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 peek at these categories and discuss how health plans can handle new health information technologies to meet some of these requirements, while convenient 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 coming drug utilization review aimed at identifying conceivable 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 aspect; public health education campaigns performed in nearness with state and local health departments; and actual bays, 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 selfsame case management, chronic disease management, care construction, 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 definite post - discharge counseling by an desired healthcare trained.
5. Handle 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 grade and avoid harmful drug interactions or direct correct care.
This last category is significant, not only for MEDecision and companies equaling ours, but for the whole of healthcare. By making health information technology ( IT ) a immense part of the medical component of health plan expenses, HHS is distinctly promoting it as a central component in achieving its recommended quality and clinical goals. Undifferentiated reform itself, this significantly endorses IT and its lurking to transform our healthcare system.
MEDecisions experience and innovation position us entirely 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 skill 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 plan and delivery style they desire.
According to the new MLR definitions, MEDecisions solutions can be classified as a medical monetary worth specifically health information technology cognate to health improvement and / or quality improvement which will help health plans meet their obligations under the new directives. They can also sustain a long - term competitive advantage by impressive as a strategic foundation for health plans building the differentiated programs and models they need to evolve in this new era for healthcare.
Its very inspiring for us to see that the approach weve taken as a company for the ended two - plus decades has now become the backdrop for health plans growing need to give blessing consumers and providers with enlightenment that optimizes consumers health, improves outcomes, eliminates gratuitous tasks and reduces the cost of care. Our end - to - end health management solution suite is intended to: unite pertinent medical information from multiple sources, transform all sources of data into education using analytics and intelligence, and deliver programs and alerts that streamline care and effectively engage consumers.
We swear by our solutions and philosophy give health plans the tactical 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 settle with the new mandates, but to adapt and pin money as needs order in the long - term. And in todays healthcare environment, thats a definite advantage to have.
What do you plan for of the new MLR categories festive by HHS? Where would you classify health management technology? Do you plan for 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 for free 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.
