Medicare Compliance & Reimbursement

Health plans push innovations that improve quality, cost and effciency, survey finds.

For a while now, health care commentators have been noting the role health insurers are playing in stimulating and supporting health information technology. But some experts worry that the fast-growing health IT advances could create serious roadblocks when too much variety in IT products makes across-the-board adoption difficult.

Those looking for more concrete details can now see how 38 health insurance companies have implemented more than 40 different health IT advances in a new America's Health Insurance Plans report.

U.S. health insurance plans have established technological innovations that providers and patients use as well as insurers. "Health insurance plans are using IT not only to process claims more efficiently but also to promote evidence-based care, add value to health care services, and empower consumers through access to information and decision tools," says AHIP president and CEO Karen Ignagni.  Such achievements have stemmed from technological advances in case management, e-prescribing, consumer-information tools, claims processing and personal health records, the report notes.
 
But even as the report touts the wide range of initiatives health plans have undertaken, some industry insiders worry that the variety itself could be hampering IT efforts--and argue that the progress the industry has made could move even more rapidly. The health care industry's past efforts to advance technology "were not successful because there was too much variation in the technology, which made it hard to invest," says William Fleming, Pharm.D., vice president of pharmacy and clinical integration at Humana. Pharmacies have made inroads on their end because they can organize around the National Council for Prescription Drug Plans, "but physicians and hospitals don't have the same kind of entity to govern" developments, he laments.

Still, health plans undeniably have been instrumental in forwarding technology use and anticipate continuing to generate and refine products in 2006, according to the report.  PHRs Especially Valuable In Current Treatment Climate PHRs hold perhaps the most promise and the most importance for future development, as Hurricane Katrina illuminated the potential disaster of strictly paper-held medical records, the report remarks. The features the report highlights include:

• Member input: Plans cite the need to give control to beneficiaries in constructing their PHRs for better operability and user-friendliness. For example, Empire Blue Cross Blue Shield's PHR My Health Record enables members to complete a health risk assessment when they first log in. Members also have the ultimate say in whether--and which--providers can see their records and which entries remain outside physicians' view. "This will hopefully lead to better decision-making, as members become increasingly engaged in their own care," says Empire Chief Medical Officer Alan Sokolow, M.D.

• Data for consumers: Some plans emphasize giving members information about upcoming treatments, [...]