http://www.mceg.net Mon, 18 Mar 2013 18:14:38 +0000 en-US hourly 1 http://wordpress.org/?v=3.5.1 http://www.mceg.net/health-insurance-exchanges-hixs/ http://www.mceg.net/health-insurance-exchanges-hixs/#comments Mon, 11 Mar 2013 19:49:04 +0000 admin http://www.mceg.net/?p=830

Health Insurance Exchanges (HIXs) will be a key component of health reform but structure will vary widely by State and be impacted by whether each State decides to participate.

Efforts to address governance, budgets, legal/privacy issues, technical infrastructure, and business /technical operations will be important for the success of HIXs.

Consumer interests and health plan opportunities could create robust wholesale and/or retail channels, with or without public or private exchanges.

The trend by employers to move from “defined benefits” to “defined contributions” and contribute less to healthcare costs will be accelerated by the exchange.

Health plans will struggle as to what products at what price to offer but will find effective distribution channels as they build or participate in public or private exchanges

Fears will continue about adverse selection, administrative costs, movement in/out of Medicaid and how to align benefit plans with behavior and buying preferences.

Subsidies and other exchange programs will complicate employer and individual decisions.

]]> http://www.mceg.net/health-insurance-exchanges-hixs/feed/ 0 http://www.mceg.net/reform-regulation-and-market-uncertainties/ http://www.mceg.net/reform-regulation-and-market-uncertainties/#comments Tue, 12 Mar 2013 15:19:57 +0000 admin http://www.mceg.net/?p=1126

Health reform and changing regulations will require close attention by health plan executives.

Compliance to specific reform regulations, as they develop and/or are refined, could result in new agencies, programs and projects that will impact health plan operations and costs.

Unique state and regional market differences, personalized collaboration tools, privacy technologies and social media will play an increasing role in the future for health plans.

State and Federal budget constraints and the slow recovery will limit program flexibility and will have a significant impact on health plan strategy, operations and market positioning.

Health plans will have to incorporate scenario planning around the uncertainties and allocate resources to contingencies that might affect their market positioning and growth strategies.

Coordination of NCQA/URAC/HEDIS, Meaningful Use, Provider Quality Reporting and other State, Industry or private initiatives and reporting requirements will benefit all stakeholders.

States variations in employer-sponsored insurance, Medicaid, and personal income distribution will impact insurance and information exchanges, mandated benefits and other programs.

The State/Federal tug-a-war over support, standards, programs, intervention and regulation will have significant impacts on payer operations, costs and market strategies.

More fines and regulatory penalties by will increase litigation costs and complicate health plan operations independent of the potential for cost savings with malpractice reform.

Increased government scrutiny of and pressure on premium increases will result in a new emphasis on affordability for all healthcare stakeholders.

]]> http://www.mceg.net/reform-regulation-and-market-uncertainties/feed/ 0 http://www.mceg.net/consumerism-driving-health-care/ http://www.mceg.net/consumerism-driving-health-care/#comments Mon, 11 Mar 2013 19:47:58 +0000 admin http://www.mceg.net/?p=826

Patients will become more engaged and responsible for care and health and will force the industry to compete on convenience, price and quality transparency.

More technology savvy consumer will drive how information is presented, utilized and shared.

Consumer focused service, loyalty programs and sophisticated pricing strategies will be needed to meet consumer needs and wants.

Other integrated, web-based technologies will increase the consumer’s engagement and involvement in product offerings, benefit design, cost, access and convenience.

The shift from the employer to individual market will identify and prove out new ways to influence behavior and be more flexible, quick and nimble with new product development.

New data (purchasing patterns, financial and demographic information, social connections) integrated with healthcare will help understand what consumers like and want.

The technology to continually update and redirect healthcare efforts will reflect more retail activities and services being orchestrated in a cost effective and efficient way.

Benefits for spouses, families and/or retirees will continue to decline or cease to exist because of the rising costs of healthcare and exchanges will cloud and complicate family coverage.

Electronically extending sales and service channels directly to the member will enable them to search and select benefits that are right for them and then purchase and be serviced on-line.

Interest in high deductible, consumer directed health plans with tax-preferenced HSAs for out-of-pocket expenses, will continue to grow.

]]> http://www.mceg.net/consumerism-driving-health-care/feed/ 0 http://www.mceg.net/care-management-data-analytics-and-informatics-to-improve-outcomes/ http://www.mceg.net/care-management-data-analytics-and-informatics-to-improve-outcomes/#comments Mon, 11 Mar 2013 19:46:56 +0000 admin http://www.mceg.net/?p=823

EMRs, computerized physician order entry (CPOE), e-prescribing, on-line reporting, appointment scheduling and other care coordination technologies will catch on.

Wellness, disease management, mental/behavioral health support systems, real-time decision-support, case management, customer segmentation, and protocol/rules will continue to grow.

Real-time, actionable, operational, clinical insights will help to eliminate errors, better identify care options, improve outcomes, and lower costs.

Clinical information will be broad and deep, enabling caregivers to more precisely identify diagnoses, target treatments and develop personalized care plans for each patient.

]]> http://www.mceg.net/care-management-data-analytics-and-informatics-to-improve-outcomes/feed/ 0 http://www.mceg.net/medicare-medicaid-and-other-government-programs/ http://www.mceg.net/medicare-medicaid-and-other-government-programs/#comments Tue, 12 Mar 2013 15:15:07 +0000 admin http://www.mceg.net/?p=1109

CMS’s shift to reimbursing for improved clinical outcomes and constituent satisfaction makes it critical for Medicare Advantage plans to identify and track Risk Adjustment and Quality gaps.

Medicaid increases are creating new burdens for already-strained State and Federal budgets with little flexibility for more consumer-friendly and/or taxpayer friendly systems.

The large number of HHS waivers granted is promoting new pressures for change and Governors are demanding significantly larger roles in how each State develops under reform.

Individual market expansion will continue in Medicare, Medicaid and grow with HIXs.

Declining Medicare and Medicaid payments will further compound industry financial stability.

]]> http://www.mceg.net/medicare-medicaid-and-other-government-programs/feed/ 0 http://www.mceg.net/new-provider-payment-models-delivery-systems/ http://www.mceg.net/new-provider-payment-models-delivery-systems/#comments Tue, 12 Mar 2013 15:17:06 +0000 admin http://www.mceg.net/?p=1116

ACO partnerships and quality collaborations could be vital to maintaining a reasonable risk profile and cost effective overall population health management.

Centers of Excellence and specialization in narrowly defined treatment areas could reduce major medical costs, including domestic and/or International “medical travel.”

With enhanced clinical interaction, coordination and bundled payments, more providers will consider new care delivery structures and systems such as ACOs and PCMHs.

Healthcare will evolve from uncoordinated, encounter-based systems to structures that are more accountable, reliable, integrated, patient-centered and quality-based.

How PCPs get compensated may define a “middle ground” for both legislators and healthcare stakeholders and gain provider agreement on quality, cost, efficiency and incentives.

Patients will demand cost and quality-of-care data about providers for value-based purchasing.

The technology and data to allow providers, patients and health plans to access robust, secure information and have systems to understand implications will continue to expand.

Comparative effectiveness, peer grouping, provider report cards and advanced predictive modeling will offset competing interests and capabilities as more transparency is required.

The transition will continue from a volume-based past to a value-based future.

]]> http://www.mceg.net/new-provider-payment-models-delivery-systems/feed/ 0 http://www.mceg.net/operational-overload-and-competing-priorities/ http://www.mceg.net/operational-overload-and-competing-priorities/#comments Tue, 12 Mar 2013 15:17:43 +0000 admin http://www.mceg.net/?p=1118

Health plans have too many operational issues and not enough resources to address them all.

Opportunities could come at a high price in how to not lose more than is gained.

Forced or pressured decisions may be replete with potential “unintended consequences.”

There is a growing requirement to be able to move quickly, be more responsive to change and absorb and integrate all the required technology and other capacities needed to growth.

More and better project management and support in how to prioritize competing and conflicting mandates and other market requirements will be needed.

]]> http://www.mceg.net/operational-overload-and-competing-priorities/feed/ 0 http://www.mceg.net/social-media-mobility-byod-and-digital-health-technology/ http://www.mceg.net/social-media-mobility-byod-and-digital-health-technology/#comments Tue, 12 Mar 2013 15:20:26 +0000 admin http://www.mceg.net/?p=1128

Hand held devices, smartphones, and apps will track activity, remind members of appointments, medication refills, and present diagnostic links and personalized videos.

Enterprise-wide programs, strategies and analytical tools will be needed to plan for social media and apps that improve consumer engagement and facilitate “social health.”

Twitter, Facebook and other social media for connecting people with shared healthcare experiences will expand, but also create patient privacy risks if not used properly.

Personalized, timely and readily available access (mobile, email, live calls or IVR) will increase healthcare’s ability to serve consumers the way they want and when they want.

Workflow integration, web-enabled applications and digital health devices will provide care givers and patients with more self-service capabilities and improve healthy living.

Mobility will increased data availability, engage more patients and improve health outcomes.

Readily available information such as location, personal situation and/or recent inquiries will augment and target individual specific services and solutions.

Health plans will need to create, deploy and expand effective tools to tap the social media and wiki market opportunities and to maintain brand loyalty.

Technologies will enable members to search and select benefits that are right for them and then purchase and be serviced on-line or via mobile devices.

Health plans will need enterprise-wide application integration and automated processes to connect web portal to insurance, enrollment, sales, customer service and premium collection.

]]> http://www.mceg.net/social-media-mobility-byod-and-digital-health-technology/feed/ 0 http://www.mceg.net/innovation-and-collaboration-of-business-and-it-for-competitive-advantage/ http://www.mceg.net/innovation-and-collaboration-of-business-and-it-for-competitive-advantage/#comments Mon, 11 Mar 2013 19:50:35 +0000 admin http://www.mceg.net/?p=836

The CIO will become the “Chief Accelerator Officer” and will partner with business executives to address critical path issues such as costs, speed of operations, design, execution and value.

User interfaces with windows, apps, icons, menus and pointers are being replaced by mobile tools such as touch, hand gestures, robust search and even voice and video applications.

Health plans not focused on “innovation to respond” will be slower than their competitors and unacceptably out of touch.

Breakthroughs in collaborative innovations will pioneer paths to new business models, new value propositions and competitive advantages.

Information flows among systems, departments, members, providers and plans will require management and technology to track transactions and ensure high service and satisfaction.

]]> http://www.mceg.net/innovation-and-collaboration-of-business-and-it-for-competitive-advantage/feed/ 0 http://www.mceg.net/hiring-engaging-and-empowering-staff-for-the-21st-century-workplace/ http://www.mceg.net/hiring-engaging-and-empowering-staff-for-the-21st-century-workplace/#comments Mon, 11 Mar 2013 19:50:05 +0000 admin http://www.mceg.net/?p=834

Finding the right healthcare professionals will become increasingly challenging.

Staff will need more astute expertise in social media capabilities and technologies to effectively create tools and systems, manage BYOD (Bring Your Own Device) and other skills.

Gaining great customer loyalty, tapping the new market opportunities, and leading the way in market innovation will require all professionals to grow and develop new skills.

Acquiring the needed combination of talents will be a challenge in moving healthcare into the 21^st century.

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