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TECH/HEALTH PLANS: Quick recap on PHRs and consumer health care

Yesterday I ran a panel at Teradata’s partner conference in MickeyMouseville, FL. On the panel were Liz Dudek from Medstat, Jill Burrington-Brown from AHIMA and David Cochran from Harvard Pilgrim health plan.

Pretty interesting conversation. David is particularly fun and funny. He thinks that consumers are being driven to the CDHP and have no real interest in it. Liz thinks that PHRs based on claims are going to be introduced by many more employers this fall. Jill is out educating anyone who listens about PHRs, but we all agreed that a unified consumer view of all their data is far away.

Funnily enough I was the most optimistic—I think that PHRs will be relatively common (15–20% uptake in 5–7 years?). Harris apparently said that it’s now 7% but I don’t believe that number. But after Wellpoint and United started providing it to their members

David had an interesting parsing out of the functions being lumped in a PHR

a) Communication transactions with physicians (appointment setting, refills, online visits)b) Information relevant to individuals health (Rx, Healthwise et al)—the Information therapy piecec) Financial transactions (EOB, related accounts)d) One other that I’ve forgotten!

His point is that not all organizations can do all pieces. The physician transaction piece is tough for a health plan, but is the most popular part of the PHRs run by Group Health, Caregroup, PAMF et al. So as in much of health care, expect spotty and varied implementation.

I agree, but I think that if the plans get serious about this it’ll force the providers to get involved. We shall see.

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  1. South Carolina’s new (improved?)proposed Medicaid Transformation Plan is built around a Medicaid beneficiary’s PHR. The PHR will be built around Medicaid’s claim data on the beneficiary. Enrollment counselors will “assist” the beneficiary in selecting the managed care plan that best meets his/her individual needs based on his/her PHR. I think this is a bit like having the DMV clerk tell you which car to buy based on your driving record.
    Providers will also have access to the Medicaid beneficiairy’s PHR. I’m still not sure how they coordinate this PHR with the current EMRs the practices may have in place.
    I’m also not certain how this will $ave money. But I do love that our Libertarian/GOP Gov is spouting a Medicaid Transformation Plan designed around the concepts of HillaryCare circa 1994/95.

  2. PHR is personal health record….if you search this site you’ll find that I’ve used that term many times
    Emdeon sold Medical Manager recently–the WebMD PHR is sold to a completely different client set. So I am very unsure what you are going on about SBD.

  3. Take a look at Emdeon, the company that owns WebMD and the former Medical Manager and the secret VIPs service they offer to top clients.
    Early Warning Detection
    Our overpayment and fraud protection approach begins with Emdeon STARSentinel and its early-warning healthcare detection that can help identify duplicate claims, falsified procedure codes, false diagnosis codes, upcoding, over utilization of diagnostic procedures and a long list of other common fraud tactics.
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    Reliable.
    Emdeon STARSentinel applies a rules-based methodology to call your attention to claims that differ dramatically from a provider’s past history or from the norms for a given condition or specialty.
    Value.
    With its built-in business intelligence, Emdeon STARSentinel not only identifies possible fraud, but also shows you the impact on your business. It’s affordable, and its analytic tools let you drill down to individual claims and target the “next steps,” ranking priorities where they will produce the greatest return on investment (ROI) and optimize resource efficiencies.
    Flexibility.
    Emdeon STARSentinel is easy to use, based on familiar web-based browser interfaces and extensive rules-based analysis. Your staff won’t need special knowledge of data processing, statistics or fraud patterns because up-to-date schemes are built in to the software. Plus, all required questions and reports are incorporated. It’s highly flexible, and you can customize it to meet precise needs.
    Data Warehousing & Analysis
    For more advanced investigation, Emdeon STARS offers the most complete and fully integrated care analytics solution for overpayment and fraud protection in the marketplace. With our anti-fraud solution, health payers receive critical decision support and the guidance needed to address loss identification and recovery.
    Emdeon STARS® – the most complete and fully integrated overpayment and fraud protection solution in the marketplace. Emdeon STARS is a premier software that offers the following:
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    Emdeon STARS combines a data-warehousing environment with a broad array of powerful data analysis and reporting tools that transform the way you detect, investigate and pursue fraud. It is the only software that supports SIUs or Program Integrity initiatives in all three steps of the investigative process: (1) detection and identification of fraud; (2) assessment and prioritization of specific cases; and (3) pursuit of priority cases for recovery or prosecution.
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    Emdeon explicitly designed STARS to help your staff members prepare cases for legal action. It provides near-endless ways to structure queries and find abnormal billing patterns, along with tools that help prioritize cases and generate reliable forensic records that will stand up in court.
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    Emdeon STARS case management features support your investigators in their day-to-day handling of case files. It maintains references to all verbal and written contacts in secured files, and documents each case’s important dimensions. The system interacts with your other departments, and all research documentation is available online, so that complete audit trails can be accessed at any time.
    Now that the software tells them that there is a potential fraud, they decide what to do with you, not by investigating what the software spit out at them, but rather by looking at your credit report and assets to see if they can collect and take your assets. Check this out!!
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    Instant access to this information can greatly aid the process of assessing your patient’s ability to pay for any services you perform. Although healthcare services are rarely denied, your facility can stave off fees resulting from uncollected debts before they are incurred.

  4. What’s a PHR?
    A word to the wise – not every visitor to your site will automatically know all the vocabulary. Nothing more frustrating than finding a topic relevant website that is peppered with acronyms.
    PHR Partnerships for Health Reform
    PHR Parts per Hundred of Rubber
    PHR Payroll, Human Resources
    PHR Peak Heart Rate
    PHR Performance Horse Registry, Inc.
    PHR Personal Health Record
    Phr Phrygian (linguistics)
    PHR Physicians for Human Rights
    PHR Potential Health Risk
    PHR Preliminary Hazard Review
    PHR Presse Hebdomadaire Régionale
    PHR Profession of Human Resources
    PHR Professional in Human Resources
    PHR Public Health Region (Texas)
    PHR Public Health Reports

  5. Aren’t all of these requirements available already by WebMD? Aren’t they also the parent company of Medical Manager?
    Maybe I am not understanding, but aren’t doctors and the major HMO’s already using this software for everything from Datamining, to using the sometimes unsubstantiated information from WebMD to deny claims?
    I always thought it was unethical to both make the billing and claims software which ties into the medical information you publish that may just happen to fit the plans needs.
    Almost forgot, wasn’t everyone at Medical Manager Corp recently indicted by the FBI for buying companies and then forcing the new company to buy their software before the sale was complete in order to book the revenue illegally twice?

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