Payers can drive healthcare transformation with IT

张琨

Payers can drive healthcare transformation with IT help
<br />Healthcare IT News
<br />By  Patty Enrado, Contributing Editor  06/08/06
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<br />SAN DIEGO, CA – It is no secret that the healthcare system is broken and needs to be fixed, health plan executives at America’s Health Insurance Plans annual meeting said Wednesday. But payers may be in the best position to provide the fix.
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<br />“The healthcare system is ripe for fundamental transformation,” said Mark Ganz, president and CEO of The Regence Group, in a panel. “Health plans have the best opportunity to drive that transformation.”
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<br />“We have a role to play,” agreed Jeannine Rivet, executive vice president of UnitedHealth Group. Rivet added that technology will be the enabler to simplify the system.
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<br />Ronald Williams, CEO and president of Aetna, said the industry is at a critical juncture and has an opportunity to take advantage of the sophisticated level of technology and information to address the evolving consumerism movement and the challenges of moving from a wholesale to a retail industry.
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<br />The employer fear of consumers not knowing how to buy in the industry can be appeased by health plans providing ease of administration and getting tools to consumers, according to Rivet. “We need to provide appropriate services and be supportive in a meaningful way,” she said.
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<br />Health plans have been piloting incentive programs, including pay-for-performance, practice rewards and employer waivers for drugs for employees in disease management programs, and seeing significant uptake.
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<br />Ganz stressed that the fundamental strategy for appealing to providers and consumers is to get the information into the hands of providers and democratizing information and getting it to consumers.
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<br />Whether providers use member-loaded personal health records or not, Williams said, well-run health plans have more data – pharma, lab, behavioral health, dental – and have the ability to aggregate that data. “We can reach out and share that data with providers,” he said.
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<br />All three executives agreed that challenges abound as they address the financial issues related to consumer-directed healthcare (CDHC). All three, however, noted that it is also a great opportunity for health plans to lead the way in administering CDHC services.
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<br />“We’ve had a swipe card for two years now that physicians can use to view benefit and eligibility information,” said Rivet. The problem has been in getting physicians to use it.
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<br />Despite the cultural barriers and other technological challenges, Karen Ignagni, president and CEO of AHIP, said, health plans are stepping up and developing new strategies and opportunities to take advantage of the shift from a wholesale to a retail healthcare industry.
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