UnitedHealthcare announced an interesting new product the other day that, in essence, is designed to insure your insurability. As I understand it, UnitedHealth Continuity enables a consumer to purchase individual health insurance at any time, but not activate it until they feel they need it. In other words, a 50 year-old-person who’s planning to retire at 55 can buy the insurance-to-insure now, while they’re covered under their employer’s health plan and presumably healthy, and then buy the full individual coverage once they retire and/or lose their employer’s benefits. Should the individual develop a chronic illness in those five years between the purchase and the activation of the plan, they’re covered, no pre-existing conditions questions asked. United’s Web site says the policy is also aimed at people who decide to become self-employed, suddenly find themselves unemployed or take a different job without benefits. Users can turn the coverage “on” or “off” as they need it as many times as they want.

This novel concept illustrates how the health care industry is adjusting to the current state of the economy. United has seemingly done its homework and come up with an innovative product to capitalize on new and different opportunities. I think we’ll see a lot more of this going forward as economic conditions force businesses in general and health care entities in particular to be more inventive and think outside of the box. Old products (including this UHG Continuity offering) may become obsolete in the near future, depending on what systemic changes the new administration is able to implement, but change inevitably brings renewed opportunity as well. I'm told that the Chinese symbol for "crisis" is the combination of the symbols for "danger" and "opportunity." Perhaps something good — innovation — can come out of the economic crisis after all!

I had the pleasure of sharing some exciting personnel announcements with the folks at MEDecision on Monday. The two additions and one promotion signal good things for our company as we continue to build on the momentum created by the release of our Alineo and Nexalign products earlier this year.

Scott Storrer is our new President and Chief Operating Officer. He brings with him 15 years of executive leadership experience in the health care industry with a number of high profile organizations including Liberty Mutual, CIGNA and, most recently, Cardinal Health. He will be responsible for managing and overseeing all of our operations. We also added Jim Adamek as Senior Vice President of Sales. Jim has more than 20 years of experience in sales and sales management, primarily in the software technology arena. And our own Kathy Gincley has been promoted to Senior Vice President of Development. Kathy has done an outstanding job in her role as Vice President of Development in the years she’s been with us and her promotion is well deserved.

These organizational changes allow me to transition back to having more of an external focus. I will be able to spend more time with clients and prospects, on speaking engagements, legislative affairs, and industry involvement. I will also continue to spend a considerable amount of time refining our health information technology strategies and investments and, of course, I’ll have more time for blogging.

All of this amounts to some really good news for MEDecision, particularly in light of current national and international economic conditions. Things are quite firmly on the upswing for us and I’m excited about the possibilities that lie ahead.  

The New England chapter of HIMSS conducted a conference on health information technology a few weeks ago. One of the speakers was Dr. David Howes, president and CEO of Martin’s Point Health Care which, according to its Web site, “is a diverse health care company that offers both health plans and primary care.” The upshot of Dr. Howes’ talk was the growth of the medical home concept and the crucial role that health IT will play in its success.

This is something we’ve discussed several times right here on this blog in recent months. It’s actually quite satisfying to see it echoed by someone else within the industry in an important public forum. Dr. Howes pointed out the importance of changing the delivery of healthcare and noted that real change must originate in the primary health care system. That, of course, is where the medical home comes into play and can have the biggest impact. And, given the criteria the NCQA has established for the medical home concept — quality, safety, enhanced access and coordinated care — the use of advanced technology is going to be essential.

As Dr. Howes pointed out, IT can support the medical home concept by offering a single source of information that can be electronically shared by various stakeholders. It can also ensure better communication and increased safety. And when you add in things like clinical decision support, e-prescribing and having a more complete and consistent view of a patient’s medical situation, it’s a no-brainer that IT stands to make a major impact on medical home initiatives. Kudos to Dr. Howes for bringing the issue to light.

The medical home has come a long way in a relatively short period of time. It will be most interesting to see where it goes — and to see the impact IT has on its development — over the next few months.

On the heels of a previous blog entry about momentum building toward greater health IT adoption comes survey results showing that there is some $700 million available to help physicians fund technology purchases. What makes this especially encouraging is that cost has long been cited as one of the major obstacles to more widespread proliferation of HIT. It’s exciting to see that we’ve come to a point where interest in technology is growing commensurately with financial assistance to adopt it.

The Certification Commission for Health Information Technology (CCHIT) says its survey found that there are no less 90 public and private programs underway nationwide aimed at helping medical practices acquire and implement electronic health records. The largest is in New York where $157 million has been made available to about 18,000 doctors through regional networks. Other initiatives have been launched by hospital groups, insurers, employers, public-private partnerships and governments at various levels. All told, CCHIT says money is available to help more than 40,000 physicians adopt electronic health records.

Of course another way to overcome the health IT cost hurdle is to implement an approach I’ve discussed in this forum several times; one that requires physicians to simply invest in a computer and Internet access. This is all docs need to connect to a growing number of insurers that are willing to exchange clinical data with them absolutely free. It would be an opportunity for providers to sort of test drive health IT. And I’m quite confident that once they experience its value, they’ll come to rely on it and be willing to incrementally upgrade in terms of both technology and data complexity. The fact that more funding is available to facilitate this can be even more incentive to do so.

In any event, let’s be thankful that more and more entities are starting to realize the value of HIT and making money available for its adoption. Every little bit counts.

One of the up-and-coming trends I’ve seen in the health care industry is a renewed engagement and vigor toward the integration of pharmacy utilization management and medical management among health care providers. The idea was the topic of least two presentations I attended at various conferences in the past year, and now seems to be gaining real momentum.

With the growing use of extremely expensive biological medication therapies, or “specialty pharmacy medications,” health plans are increasingly realizing the benefits of bringing pharmacy back into the core health management process. Given their high cost and the complexity of their indications, specialty pharmacy medicines generally require a case manager’s manual review. It therefore behooves the plan to ensure that the medication is going to be appropriate; that other, less expensive treatments have been attempted and that the medication is being used for its intended purpose (as opposed to an off-label use).

Further strengthening the integration of pharmacy and medical management has clinical benefits as well, not the least of which is providing a more complete, holistic view of patients. For example, with information sharing technology, disease managers and/or physicians can be alerted when a patient has filled a prescription from a specialist or other physician. Obviously, this would enable the disease manager or primary physician to determine potential interactions or simply be aware of the new medication and how it fits into the patient’s overall care regimen. Alternatively, it could underscore medication “gaps” so to speak. The disease manager or physician could be alerted when a patient hasn’t gotten a scheduled refill and then contact the patient to determine the reason. Also, sharing this information with a pharmacist incorporates the input of a medication expert who might offer suggestions on alternative or complimentary treatments. .

Naturally, health information technology will play a large role in the success of pharmacy/medical management integration. It will be the means through which the respective entities — insurers, physicians, pharmacies and even patients themselves — will be able to communicate and share information. This is precisely the type of scenario we at MEDecision had in mind when we designed our new Nexalign collaborative health care exchange technology. One of its core competencies is to facilitate secure, private and trustworthy electronic information connections between various health care constituencies, so this emerging trend is a very satisfying validation of our market forecast, if you will. It will be very interesting to see how this plays out in the coming months.

There was some encouraging news for the health IT sector in recent days with two interesting reports showing growth in HIT adoption and usage.

Jason Mitchell, MD, a technology expert with the American Academy of Family Physicians told the group’s Scientific Assembly that AAFP doctors have passed the stage of discussing health IT adoption and implementation and are now more concerned about how to deploy technology to optimally benefit their practices. Dr. Mitchell said at least 40 percent of AAFP docs are using EHRs and that another 11 percent are in the process of adopting them. Granted, Dr. Mitchell also reported that the doctors are having a hard time seeing the value proposition in health IT and are skeptical about ROI, but these numbers are certainly encouraging.

The research firm Datamonitor released a report earlier this month indicating that while IT budgets in general are getting smaller, the trend isn’t true for health IT. In fact, health care is planning to spend more on IT in the coming year. The downturn in overall IT spending isn’t that great a surprise, as IT spending has been declining in recent years. But it’s obviously very encouraging on many levels that health IT isn’t following suit.

Clearly more and more people are seeing the value of technology in health care. And this comes in the face of what are some of the most troubling economic conditions we’ve seen in many years. That bodes quite well for our industry but by no means is this the time to claim victory. We still have a very long way to and a lot more work to do. Maybe the change of administration in Washington in a few months can give our efforts a boost. At any rate, it’s very nice to see that the work we’ve done to this point is paying dividends. A little positive reinforcement is always welcome.

In two blog entries earlier this year I discussed the emergence of the Medical Home concept in health care. I mentioned back then that I felt the issue was one worth keeping an eye on because it was beginning to build a lot of momentum. An article I read recently week suggests that the idea has permeated the mainstream and that it is generating quantifiable results even faster than I had anticipated.  

I think it’s worth reiterating what I wrote in the earlier blogs about the Medical Home being an outstanding opportunity for health IT. In short, the Medical Home relies on a primary care physician to oversee and coordinate all of an individual’s care. The thinking is that by being the lead physician on a medical “team” of sorts, the primary doc can help streamline care: fewer unnecessary tests, more open communication with other providers, less waste, better care quality, improved outcomes and so on. There are any number of technical systems already in existence to help facilitate the communication necessary for the Medical Home to work optimally. And we can by all means work closely with Medical Home initiatives to customize these technologies and/or to design new ones as needs dictate going forward.  

It’s definitely good to see the Medical Home concept gaining momentum, because it’s a really good idea. With the proper involvement of technology, we can make it an even better one.

The many lessons learned in the wake of Hurricanes Katrina and Rita in 2005 are even paying benefits in the health IT arena. Drawing on its experiences with the two massive storms three years ago, Ochsner Medical Center in Louisiana, was well prepared when Hurricane Gustav hit earlier this month. The facility had back-up generators in place and was able to remain open all the while Gustav was wreaking its havoc. Those generators enabled Ochsner to keep its electronic medical records powered and in use, which officials reported to be most advantageous. The EMRs allowed emergency docs to more quickly treat those who came in with storm-related injuries. Physicians had a better sense of patients’ medical situations thanks to the availability of medical histories, pre-existing conditions, medications and all of the many other details EMRs provide.

The situation brought back vivid memories of a very special project we here at MEDecision were involved in with Blue Cross Blue Shield of Texas during Hurricane Rita in ’05. We worked around-the-clock for two days to create payer-based health records for BCBSTX’s 830,000 members who were potential evacuees from the approaching storm. The BCBSTX technical staff gathered claims data for members who lived in the zip codes in the Texas coastal areas. They then turned that information over to our people who organized and processed it using our clinical validation rules to create clinically enhanced payer-based health records for the affected members. When Rita stormed ashore, BCBSTX members had their clinical histories available through their insurer for use by their doctors should the need arise far from home. Three short years later, this initiative has become established procedure for a number of insurers. In fact, we recently worked with HCSC to ensure that Patient Clinical Summary records were in place for potential Gustav and Ike victims, even extending our reach into parts of Oklahoma. What’s interesting (and encouraging) is that, back in ’05, our work with BCBSTX was a momentous thing that garnered media and Congressional attention. Now it’s pretty commonplace for us. Definitely a sign of progress! 

This all goes to illustrate the tremendous impact health IT can have on our health care system and, more importantly, our society — particularly in times of crisis. Imagine the elderly person who has to evacuate their home, winds up somewhere 100 miles away and needs medical attention. Normally the treating physician would have to rely on patient-provided background and the limited conclusions of a brief examination. As evidenced in the Ochsner case, the presence of EMRs puts much more thorough and detailed information at doctors’ fingertips, meaning that more displaced hurricane victims can receive better treatment.  Of course, the prevailing hope is that we would never need EMRs for this purpose going forward, but when we do, it’s comforting to know that the technology is in place to assist people in what is likely their time of greatest need.