Value based insurance design (VBID) translates to lowering barriers to valued services. For chronic patients it means easier access to medication and primary care that will help them manage their disease and reduce the risk of hospitalization. A comprehensive care plan for the patient will capture the necessary interventions and opportunities for closing gaps in their care. The care plan in essence contains many of the valued services for a given patient. A benefit administration system can interface with a care management system and define benefits that are fine tuned to the patient based on that patients plan of care.
Using SMS or texting to keep in touch with your members
March 29, 2010 — samText messaging has become a very efficient means of sending short and quick communications. Alerting a member about an appointment in a PCMH scenario or alerting a diabetic about a missing foot exam in their treatment plan has high impact when delivered directly into their cell phones. Further for some populations like Medicaid, cell phones are the only means of being connected to the online world. In Jiva we have this capability built into the core platform. The integration is seamless without having to involve multiple vendors. The sentinel rules engine has built in rules to automatically send out communication based on members preferences. A care manager can send text messages to the patients phone and help overcome the challenges that come with traditional voice based methods.
Eliminating caps and impact on medical management
March 18, 2010 — samIf the senate bill on health care reform is passed this week by the house an immediate change that will impact insurers is the elimination of caps. Insurers will not be able to place any caps on how much they will cover. This means complex case management will become an important process to manage costs. We all know care co-ordination cuts down on medical loss . Access to real time tools that empower case managers will become important. Events that occur in a patients care months before a claim hits should drive work flow for case management . In Jiva we tie events to multiple data sources and help case managers intervene sooner than later.
Health information exchanges and EHR explosion
March 17, 2010 — samHHS has released close to $600 million in funding to help states build HIE’s. These efforts seem to be directed around NHIN Direct and reuse of the standards being recommended as part of NHIN. Using this infrastructure HL7, LOINC,DICOM and CCR formatted data may be exchanged based on a peering relationship. This exciting development is coinciding with the roll put of EMRS at providers nationwide. All of a sudden the promise of health connectivity is almost palpable. Both the structured data source and the plumbing is coming together. Payers will now have the ability to engage providers and effect a change in work flows around a comprehensive EHR. Chronic care management can improve with standardized information infrastructure to support it. There is going to be a gold rush and the winners will be those who set realistic goals and expectations around this major shift in the health care management landscape.
Care management software vendors impacted by the HITECH act
February 27, 2010 — samBuried in the details of the HITECH Act of 2009 are changes to details of the HIPAA data privacy and security requirements. To date care management software vendors were business associates to covered entities like health plans and were liable to the covered entity. The recent changes will now subject these vendors to the same civil and criminal penalties as covered entities. Care management and analytics are by nature involved with PHI. The weakest links are any processes and employees involving PHI and access to the environments of covered entities. Risk mitigation is a good strategy to pursue by ensuring that all PHI exported out of covered entities are effectively de-identified before transmission. This is the safest way of ensuring that stolen or lost laptops which are by far the source of most breaches can be avoided. Enforcing security policy has now become more important than ever before for care management software vendors.
encrypted email and care management
January 26, 2010 — samOne of the challenges in communicating with net savy members is the sensitive nature of PHI and unencrypted email. A care management platform should be able to support this requirement without requiring users to register for encrypted email services or require a specific platform. Making it seamless and idiot proof is important. For example you can send encrypted attachments using personal information such as date of birth as a password. Some banks already send statements in this fashion. Supporting this technology in care management software has significant impact on cutting costs for payers who send communication to their members via traditional mail .
