It’s also necessary to deliver information to the point of care. Most patients see more than one provider, something even more prevalent among the chronically ill. Making each clinician aware of the procedures, medications and tests the others have implemented focuses and improves care. It also addresses the problem of duplicative services and helps eliminate waste. Through health information exchanges, real-time data can be delivered to provid- ers in virtually any format and through a multitude of devices to provide a consis-
Eric Demers is executive vice president and chief strategy offi cer at MEDecision. For more information on MEDecision solutions: www.rsleads.com/106ht-204
tent and more complete view of each patient’s medical situation. We must also start better aligning incentives for payers and providers to address the problem of provider utiliza- tion. As reimbursement models shift from the traditional fee for service to patient-centered medical homes and ac- countable care organizations (two other concepts strongly advocated in the reform law worth noting), providers will be encouraged to proactively engage with patients because providers will share in generated savings. Value-based
insurance design concepts will have a similar impact. All of this will require advanced technology that can simply and easily identify and reach those patients most in need of help, and task management tools to link multiple pro- viders and health plans so that care can be optimally and appropriately coordinated. Excessive costs, particularly those generated by the chronically ill, can also be controlled through medication management therapy (MTM). In this approach, analytics technology is applied to the available medical information for individual patients to enable better therapy adherence, avoid drug interactions and identify proper usage of gener- ics. It has been shown to help identify and enforce the best use of drugs and decrease ER visits and admissions. In some cases, it has produced a 4:1 return. Together, each of these methodologies can help foster more coordinated medical management. And, under re- form, the cost of implementing them can be attributed to MLR.
Healthcare reform will undoubtedly bring its share of challenges, but meeting the new MLR requirements doesn’t have to be one of them. With the right technology, it can actually be an opportunity.
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