Top 10

Administrative Mandates (Compliance HIPAA 5010, ICD‐10, etc.): The implementation of the HITECH Act, ICD‐10, HIPAA 5010, and other mandates will be among the top investments in 2011; all part of administrative simplification and the drive for systems optimization and refinement to impact quality, cost and care improvement.

Care Management, Data Analytics, and Informatics: As new and more adopted technologies such as EMR’s, Computerized Physician Order Entry (CPOE), e‐prescribing, on‐line reporting and appointment scheduling become more pervasive...

Health Insurance Exchanges: Health Insurance Exchanges (HIX’s) are a key component of reform but structures will vary widely state by state – if the State decides to participate.

New Provider Payment Models & Delivery Systems (ACOs, PCMHs, etc.): ACO partnerships and quality collaborations with health plans could be vital to maintaining a reasonable risk profile and an overall cost effective population health management.

Bend the Cost Trend: Reform legislation lacks details on bending the cost trend, which is part of the underlying challenge facing healthcare.

Medicare and Medicaid: Increased Medicare and Medicaid eligibility and higher costs under health care reform are creating big new burdens for already‐strained State and Federal budgets.

Health Information Exchanges: Delivering the right information, in the right format, at the right time, about the right patient, to the right provider is a critical healthcare challenge.

Consumer’s Role in the Modernization of Health Care: From care management to how we market health care, the more technologically savvy consumer of the future will drive how information is presented, utilized and shared.

Reform Uncertainties: The recent Florida ruling, siding with 26 states in finding reform unconstitutional, will create more uncertainty and require very close attention by health plan executives.

Payer / Provider Interoperability: Prior authorization and utilization reviews are fading, and in their place will be more collaborative models based on real‐time eligibility, benefit verification, Rx interactions, access, quality, safety, effectiveness and patient centeredness.