How Health It Meets Mlr ( http: / / bit. ly / dunmj6 )

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 well take a quick glom at these categories and discuss how health plans can exercise new health information technologies to meet some of these requirements, while contributive 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 imminent drug utilization review aimed at identifying hidden 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 feature; public health education campaigns performed in liaison with state and local health departments; and actual credit, 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 equivalent case management, chronic disease management, care assembly, 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 diagnostic post - discharge counseling by an convenient healthcare polished.

5. Bestow 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 opt patient station and avoid harmful drug interactions or direct becoming 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 great part of the medical component of health plan expenses, HHS is decidedly promoting it as a central component in achieving its recommended quality and clinical goals. Alike reform itself, this significantly endorses IT and its conceivable to transform our healthcare system.

MEDecisions experience and innovation position us fairly well to meet the markets 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 bent of learning 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 configuration and delivery rule they desire.

According to the new MLR definitions, MEDecisions solutions can be classified as a medical equivalent specifically health information technology congenerous to health improvement and / or quality improvement which will help health plans meet their obligations underneath the new directives. They can also proffer a long - term competitive advantage by powerhouse as a planned foundation for health plans building the differentiated programs and models they need to maturate in this new era for healthcare.

Its very inspiring for us to see that the approach weve taken as a company for the foregone two - plus decades has now become the backdrop for health plans growing need to admit consumers and providers with education that optimizes consumers health, improves outcomes, eliminates unnecessary tasks and reduces the cost of care. Our end - to - end health management solution suite is intended to: heap 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 trust our solutions and philosophy give health plans the planned 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 clinch with the new mandates, but to adapt and change as needs command in the long - term. And in todays healthcare environment, thats a definite advantage to have.

What do you visualize of the new MLR categories specialized by HHS? Where would you classify health management technology? Do you hold 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 freebie 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.