Healthcare IT News - November 2007 - (Page 35) www.HealthcareITNews.com pAYERS November 2007 ■ Healthcare IT News 35 CollECT Continued from page 33 QSSI awarded PHR pilot project CENTENNIAL, CO – reconcilable,” she said. Ultimately, payers need to have banking capabilities and technology infrastructure to provide a seamless workflow. Aetna has a number of payment solutions. Its partnership with Medical Funding Services, available in six states, allows for electronic billing and reimbursement, said Paul Marchetti, head of national networks and contracting services. “I really see the onepay model as a stepping stone to what most plans are really striving for – REAl-tImE ClAImS adjudication.” – Carl Doty Cigna spokesman Joseph Mondy said that Cigna is developing as part of its Health ePass initiative a hold-and-settle process at the point of care, whereby the patient receives an estimate of costs and Cigna puts a “hold” on a member’s HSA, HRA and FSA, or flexible spending arrangement, funds when the provider submits the claims. Carl Doty, analyst at Forrester Research, said that OnePay’s innovative approach won’t be a widespread trend. “Most health plans don’t own their own bank – and never will,” he said. The financial institution partnerships exist solely for consumer-directed health products. “I really see the OnePay model as a stepping stone to what most plans are really striving for – real-time claims adjudication,” he said. ■ More at HealthcareITNews.com e Connect: collect 1107 The Centers for Medicare and Medicaid Services has selected QSSI as the prime contractor for a pilot project to develop personal health records for fee-forservice beneficiaries in South Carolina. The QSSI team, which includes HealthTrio, Palmetto GBA and IBM, will develop a provider and beneficiary outreach campaign to ensure that seniors involved in the program have access to their PHRs. The PHRs will include a beneficiary’s most recent two years of claims data. “We are excited to be working with CMS, QSSI, Palmetto GBA and IBM to improve the overall quality of healthcare to Medicaid beneficiaries,” said Malik Hassan, MD, president and CEO of HealthTrio. “I am confident that the successful implementation of the HealthTrio, LLC PHR solution will empower Medicaid beneficiaries to better manage their on-going healthcare needs and bring us closer to a patient-centric healthcare.” The pilot program will give participating seniors online access to an integrated view of their health information regarding medical conditions, medical procedures, hospitalizations and doctor visits. The South Carolina pilot is part of a broader effort by CMS to encourage the Medicare-wide adoption of PHRs. QSSI plans to develop a provider and beneficiary outreach campaign to ensure that the South Carolina seniors have access to their PHR. ■ More at HealthcareITNews.com e Connect: PIlot 1107 ● transforming healthcare through IT TM Innovation with a shared vision isn’t for everyone. It’s for people who need tomorrow’s solutions…today. It’s for people who have a stake in the future. It’s for innovative thinkers seeking same. It’s for people like you. Come and share the vision…. ● CoNTraCTs Continued from page 33 to look for opportunities to gain efficiencies. “Health plans are adopting automation to react better to the marketplace,” he said. Janice Young, program director for Health Industry Insights, an IDC company, agreed. The creation of large payers through mergers and acquisitions and the extension and expansion of provider networks to support new products such as consumer-directed health plans, Medicare and Medicaid are increasing contract management complexity, she said. “Multiple contracts, rates, terms and applications to different products require automated solutions and processes for contract negotiations and renewals,” she said. While this is the current concern for payers, future challenges will arise as pressure to improve cost, quality and efficiency increases and the industry moves to realtime payment strategies. As the industry moves toward consumer-defined health plan models such as individual plans, payers will need an automated way of getting to information in order to model contract terms, said Young. Pay-for-performance programs will also require payers to be able to accurately track and pay based on new parameters, she said. ■ More at HealthcareITNews.com e Connect: coNtractS 1107 ANNUAL CONFERENCE & EXHIBITION FEBRUARY 24–28, 2008 / ORLANDO Explore exciting, thought-provoking and controversial issues and emerging trends— ► The rise of healthcare consumerism—retail health clinics, pharmacies in retail outlets and more “E-iatrogenesis”—the cause-and-effect of HIT generated errors and the newest preventative measures The new Stark Rules and its industry-wide impact Leveraging healthcare IT to improve care for the poor and uninsured Discover the absolute best-in-class in the healthcare IT industry today and take away real-world solutions you can use. Come and experience— ► ► ► 300+ educational sessions taught by the industry elite 900+ vendors showcasing cutting-edge solutions Networking events throughout the week ► ► Steven D. 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