How Health IT Meets MLR (http://bit.ly/dUNmJ6)

At first glance, the new medical loss ratio (MLR) mandates may seem daunting for health plans, but the Department of Health and Human Services (HHS) has outlined a number of care and quality improvement measures that fit the bill. As promised in my previous blog, today we'll take a quick look at these categories and discuss how health plans can utilize new health information technologies to meet some of these requirements, while improving care and reducing costs. Here are the five categories:

1.      Improve Patient Safety and Reduce Errors

This category includes expenses for the identification and use of best clinical practices to avoid harm; and the identification, and encouraging the use of, evidenced-based medicine in addressing independently identified and documented clinical errors or safety concerns. It also includes lowering the risk of facility acquired infections and prospective drug utilization review aimed at identifying potential adverse drug interactions.

2.      Wellness and Health Promotion Activities

This includes expenses for wellness assessment and lifestyle coaching programs; coaching programs designed to educate individuals on managing a chronic disease or condition; public health education campaigns performed in conjunction with state and local health departments; and actual rewards, incentives, bonuses or reduction in co-pays.

3.      Improve Health Outcomes

This is intended to promote the direct interaction between the health plan, providers and members to improve health outcomes. It includes things like case management, chronic disease management, care coordination, patient-centered medical homes, and medication and care compliance.

4.      Prevent Hospital Readmissions

This means any activities to prevent readmissions, including: comprehensive discharge planning and personalized post-discharge counseling by an appropriate healthcare professional.

5.      Utilize Health Information Technology for Healthcare Quality Improvements

This includes expenses for monitoring, measuring or reporting on clinical effectiveness; tracking outcomes of specific medical interventions; providing electronic health records and patient portals; and advancing the ability of enrollees, providers and health plans to communicate patient clinical or medical information rapidly, accurately and efficiently to determine patient status and avoid harmful drug interactions or direct appropriate care.

This last category is significant, not only for MEDecision and companies like ours, but for the whole of healthcare. By making health information technology (IT) a large part of the medical component of health plan expenses, HHS is clearly promoting it as a central component in achieving its recommended quality and clinical goals. Like reform itself, this significantly endorses IT and its potential to transform our healthcare system.

MEDecision's experience and innovation position us quite well to meet the market's need for technology that facilitates quality improvements and compliance with MLR mandates. Our products are designed so that payers and other healthcare organizations can harness the power of knowledge and information to enable the best clinical decisions and improve health outcomes. They are built on a patient-aware philosophy that puts the individual at the center of the healthcare universe and supplies those involved in their care with simplified access to more complete information, wherever they need it, whenever they need it, and through virtually any format and delivery method they desire.

According to the new MLR definitions, MEDecision's solutions can be classified as a medical expense — specifically ‘health information technology related to health improvement and/or quality improvement'— which will help health plans meet their obligations under the new directives. They can also provide a long-term competitive advantage by serving as a strategic foundation for health plans building the differentiated programs and models they need to thrive in this new era for healthcare.

It's very inspiring for us to see that the approach we've taken as a company for the past two-plus decades has now become the backdrop for health plans' growing need to engage consumers and providers with knowledge that optimizes consumers' health, improves outcomes, eliminates redundant tasks and reduces the cost of care. Our end-to-end health management solution suite is intended to: gather pertinent medical information from multiple sources, transform all sources of data into knowledge using analytics and intelligence, and deliver programs and alerts that streamline care and effectively engage consumers.

We believe our solutions and philosophy give health plans the strategic platform they need to focus on quality, streamline care and effectively engage providers and consumers in the MLR era of healthcare. Our technologies make it easy for insurers to not only comply with the new mandates, but to adapt and change as needs dictate in the long-term. And in today's healthcare environment, that's a definite advantage to have.

What do you think of the new MLR categories defined by HHS? Where would you classify health management technology? Do you think the new MLR definitions will spur greater investment in HIT?

We talk more about the new MLR mandates in the second of our new series of e-books called MEDecision Insights. I invite you to download your complimentary copy of "Medical Loss Ratios: Important Implications for Care Management" and share your thoughts with us today. Get your e-book here: http://www.medecision.com/insightseries.