Consumers Are Top Priority for Managed Care CIOs

By Stacy Lawrence  |  Posted 05-10-2005
After a recent conference held by the Managed Care Executive Group, the organization released a list of the top ten issues facing managed care IT executives in America. The group was founded in the late eighties for managed care information services executives and has members from regional managed care groups around the country.

"This year's conference focused on the drivers of a changing health care market," said Alan Abramson, president of the Managed Care Executive Group. "Those drivers lead to demands on the information technology infrastructure, requiring successful organizations to deliver those changes in an increasingly timely and efficient manner."

The survey found, not too surprisingly, that implementations that help the consumer and the bottom line are the most popular among these health care IT executives.

Here is the complete top ten list of upcoming priorities for these managed care IT execs:

1. Consumer focus. Health plan products featuring choice, customization, flexibility and direct involvement by individual members in their care will drive large data warehouse implementations and the integration of these with multithreaded customer-facing applications.

2. Collaboration with providers. Prior authorization and utilization reviews are fading, and in their place is a more collaborative model based on access, quality, safety, effectiveness and patient-centeredness.

Health plans will increasingly encourage provider investments and/or jointly invest in clinical automation, CPOE, networks and revenue cycle enhancements to further automate the care process. National initiatives such as NHII (National Health Information Infrastructure) will provide stimulus for this effort.

3. Providing transparency to health plan data and operations.

4. Investment in real-time infrastructure. Innovation in business processes continues to yield returns in customer satisfaction and increased revenue. Business process fusion requires a robust and scalable real-time infrastructure.

In addition to high availability processors, storage redundancy and alternate path networks, this infrastructure includes advanced monitoring software to aid in the discovery and removal of bottlenecks and to continuously tune the technology environment for optimal performance.

5. Retention and use of clinical information as it impacts predictive modeling, disease management and health outcomes.

6. Managing all the health information needed by members, employers, providers and other stakeholders to maintain and improve health.

7. Impacts and movement to service-oriented architecture.

8. Nimble, speed-to-market solutions (tie with #9). Fast, focused and results-driven projects will be required to address the rapidly changing product portfolios and changing demands of the market. These IT projects will need to fit within overall standards and architectures to avoid rework and too-early replacement later.

9. Impact of Medicare reform legislation (tie with #8). Recent Medicare reform both extends the role of health plans and introduces new elements of competition. The pharmacy discount provision, for example, may cause many plans to rethink the traditional role of PBMs. New business partnerships may appear and others may be reconsidered or dropped as new carriers enter local markets.

10. Rapid product development to meet changing demands of members.