IBM approach to implementing ICD-10, X12 5010 for health care payers

While at the America's Health Insurance Plans (AHIP) health care reform conference held in June 2009 in San Diego Ms. Barbara Archbold, Partner, Payer Industry for IBM Global Business Services is interviewed by Mike Arrigo, CEO of No World Borders.

Ms. Archbold recommends that health insurance payers approach the issue from a business point of view, start planning now for the new medical coding standard ICD-10, that they create a strategy and approach to reduce risk and cost for modernizing legacy systems by "touching these systems only once."

Barack Obama’s address to the annual meeting of the American Medical Association

health care,AMA,American Medical Association

President Barack Obama’s address to the 158th annual meeting of the American Medical Association today attempted to assure doctors and their patients that his prescription for overhauling the health care system would be good for them. Obama cited the need for doctors to cut health care costs by reducing the number of unnecessary tests and procedures that are performed to reduce the risk of malpractice claims. Such reductions might require restrictions on malpractice liability to protect doctors.

". . .The first thing we need to do is protect what’s working in our health care system. Let me repeat – if you like your health care, the only thing reform will mean is your health care will cost less. If anyone says otherwise, they are either trying to mislead you or don’t have their facts straight.

If you don’t like your health coverage or don’t have any insurance, you will have a chance to take part in what we’re calling a Health Insurance Exchange. This Exchange will allow you to one-stop shop for a health care plan, compare benefits and prices, and choose a plan that’s best for you and your family – just as federal employees can do, from a postal worker to a Member of Congress. You will have your choice of a number of plans that offer a few different packages, but every plan would offer an affordable, basic package. And one of these options needs to be a public option that will give people a broader range of choices and inject competition into the health care market so that force waste out of the system and keep the insurance companies honest."

President Obama said that limits on medical malpractice lawsuits could be a necessary part of overhauling the nation's ailing health care system.

"I'm not advocating caps on malpractice awards, which I personally believe can be unfair to people who've been wrongfully harmed, but I do think we need to explore a range of ideas about how to put patient safety first, how to let doctors focus on practicing medicine, how to encourage broader use of evidence-based guidelines," he said

Interview with TriZetto's Rob Scavo (AHIP)

While at the America's Health Insurance Plans conference in San Diego (AHIP) we met with Rob Scavo, President of Product Management and Core Administrative Solutions at TriZetto.

We asked Rob to provide TriZetto's view on what the new HIPAA standards, X12 5010 and medical coding standard ICD-10 mean in terms of not only compliance but opportunities to innovate and improve operations for both payors and providers.

Click play below to view the interview.

HCI addresses fraud, other health care cost issues - AHIP

While at the San Diego AHIP conference we interviewed HCI Insight, a company that promises to reduce the cost of health care by addressing fraud. HCI's loss calculators indicate that a health insurance firm with 3,000,000 (3 million) lives insured stands to lose $381 million over a specified period of time, and their solution is designed to address this issue, according to HCI executives.

We'll post our video interview in an update to this blog later today.

Protests outside AHIP Conference, San Diego

Today while entering the AHIP conference we encountered demonstrators who want the health care industry to change. We intereviewed Kathy Rallings, an employe at California Techers Association. The people *inside* the conference were a bit more subdued in their approach, but we believe that both the demonstrators and those exhibiting inside the conference are interested in improving health care. See our blog and twitter enteries (www.twitter.com/marrigo) for a balance of perspectives from both groups.

Click the play button below to view this video.

AHIP Day One - Passion in the Streets

Fresh blog from the floor of AHIP San Diego.  AHIP (America's Health Insurance Plans) is having their annual meeting in San Diego this week.   Here is a recap of June 3, 2009 the first day.

Last year at AHIP, health care reform was discussed, but most political commentators didn't think much would happen: there was interest, but not passion.  This year the passion has spilled onto the streets.

January 2009, the OMB made a statement that has remained at the center of where we are today- we cannot fix the economy unless we fix health care.

Of the significant debt we are now assuming with the new budget- $35 trillion of that debt is Medicare. We can't fix the economy if we don't fix health care.

One vendor’s health care reform includes four components developed sequentially. First is establishing a solid health information technology structure that we don't have today. Second is focusing more intently on comparative effectiveness and evidence-based service delivery, third is coordinating care, and fourth is consumerism. All of these components are being discussed.  Will we have time execute sequentially as opposed to combining these into a parallel path? The group estimated that this would take six to ten years to put the model in place, but do we have the time?

At a completely different end of the spectrum, there are also protests being organized, to show the angst developing in the industry.   Nurses from the  California Nurses Association and allies from groups like Physicians for a National Health Program and Progressive Democrats of America will be there to greet health plan executives.  Their tone is extremely hostile in some cases, calling the insurance industry some surprisingly caustic names.

Our view: HIPAA standards promise to improve health care, but we cannot wait.  Embracing the standard, technology, people and process must proceed briskly.  This is a challenge as member premiums have declined with unemployment ranks rising.   Click here four our recent update: mentoring health payers and providers on how to embrace HIPAA standards and improve process.

The exhibit hall is smaller this year given budget constraints.  However, we will spend more time there on day two.