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Insurers must address new business models By Ray Desrochers,

executive vice president, sales and marketing, HealthEdge

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The healthcare industry is currently experiencing a period of unprecedented change. We are rapidly moving from the one-size-fi ts-all world of healthcare that has existed for the past 30 years to a world that now includes a number of new healthcare business models designed to drive better behavior from members, increase the role

of providers and help reduce the overall cost of care. In order to successfully participate in this new healthcare economy, payers must quickly become familiar with these new models, and they must make sure that they have the systems in place that will allow them to be ready to address next-generation initiatives, including those driven by healthcare reform, ACOs, payment reform and value- based healthcare. Payers can ensure that they are ready to compete in this new healthcare marketplace by following these three simple steps:

1. Evaluate new healthcare business models: Payers should become familiar with the new business models that have been adopted or proposed, and should begin to make decisions related to which models they will want to support.

2. Understand existing capabilities and identify gaps: Payers should carefully evaluate all of their existing systems and then determine which of the new healthcare business models cannot be supported by their current technology infrastructure.

3. Implement required improvements: Once there is a clear understanding of both the new models that the payer wants to support and the limitations of their current systems, a plan should be created that details how the organization will transform its healthcare technology infrastructure in order to achieve its business goals. Given the rate of change in the market and the number of new options that will likely emerge over the next several years, payers should also make sure that they are choosing systems and technologies that will position them to be able to quickly and easily support additional models as they are announced.

Payers will continue to face significant changes over the coming years. Those that prepare now will find themselves ready to address many of the new opportunities that the market will offer. These industry leaders will have the opportunity to help shape the new world of 21st-century healthcare.

The year of 2012 will mark the healthcare system’s shift to a true patient-centered focus that will have a profound and lasting impact on both patients and the healthcare delivery system. The push for greater patient-centeredness was one of the six goals identified in the Institute of Medicine’s landmark 2001 report, “Crossing the Quality Chasm.” So why – a full decade later – is patient engagement finally emerging as a priority? Not surprisingly, the threat of financial penalties and the upside of improved outcomes are major drivers. Patient engagement requirements for hospitals (as contained in federal health-reform initiatives for value-based purchasing, meaningful use, avoidable hospital readmissions and the creation of ACOs) are jump-starting patient engagement efforts because non-compliance will substantially reduce Medicare reimbursement rates. The soaring increase in often-preventable, lifestyle-

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related chronic conditions – which account for about three-quarters of all U.S. healthcare spending – has also created a sense of urgency. Research has shown that when patients become more knowledgeable

about their conditions and understand the consequences of ignoring needed treatment and making poor behavior choices, they often stop being bystanders and start actively participating in their care.

As patient engagement becomes a priority, many hospitals will leverage their existing in-room TVs to empower patients via the use of an interactive system that includes shared decision-making tools, personalized information and education videos prescribed by care team members. Following discharge, patients will continue to receive education content and helpful information (such as medication and testing reminders) via cell phones, computers and other web-enabled devices. In addition, patient- initiated data captured during hospitalization will be shared with other care providers via EMRs, thus improving communications across the care continuum. Patient engagement will continue to gain ground in 2012, resulting in improved care transitions, better clinical outcomes and reduced preventable readmissions.


The patient will see you now By Gary Kolbeck, president, LodgeNet Healthcare


January 2012


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