Healthcare IT News - October 2008 - (Page 46)

www.HealthcareITNews.com October 2008 ■ Healthcare IT News 45 NEWSBRIEFS TENNESSEE BluES auTomaTES SalES WITh NEW TEchNology BlueCross BlueShield of Tennessee will automate its business processing in the individual market. The insurer tapped Altlanta-based Connecture Inc. to provide the technology. Connecture’s InsureConnect EZ software, released last year, is a packaged version of InsureConnect, a sales automation software for health plans. BlueCross BlueShield of Tennessee was looking for a tool to improve efficiencies in both their broker-facing and direct-toconsumer channels. Stark bill draws support from payers Legislation takes carrot-and-stick approach to drive IT adoption. By PaTTy ENrado, Contributing Editor WASHINGTON NEW JERSEy plaN SpoNSoRS hEalTh daTa ExchaNgE AmeriHealth New Jersey, which provides health coverage to more than 230,000 members in New Jersey, is sponsoring the New Jersey Health Information Exchange, a new initiative designed to give radiologists and other physicians 24-hour electronic access to shared-patient medical imaging records through a secure Web portal. The Exchange is being built by Philadelphiabased HxTechnologies (HxTI), a health care IT and services company specializing in health information exchange. – House Ways and Means Health Subcommittee Chairman Pete Stark (D-Calif.) introduced HR 6898, which features a few provisions absent from other current healthcare IT bills. The bill would offer incentives tied to Medicare payments to drive early provider adoption of healthcare IT systems and reduce Medicare reimbursements to providers who delay or refuse implementation. “The approach of using a carrot and a this bill recognizes stick is something that penalties must that’s already law be coupled with real with regard to health incentives to help IT adoption, in epush providers on prescribing,” said both ends,” he said. a House Ways and While the disincenMeans Democratic tives distinguish the staff member. bill from others, “it is He pointed out only one part of makthat the bill’s incening the bill effective,” tives for early adop- Congressman Pete Stark’s healthcare IT bill ties he said. tion are “very gener- incentives to Medicare payments. Jeff Nelligan, spokesman for the Centers ous” – up to several million dollars for hosfor Medicare and Medicaid Services, said, pitals. “Using a carrot-and-stick approach is the “We’re closely reviewing the legislation.” best way to drive adoption of health IT, but STark see page 47 oklahoma manages disease using predictive modeling Holistic approach aims to give care at right time. By PaTTy ENrado, Contributing Editor OKLAHOMA CITY – Through predictive modeling, the Oklahoma Health Care Authority is achieving its goal of focusing on the whole person rather than just the disease in its SoonerCare Health Management Program. The authority, called OHCA, is reaching the right members and providers at the right time with care intervention, thereby being smarter stewards of state funds for the highest return on investment, said Michael Herndon, MD, OHCA’s medical director of healthcare management. Using MEDai’s predictive analytics tool, OHCA can look N.C. Blues boosts claims automation By PaTTy ENrado, Contributing Editor DURHAM, NC BcBS oF mINNESoTa To BooST pRoducTIvITy, accuRacy Blue Cross Blue Shield of Minnesota (BCBS MN) is deploying new technology to boost productivity and increase accuracy across their claims operations. The health plan will roll out Pegasystems’ Claims Repair Solution Framework, a pre-packaged business process management software, developed by the Cambridge, Mass.-based company. Health plan officials said they expect Claims Repair will help BCBS MN meet Blue Cross Blue Shield Association claims mandates that become effective this month. Officials at the Oklahoma Healthcare Authority say predictive modeling helps them be better stewards of state funds. pRESIdIo coNTRacTS WITh BENEFIT INFoRmaTIcS Presidio Excess Insurance Services has contracted with Jenks, Okla.-based Benefit Informatics, a healthcare data warehouse provider, to provide comprehensive data analysis and reporting solutions to its clients. The Reinsurance Edition of Benefit Informatics’ data analysis and reporting solutions provides regular access to a variety of analysis and reporting functions, including shock-claim alerts, trigger diagnosis filtering and eligibility review. Presidio’s clients can actively monitor utilization for individual members or over their entire book of business, as well as provide individual access to patient information. More at HealthcareITNews.com e Connect: PaYerS 1008 at its Medicaid membership by risk and not by disease, said Lynn Puckett, analyst/planning specialist for OHCA. The tool’s indicators identify those most at risk of developing acute episodes and help OHCA direct resources and intervention where they are most needed. “We got beyond looking at cost and pay attention to who can be impacted and how they can be impacted,” said Karl Weimer, account manager for MEDai. “If you apply resources to find them early, you make the biggest impact oklaHoma see page 49 – Blue Cross and Blue Shield of North Carolina has implemented its Claims Optimization Framework to enable the build-out of applications for business changes. The implementation has resulted in the “extremely successful” reduction or elimination of the majority of its claims duplicates, said Rod Dunlap, director of Operational Metrics and Support at BCBSNC. The Framework is powered by Pegasystems’ Build for Change technology, which automates workflow processes, including auto-unification of business policies and procedures across the organization’s system. Business users, and not developers, write the business rules, a process which eliminates lostin-translation issues when BluES see page 49 Humana adds power to its military services Web portal By BErNIE moNEgaIN, Editor Evaluating providers consumers’ online preferences Health plan’s Web site Government Web site Commercial comparison tool Nonprofit, association Web site Hospital Physician ● – Humana Military Healthcare Services and ValueOptions, Inc., the South Region subcontractor for behavioral health, launched new educational features on the AchieveSolutions behavioral health portal at www.humanamilitary.com. AchieveSolutions, a Webbased behavioral healthcare LOUISVILLE, KY tool developed by ValueOptions, offers South Region beneficiaries a private, safe environment to seek information, educational materials and self-assessment tools on behavioral health, addiction and recovery, life events and daily living skills. In the past year more than 87,000 pages, covering 200 different topics, have been accessed. HumaNa see page 48 0 e ● Connect: GraPHS 1008 10% 20% 30% 40% 50% SOuRCE: BLuE CROSS ANd BLuE SHIELd ASSOCIATION http://www.HealthcareITNews.com http://www.apisoftwareinc.com/hcitn http://www.apisoftwareinc.com/hcitn http://www.HealthcareITNews.com http://www.healthcareitnews.com/eConnect.cms?id=10142 http://www.healthcareitnews.com/story.cms?id=10106

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

Healthcare IT News - October 2008 Contents Seattle's Slate Board 2.0 MGMA Newsmaker IT Battles Infection Beyond Adoption Excellence in Maine Carrot and Stick HP Layoffs Mobile Workstations Automating Offices

Healthcare IT News - October 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.