Healthcare IT News - October 2008 - (Page 50)

www.HealthcareITNews.com payERS dates, for example. Being able to pay claims correctly and quickly is no longer a differentiator for payers, said Robert Booz, vice president of insurance practice for Gartner. “Insurers have to execute flawlessly every time,” he said, whether it be for claims adjudication, document control, image management or customer service response. Payers are turning to IT to manage business processes such as claims transactions in recognition of the “new consumer,” he said. Janice Young, program director at IDC, said the implementation “hit on the top three objectives that payers want towards managing their technology” – Service Oriented Architecture’s reusable business objects, moving business logic to the end users and decreased time to market. BCBSNC is leveraging the Framework in other areas of the company, including enrollment and customer service. ■ More at HealthcareITNews.com e Connect: oklaHoMa 1008 October 2008 ■ Healthcare IT News 49 Blue Cross Blue Shield North Carolina is putting its new claims optimization technology framework to manage a number of business processes in many areas of the company. BluES Continued from page 45 claims staff hand over business requirements and changes to developers, Dunlap said. “This is one of the classic benefits of business rules, and we’re achieving them,” he said. With the Framework’s building blocks infrastructure, users can reuse modules, leveraging the code and technology, which saves time and resources, he said. The BCBSNC implementation is notable for its rapid 30-day deployment for business changes, the “game-changing” collaboration between business and IT departments, and the technology’s reusable objects, which enable personalization of the payer’s rules, said Elizabeth Hart, director of healthcare solutions for Pegasystems. Business process management is critical for payers to stay current with market-leading changes, she said, such as consumer-directed health plans’ nonstandard benefits and regulations – association man- ● It could happen sooner than you think. SNOMED Clinical Terms® (SNOMED CT®) enables the safe, accurate, and effective exchange of health information. Nine countries* are supporting its use. Are your systems ready? oklaHoma Continued from page 45 on future cost.” The tool also stratifies risk and identifies physician offices that need assistance in the care coordination of its assigned SoonerCare members. In this opt-out program, practice facilitators enable quality and process improvement and redesign of office systems. Herndon said focusing resources on the physician offices builds long-term sustainability, whereas case management investment spent only on members is not recoupable if the member loses coverage. There is already a waiting list of practices wanting to opt-in, and OHCAA is redesigning its methodology for selecting practices to obtain the highest ROI. Oklahoma is the only state using predictive modeling in-house, according to Herndon. OHCA selects the members and providers using predictive modeling and the Iowa Foundation for Medical Care administers the care coordination. OHCA replaced its Medicaid Management Information System in 2002 using EDS’ interChange system to automate claims processing and payment, meet regulations and control costs. Weimer said the partnership among OHCA, EDS and MEDai has helped to improve the coordination of care for Oklahoma’s Medicaid members. “This could be the model for other state Medicaid programs,” said Scott Mack, account executive for EDS. “Our holistic approach is to make the whole person well,” Puckett emphasized. “It’s the right thing to do.” ■ More at HealthcareITNews.com e Connect: oklaHoMa 1008 SNOMED Terminology Solutions TM Expert Advice. Expert Implementation. Expert Education. SNOMED Terminology Solutions (STS) is the world’s leading and most trusted resource for SNOMED CT® expertise and advice. Our expert team of clinicians, coders, and developers offer a broad spectrum of consulting services and products—Clinical Informatics Consulting and Mapping, Technical Consulting, and Education—to help you achieve the clinical and business outcomes enabled by SNOMED CT®. Our Clinical Informatics Consulting and Mapping Services team offers: • Strategic planning for terminology integration • Mapping legacy data, proprietary code sets, and classifications (eg, ICD-9-CM, ICD-10-CM) • Clinical consulting including assessment, delivery, validation, and maintenance of terminology solutions Learn how STS can help you achieve semantic interoperability for your electronic health record and other health information technology systems. *Member countries of the International Health Terminology Standards Development Organisation® (IHTSDO®). CAP STS is the original creator of SNOMED CT® and has fostered its development for more than 40 years. Today, on behalf of the IHTSDO®, STS continues to develop and maintain SNOMED CT®. SNOMED CT and IHTSDO are registered trademarks of the International Health Terminology Standards Development Organisation. e ● Connect: caPStS 1008 ● www.capsts.org snomedsolutions@cap.org 800-323-4040 ext. 7700 http://www.philips.com/speechrecognition http://www.philips.com/speechrecognition http://www.healthcareitnews.com/eConnect.cms?id=10146

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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

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