJ Health is New Jersey’s largest healthcare management company serving publicly insured individuals in the Medicaid and NJ FamilyCare programs. Headquartered in West Trenton, Horizon NJ Health is wholly owned by Horizon Blue Cross Blue Shield of New Jersey. ing its provider portal in June and transitioning its network providers to a multi-payer portal. While Aetna has a strong portal history, Paul Marchetti, head of national networks and contracting services, said it is Paul Marchetti committed to better serving its physicians and hospitals. “We recognize we’re one payer in their world,” he said. With NaviMedix’s NaviNet platform, Marchetti said Aetna will help simplify business processes without disrupting workflow and speed the revenue cycle, which will translate aETna see page 30 moNRoE plaN tapS poRtIco to maNagE pRovIdER NEtWoRk Monroe Plan for Medical Care, a nonprofit, IPA managed care organization serving the Western, Finger Lakes, and Southern Tier Regions of New York State, has tapped Portico Systems to help manage its more than 4,500 healthcare providers. Monroe Plan will use Portico’s hosted model. Portico will automate and manage critical provider network management processes, including network strategy, provider recruiting, contracting, enrollment, servicing, and provider selection for claims adjudication. The provider network serves Monroe’s 100,000 members. More at HealthcareITnews.com e Connect: PaYerS 0408 Blue Cross of California launches pay-for-performance hospital program HEalTHCarE IT nEws Editors THOUSAND OAKS, CA – Blue Cross of California last month introduced its Quality-in-Sights Hospital Incentive Program (QHIP) in 23 California hospitals. Q-HIP is designed to align financial incentives with quality improvements. It uses select indicators that have been identified for public reporting by the California Hospital Assessment and Reporting Taskforce (CHART) to assess hospital performance. These indicators are also promulgated by Health plan’s claim service “Which of the following best describes your experience with your health plan’s claim service?” The Web site completely answered my question The Web site partly answered my question The Web site partly answered my question - contacted customer service The Web site did not answer my question at all 22% 54% several national standard setting organizations, including The Joint Commission, the Leapfrog Group and the National Quality Forum (NQF). “Blue Cross has already established physician measurement and reward programs,” said Leslie Margolin, president and general manager of Blue Cross. “Now we are ready to introduce a process to measure the quality of hospitals within our network.” ■ More at HealthcareITnews.com e Connect: califorNia 0408 17% 6% Base: 3,402 US online non-elderly, commercially insured consumers who use online healthcare tools (multiple responses accepted). e ● Connect: GraPHS 0408 SoURCE: FoRRESTER RESEARCH’S NoRTH AMERICAN TECHNoGRAPHICS HEALTHCARE oNLINE SURvEY 2007 ● ● http://www.HealthcareITNews.com http://www.HealthcareITnews.com http://www.HealthcareITnews.com http://www.healthcareitnews.com/story.cms?id=9009 http://www.healthcareitnews.com/story.cms?id=9008

Table of Contents Feed for the Digital Edition of Healthcare IT News - April 2008

Healthcare IT News - April 2008 Contents New Media Push Stepping Down BI Headaches Decision Grants Safety Alerts Summit 08 Growing an EHR Year 24

Healthcare IT News - April 2008

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