In a recent blog, we wrote about our colleagues from MEDecision and DC Chartered Health Plan presenting a case study at the AHIP Medicaid Conference in which they analyzed Chartered’s successful implementation of our Alineo technology. On Wednesday, October 21, we conducted a webinar that, in essence, was the same presentation but intended to enable a even broader audience engagement. For those of you interested in having a look, the webinar is archived here.

Chartered’s situation is one of the more compelling we’ve come across in recent years (hence its being the subject of a presentation and webinar). In order to have its Medicaid contract renewed, the insurer was given a 90-day deadline to comply with certain disease management requirements, particularly HEDIS and NCQA. Chartered’s dated legacy system wasn’t up to the task and, in fact, was the reason the company was facing being out of compliance in the first place. 

At the same time Chartered was experiencing a significant influx of new members attributed to growing unemployment rates. And as we all know, Medicaid populations are among the most complex. The insurer decided it was time for a comprehensive new care management technology, so it carefully explored options and selected Alineo. The solution is a perfect match because it was specifically designed to do the things Chartered identified as its biggest needs: it streamlines operational efficiencies, reduces waste and improves care quality through enhanced business agility, controlled costs and better risk and compliance management.

But I suppose this is stealing thunder from the webinar. I encourage you to take a look at it for all the details. It really is a great story and one that can be replicated for others.

Last week, Matt Adamson, vice president of MEDecision’s Interoperability Competency Center joined Dr. Joe Nicholson, Chief Medical Officer of Blue Cross Blue Shield of Oklahoma to conduct two outstanding sessions at the IDC Health IT Insight Summit conference held in Savannah entitled “Using Technology to Facilitate the Medical Home.” They presented a case study of a patient centered medical home pilot project BCBSOK and MEDecision are currently working on for Oklahoma. Matt and Dr. Nicholson provided excellent insights on the details of the initiative, particularly the obstacles that may have to be overcome in planning and execution, and an insightful analysis of its anticipated benefits.  

The presentation was met with great enthusiasm by those in attendance which I think is due in large part to the role that the medical home model is anticipated to play in supporting health care reform efforts. The concept has clearly been gaining significant traction and momentum over the past year or two and, as the MEDecision/BCBSOK pilot exemplifies, has outstanding potential to bring increased efficiencies and cost containment to the system. As Matt and Dr. Nicholson explained, incorporating technology into the equation makes the model even more promising. In addition to facilitating more streamlined communication between care team members, IT will give each care provider consistent access to actionable clinical data along with the ability to input information generated from ongoing patient interactions that can help streamline reporting and tracking for quality assurance measures. The existence of clinical decision support and structured disease management programs will improve quality and foster better outcomes.  

The patient centered medical home model of care is a foundational approach to positively transforming health care delivery. As the MEDecision/BCBCSOK pilot progresses, we will update you on how leveraging technology augments efficiency, effectiveness and quality outcomes. It will definitely be worth keeping an eye on this particular pilot project and the overall progress of the medical home concept in the coming months.

My esteemed colleague, Dr. Alice Petrulis, Chief Medical Officer at KePRO, and I collaborated last Wednesday on a webinar discussing how KePRO has implemented MEDecision’s Nexalign iEXHANGE to reduce its overall cost-per-review and increase provider satisfaction through rapid turnaround. The company has really done some very innovative work with Nexalign iEXCHANGE on this project. It first implemented the approach with one customer in 2005 and by 2008 it had resulted in more than 90,000 auto-approvals and a cost savings of $250,000. As Dr. Petrulis explains in the webinar, KePRO is now extending the procedure throughout across its organization.

You can link to the webinar archive here.

In a recent article on the San Francisco Chronicle’s Web site, Dr. Deepak Chopra speculates that a lot of what’s wrong with health care today can be attributed to the false notion that more is better. As a society, Dr. Chopra suggests, we’ve come to believe that by undergoing more tests, receiving additional procedures, taking more drugs and seeing more doctors more often, we’ll be healthier. He offers myriad statistics to support this theory; numbers which clearly highlight the inefficiencies in our health care system and underscore the need for vast improvements.

Dr. Chopra’s statistics also make clear the need for the increased use of technology as part of our reform efforts. With proper evidence-based clinical support and intelligence tools, physicians would be better able to determine medical necessity, which would help to lower the number of unnecessary procedures and the growing costs associated with them. With electronic medical records providing a more complete picture of a patient’s medical background, it’s likely we could forego certain tests, medications and specialist visits. With a greater breadth and depth of patient information readily at hand clinicians could more quickly and assuredly make more informed decisions. That alone would support operational efficiencies and result in considerable savings.  We can also extend technology to better educate patients and enable them to make more valuable contributions to the decision making process. With greater knowledge, they themselves can help decide whether or not a certain test or procedure is in their best interest, or if the rewards of a certain medication are worth the potential risks, and so on.

These types of technologies are readily available and, given the potential return on investment, are relatively inexpensive to implement. While the debates in Washington and around the nation continue to focus on health insurance reform, it is important for all of us to understand that there are other, far less controversial and polarizing ways to generate health care reform. Technology is quite possibly the most promising and certainly a strategy through which we can begin making inroads while we argue the details of a more comprehensive plan.

With health care reform coming ever closer to reality, industry events such as the recent AHIP (America’s Health Insurance Plans) Institute in San Diego are taking on even more significance. Indeed, one couldn’t help but sense the palpable energy and enthusiasm permeating this year’s AHIP; the themes of change and reform were very apparent throughout the event. Personally, an AHIP highlight for me was the enthusiasm with which MEDecision’s Alineo™ 2.0 was met by both our existing and prospective customers. Alineo 2.0 is a very exciting new release of our already-powerful Alineo product — a collaborative health care management platform for case management, disease management and utilization management. With the new 2.0 release, Alineo is even better equipped than before to help health plans meet the challenges of the changing market. It gives them a powerful, yet simplified resource that is specifically designed to support business growth by streamlining operations, controlling medical and administrative costs and strengthening business processes while improving the overall quality of care.

There was convincing evidence at AHIP that health care "reform" and "transformation" are far more than the latest buzzwords. It’s becoming clear that after many years of speculation and debate, it’s really happening. This was uniformly apparent in the discussion lines of the outstanding presentations I attended. Among the recurring themes that stood out most for me was the idea that the system needs to be rebuilt. Not tweaked, not revised, but built anew. I also resonated with the sense of urgency that was consistently reflected; a feeling that we must initiate reform efforts now because further delay would bring additional severe detriment to the already seriously ailing American economy. Finally, there was the fundamental and pervasive recognition that reform is incredibly important. No one is taking this lightly, and rightfully so, since its outcome will impact the very quality of life in America, our economy and our standing in the world. Those are some pretty high stakes.

Thankfully AHIP was also abuzz with the sense that we can get this done. I think most in the health care sector are eager for beneficial change and to find meaningful ways of materially improving the system. This is certainly the case in health IT where, as we experienced at AHIP, organizations are actively seeking partnerships and collaborations in order to innovate and produce robust solutions to support reform. Just as the whole of health care is readying for change, health IT is clearly ready to do its part. It will be particularly fascinating and especially energizing to participate in developments during the coming months.

MEDecision recently convened its Sixth Annual Chief Medical Officer Forum (CMOF), which brought together an outstanding representation of physician executives from throughout MEDecision’s diverse customer base. The event was supported by facilitation provided by faculty members of the American College of Physician Executives. Our theme for the CMO Forum, which has been officially recognized for AMA PRA Category I CME credits, was “Navigating and Transforming the Health Care Environment.”

As one might expect with a gathering of individuals from these respective backgrounds, some of the latest “hot button” industry issues were a source of terrific dialogue. In fact, this was in large part by design. We constructed the event this year to facilitate greater discussion and interaction, and I was quite pleased with the results and feedback. I think this format served to provide a unique forum for our attendees to engage with one another, to share ideas among themselves and to draw conclusions which they could then further expand and apply according to their individual circumstances. The end-game of all of this, of course, was to empower the participants to return to their respective organizations with enhanced insights and ability to champion and influence health care transformation. And frankly, we hoped the CMOF would be a setting in which our physician executives could take some quality time out from everyday demands to immerse themselves in current issues and come away with new or strengthened ideas for developing effective solutions.

As we navigated the agenda for the day-long event, we covered a broad range of pertinent topics. The level of engagement by and sharing of insights from everyone in the room was evident and gave us valuable diverse perspectives. In the coming weeks I hope to be able to cover some of these issues in this blog so I encourage you to check back often for updates.

Overall the CMO Forum was an energizing and dynamic experience for all of us. I believe we came away with some great ideas that will help each of us as individuals, and certainly MEDecision as an organization, deftly drive opportunities in the challenging and evolving health care market.

I was very fortunate to have the opportunity to attend a good number of events at the recent HIMSS conference, particularly some very interesting workshops and keynote addresses. I also had a great deal of informal one-on-one interactions with new and familiar colleagues alike. From a clinician’s perspective, one of the points I heard with great consistency was a concern that the provider community was sorely under-represented at the event. Granted, HIMSS is a technology-focused conference that is basically for-technologists-by-technologists, if you will, but the sentiment was that it would have been better balanced with a stronger clinical contingent.  

I tend to agree. With virtually all eyes focused on how to best deploy technology to reform and transform health care, having additional experienced clinical insights at the table would have significantly benefited all of the stakeholders. Hopefully we can rectify this for HIMSS 2010 and promote a closer partnership between the technical and provider communities. This will give us a more accurate depiction of the health care universe, which can only be more helpful for everyone.  

Something I found quite inspiring at HIMSS was the very strong sense that technology companies are seeing beyond their respective niches and better understanding the downstream impact of what they do. For example, we’re now seeing companies that traditionally focus on, say, the payer segment seeking to augment their support for physicians, members and so on. This means the payer-focused company now understands how the products and services it offers impact its customer’s customers, so to speak. More and more, organizations are seeing how what they do — even if it’s a seemingly small part of the equation — fits in to the end-to-end process of improving health care. This can only mean great things for the partnerships and strategic alliances that will be necessary for us to deliver on health IT’s tremendous promise.  In all, HIMSS was great for both MEDecision and for me personally. I was thankful to experience the energy and enthusiasm of an industry preparing for a very bright future.

Over the past few months my esteemed colleague David St.Clair has been giving us regular blog updates about the growing momentum of the patient-centered medical home (or simply “medical home’ as it has come to be known in industry vernacular). I share David’s interest in this issue, and have for some time. I fully believe that the medical home approach has real potential to bring positive change to the American health care system and to make health care more effective, more affordable and more accessible for consumers.

I recently had the opportunity to attend the two-day National Medical Home Summit in Philadelphia. The event featured some of the nation’s leading medical home experts and authorities who explored the many issues and opportunities surrounding this promising concept. One thing I took away from the conference that has really resonated with me is that the medical home is no longer simply a model; it has become a legitimate “movement” thanks to increased awareness, support and readiness among the many varied stakeholders and constituents.

What’s exciting for those of us in the health information technology industry is that technology is poised to play a very big role in the proliferation of the medical home. And the timing couldn’t be better, as the Obama administration has made health care reform a top priority and endorsed technology as a primary means to bring about that change. As we learn more about the reform plans being formulated in Washington, it will be interesting to see what role the medical home will play. Will it be the primary model for change, or simply a major component? Time will tell, but given the momentum it has already generated, the medical home clearly will have some bearing on the future of health care.

David and I will be monitoring the issue and will undoubtedly blog about future developments, so check back often.

Andy Schuyler, M.D., DBFM, FAAFP
Executive Vice President and Chief Medical Officer, MEDecision