Executives group names top 10 challenges for managed care in 2010

Defining the role of government in healthcare is the top issue facing managed care in 2010, according to the annual "top 10" list released by the Managed Care Executive Group.

The MCEG, a leadership group of U.S. managed care executives, met recently at their annual forum. The 2010 Top 10 list is dominated by the role of government, enhancing collaboration and working on affordability.

The 2010 MCEG Top Ten Issues are:

1. The role of state and federal government in healthcare: Government support, intervention and regulation are having an increasing impact on payer operations, costs and even marketplace strategies, according to the MCEG. In 2010, the MCEG plans to focus on legislative and compliance demands from the government. The implementation of the HITECH Act, ICD-10, HIPAA 5010 and healthcare reform will be among the top investments in 2010.
2. Healthcare reform: Reform legislation, whether comprehensive or piecemeal, and whether at the federal level or state level, will result in dozens of new agencies and grant programs, in addition to adjustments to the insurance market and payment.
3. ICD-10: The impact of changing to ICD-10 for medical record coding and billing is underestimated, the MCEG says. It will likely be as significant a project across the industry as Y2K or HIPAA 5010 and, when undertaken, will push many other HIT projects to lower priority.
4. Data analytics and informatics: Disease management, real-time decision support, case management, customer segmentation and protocol development will continue to drive investment in analytics. Clinical information will be broad and deep, enabling caregivers to more precisely identify diagnoses and target treatment.
5. HIPAA 5010: New HIPAA requirements will present substantial changes in the content of the data submitted with claims as well as the data available in response to electronic inquiries. The implementation will require changes to the software, systems and perhaps procedures that are used for billing Medicare and other payers.
6. Consumer response to healthcare changes: 2010 will see a wave of consumers voicing their opinion on product offerings, costs, networks and reform, the MCEG predicts. Consumers will demand integration between Web-based technology and administrative services to improve their customer experience.
7. Health Data Exchanges: Health information organizations are a key component of the HITECH Act. State-level health information exchange efforts are addressing five critical domains identified by the Office of the National Coordinator (ONC): governance, finance, legal/privacy, technical infrastructure and business/technical operations. Finding the sustainable financial model is a core issue.
8. Automated member acquisition and retention: As participation in employer-sponsored plans decrease and the need for individual and family health insurance grows, health plans are looking to connect directly with potential members to search and select plans right for them and then purchase them on-line. Health plans will need enterprise application integration techniques and processes to connect their Web portal to their underwriting, enrollment, sales, customer service and billing and payment systems.
9. Providing transparency to health plan data and operations: The ability to allow providers and health plans to use secure shared-data continues to expand will be a major issue, the MCEG says. The need to improve patient outcomes and operational efficiency is leading to investments in quality measurement, peer grouping, provider report cards and predictive modeling.
10. Collaboration with providers as a business partnership: The MCEG says prior authorization and use reviews are fading, and in their place is a more collaborative model based on real-time eligibility, benefit verification, access, quality, safety, effectiveness and patient centeredness. P4P is holding providers accountable, as stressed by Bridges To Excellence (BTE), Leapfrog and other initiatives.