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.

EDI Watch (AHIP) - Fraud detection system for health care

While at the America's Health Insurance Plans (AHIP) conference in San Diego, we interviewed Carl Scarabelli from EDI Watch. The company's solution promises to reduce a huge problem for health insurance companies, estimated according to EDI Watch at 10% of the total cost of health care in the U.S. The company's solution is easy to get up and running, with a quick ROI for health plans, according to Scarabelli.

Click play below to watch the interview.

Market for EMRs pegged at $1.6 billion by 2013

Market for EMRs pegged at $1.6 billion by 2013 http://ping.fm/WrpmS

NEW YORK – The market for electronic medical record data transfer equipment and applications, valued at $575 million in 2008, is forecast to reach $1.6 billion in 2013, according to a study by research firm Kalorama Information.

Driven by the growing use of EMRs in hospitals and physician offices, this segment of the patient monitoring market will grow 23.3 percent annually through 2013, notes the report, "High-Tech Patient Monitoring Systems Markets (Remote and Wireless Systems, Data Processing, EMR Data Transfer)."

Increased use of EMRs and high-tech patient monitoring systems is a key piece of President Barack Obama's plan to fix the ailing healthcare system, the report notes, because they have the potential to improve patient outcomes and satisfaction, provide cost savings and more efficient use of healthcare resources and reduce hospitalizations.

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.

Coordinated Health Care & Evidence Based Medicine, Aided by Social Media

Slate Magazine's recent analysis of the Obama administration's forecasted $2 trillion in health care savings questioned which initiatives would provide true savings.  The highest ranked was "encouraging coordinated care..." and "...adherence to evidence-based best practices and therapies..."  Coordinated care seems to suggest clinical integration and savings derived from better information about what works and what doesn't, would create efficiencies.  

Increased information could increase the benefits of innovation and the ability for federated groups of health plans to use the best ideas for the best results.  Secure Social Media, i.e. the idea of aiding discovery within the enterprise can help.   No World Borders has been advising health care firms on ways to use social media techniques to provide openness, while still providing security and privileges regarding who can access the information within the enterprise.

From Slate:

"3.) Encouraging coordinated care, both in the public and private sectors, and adherence to evidence-based best practices and therapies that reduce hospitalization, manage chronic disease more efficiently and effectively, and implement proven clinical prevention strategies.

"Coordinated care" seems to suggest integration of clinical care by hospitals and doctors. If bundling requires doctors and hospitals to knock heads over submitting a single bill, integration requires doctors and hospitals to knock heads over how the patient will be cared for. "You have to grow both organically side by side," Reinhardt says. A good start, he added, would be getting the pediatrician, obstetrician, and gynecologist to develop a common plan for an individual childbirth; medical procedures don't come much more straightforward than the delivery of babies. "Evidence-based best practices and therapies" refers to compiling national statistics about which clinical approaches work best and then putting some pressure on physicians and hospitals to follow them. It's very difficult to know in advance what the budgetary impact of this information would be. In a recent article in the Annals of Internal Medicine, Theodore Marmor, Jonathan Oberlander, and Joseph White wrote, "Although comparative effectiveness research may provide useful information about the clinical effectiveness and costs of medical treatment options, that information is not guaranteed to lead to significant cost savings." The Congressional Budget Office calculates that between the new money spent on research and the savings derived from better information about what works and what doesn't, the net five-year cost to the federal government would be $490 million over five years. Total health care spending—public and private—the CBO says, would be reduced by $8 billion over 10 years. The CBO doesn't have a five-year number, so we'll slice that one in half."

Healthcare Business Models: Mayo Model Losing to McAllen?

An article in the New Yorker asks: Why does the border town of McAllen, Texas, spend more er person—an average Medicare enrollee there costs $15,000 per year—on health care than any U.S. city besides Miami? The author blames "across-the-board overuse of medicine," which stems from the fact that our health care system "pay[s] doctors for quantity, not quality." This overuse isn't just expensive—it's less effective. "In an odd way, this news is reassuring," the author notes: Providing better health care will also save money. 

This is a disturbing and perhaps surprising diagnosis. Americans like to believe that, with most things, more is better. But research suggests that where medicine is concerned it may actually be worse. For example, Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country—$6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen. Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state’s quality ranking tended to be. In fact, the four states with the highest levels of spending—Louisiana, Texas, California, and Florida—were near the bottom of the national rankings on the quality of patient care.

Do Schools Kill Creativity? How do we apply creative thought in business and process improvement?

How will education play out in the future given the use of technology and information sharing?  Children starting school in 2006 will be retiring in 2065.  We aren't sure what the world will be like in five years, so how do we educate students to innovate as the world changes?

Creativity is as important in education as literacy, according to this talk at a TED conference.  This creativity, we would like to add, does not stop in the class room.  Regulatory compliance projects such as HIPAA compliance will require re-thinking process.  This is an absolute opportunity to re-design process.  By questioning how things are done we can innovate to make them better, as this video explains.