Integrated Healthcare Creates Efficiencies

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Integrated Healthcare Creates Efficiencies

Barak Obama’s administration is expected to spend $50 billion to modernize the health care system, focusing in part on upgrading information technology for EHR for electronic health record, and PHR for personal
[electronic] health record.

Business process engineering will be a critical component.  Before IT can change, a clear understanding of existing or as is process modeling, and a new to be, or future state vision, must be determined.  As you can imagine, if health care claims are currently being processed via paper, and in the future you expect to process them electronically, the workflow of health insurance company staff, as well as health providers and patients will have to change.  The ability to facilitate meetings with key stakeholders and produce Process Models that enable simulation and what if scenarios are key competencies to help health insurers meet this challenge.

Emergence of a Retail Market in Healthcare

A retail market is rapidly emerging in healthcare as consumers pay a greater share of total costs. Per-person health spending in the United States has reached $7,110 in 2006 and is expected to climb to $12,320 in 2015. More than 46 million Americans are uninsured and growing numbers of employers are dropping coverage or thinning benefits.

With healthcare spending rapidly approaching 20 percent of the U.S. Gross National Product, healthcare has reached a crossroads. Either free-market forces will solve the current affordability crisis or the federal government may impose a solution. If the industry hopes to solve the affordability crisis, healthcare payer organizations will have to rethink their roles and fundamentally change the way they provide value in the supply chain. To sustain their role at the center of the healthcare supply chain, payers must lead the industry’s transformation by deploying solutions that enhance their revenue growth and improve the customer experience.

The Need for Innovation in Health Care

The emergence of a retail market necessitates that companies currently offering healthcare solutions undertake innovative integration with new entrants to the value chain (such as financial institutions and payment processors) in order to offer viable, enabling solutions. If payers fail to keep pace with the changing market, they risk losing business to market leaders. Or worse, as healthcare and financial services converge, payers eventually could find themselves replaced. If payers do remain at the center of the supply chain, they can ensure that all stakeholders work in an efficient, streamlined fashion to not only administer claims, but also to facilitate transactions, reduce costs, pay providers and ultimately enhance the health of plan members.

Integrated Healthcare Management (see IHA) is the systematic application of processes and shared information to optimize the coordination of benefits and care for the healthcare consumer.  No World Borders applies our talent and process knowledge to help improve the flow of information from doctors to payers and funds from payers to doctors, in partnership with leading health care solutions firms.

U.S. healthcare includes significant variability in how healthcare is delivered and in the results it achieves, largely due to divisions among the constituents in the healthcare supply chain: the consumers who use the system, the providers who give care, the employers and consumers who purchase healthcare, and the health plans that pay for services.

Integrated Healthcare Management is a framework that connects all of the healthcare supply chain constituents so that they can collaborate on and coordinate benefits and care.No World Borders is partnering with companies to provide its consulting services to give payers the software, services, and blueprint required to power Integrated Healthcare Management, and lead the transformation of healthcare.  

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By | 2017-05-04T04:07:13+00:00 January 28th, 2009|BPM, business process modeling, health care, health insurance|0 Comments

About the Author:

Michael is Managing Partner & CEO of No World Borders, a leading health care management and IT consulting firm. He leads a team that provides Cybersecurity best practices for healthcare clients, ICD-10 Consulting, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, Insurance Fraud, payor-provider disputes, and consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $4 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, Stanford Medical School - Biomedical Informatics, Harvard Law School - Bioethics.
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