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Ensuring that Payers Get the Best Treatment from Healthcare Technology

Chuck Parker

Healthcare and technology are becoming increasingly interwoven, here is how to make sure to get the best out of this new frontier.

When healthcare reform became law early this year, insurers realized the need to increase efficiencies to reduce costs had become stronger than ever.  While the approximately 30 million or more new members gaining coverage increases volume and revenue, it also strains providers, stretching their resources and adding pressure on the bottom line. The aging population, projected to account for more than 20 percent of the total population by 2050, coupled with a shortage of physicians, predicted by the Association of American Medical Colleges to range between 124,000 to 159,300 by 2025, increases the burden. These challenges present the opportunity for health information technologies to improve efficiencies, quality and access while reducing costs.

Restructuring the Healthcare System

National health spending is projected to have grown 5.7 percent in 2009 to $2.5 trillion, despite a decline in GDP of 1.1 percent due to the Great Recession.  As a result, healthcare’s share of GDP is expected to rise to 17.3 percent.  This increase represents the largest one-year rise in healthcare’s share of GDP since this record keeping began (Health Spending Projections through 2019: the Recession’s Impact Continues, Health Affairs March 2010). Current health spending, which is two-to-three percentage points above economic growth, is clearly not sustainable.  Many argue that restructuring the healthcare system is the only long-term viable option. They argue that the system would be most efficient if organized around integrated networks of care best suited to ensure top quality while minimizing costs, accompanied by payment reform that would align financial incentives for providers (Payment Reform Options, Health Affairs, January 27, 2009).

An efficient payer system along with quality member care must be in place in order to bring about cost-effective reform.

Using Telemedicine to Bring About Reform

Health information technologies improve claims processing for insurers and help payers introduce and manage health and wellness programs for their members.  These help enhance payer productivity and efficiency, reduce overall costs and soften and improve the public image of insurers among consumers.

Recent innovations in telemedicine and personal connected health technologies are allowing insurers to become more closely aligned with healthcare consumers and providers as more healthcare consumers, including the elderly, express a desire to stay in their homes while dealing with chronic illnesses.  This alignment through technology, whether wired, wireless or mobile, enables payers to be a more intimate part of the healthcare consumer/physician dynamic, offering them information regarding duplication of therapeutic or diagnostic services along with a clearer picture of how care is provided. It also allows for a comprehensive understanding of costly populations, improves knowledge of individual healthcare consumers and provides accurate and timely data to help providers better manage chronic conditions like diabetes and asthma.

Personal connected health can significantly reduce the overall cost of medical treatment by keeping people in the home as opposed to in the hospital, reducing readmissions or preventing unnecessary emergency room visits. It can help ensure better adherence to a medication regime, exercise routine or rehabilitation schedule. Early adopters of personal connected health are capitated managed care organizations, integrated delivery systems, home health agencies and disease management companies (“Trends in Remote Patient Monitoring 2009”, Spyglass Consulting Group, Menlo Park, CA, March 2009).

Personal connected health technologies also facilitate shared responsibilities among healthcare consumers, physicians, nurses and insurers, improving compliance with treatment plans.  They could modify the behaviors of those with chronic illnesses such as diabetes, asthma, hypertension, and kidney and cardiac illnesses, improving outcomes and reducing costs to insurers.  The Patient Protection and Affordable Care Act includes coordinated care provisions for telehealth, personal connected health and virtual care. It allows “accountable care” organizations to use telehealth, personal connected health and other enabling technologies and describes the use of EHR, and a Medical Home for coordinated care through primary care physicians that may use health information technology to link services virtually.

An Ecosystem of Interoperable Personal Telehealth Solutions

Numerous vendors, countless overlapping products, and a lack of customer guidelines for understanding the products’ functions and availability contribute to the need for a certification process to ensure interoperability.

Such guidelines unite the multitude of available personal connected health technologies around existing standards that insurers, consumers, physicians, and other stakeholders can trust. For connected health monitoring to fully blossom, companies must cooperate to guarantee interoperability and a consistent mode of communication to transmit data.

Open standards allow quality healthcare and help adjust for the changes resulting from federal healthcare reform.  The increase in available data facilitates tailored approaches to motivate healthcare consumers and ensure appropriate levels of care. The expanded use of available technologies in the home allows insurers to play an integral role in connected personal health solutions, in turn, connected personal health solutions have a strong potential to increase member satisfaction leading to higher retention and enrollment rates.

Nonprofit, open industry organizations are creating an ecosystem of interoperable personal telehealth solutions and defining use cases to help communicate the benefits of such technologies. Companies that align themselves with these groups are establishing and fostering the highest existing standards and guidelines aimed at enabling open communication among health technologies in the home.

Continua Health Alliance is a non-profit, open industry coalition of healthcare and technology companies collaborating to improve the quality of personal healthcare. With more than 230 member companies around the world, Continua is dedicated to establishing a system of interoperable personal health solutions with the knowledge that extending those solutions into the home fosters independence, empowers individuals and provides the opportunity for truly personalized health and wellness management. Through working with Standards bodies and industry experts, Continua publishes certification standards built upon international criteria from IEEE, HL7, Bluetooth, USB, and others.

As the Executive Director, Charles (Chuck) Parker leads the many workgroups and day-to-day operations of the Alliance. Mr. Parker has over 20 years of experience in healthcare technology, policy, and the strategic design of evaluation and measurement strategies. He has led national programs for practice transformation and has served on national committees for assessing adoption requirements.

About The Author

Mr. Parker holds a Master of Science degree in Healthcare Informatics from Northeastern University. He earned his BA in Communication Studies and Business Management at Texas Tech University in Lubbock.

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