New IDC Health Insights Report Outlines Best Practices in Payer Health Management Programs

IDC Health Insights today announced a new report, “Best Practices in Payer Health Management Programs: The Evolution of Quality and Payment Models,” (Document#HI251745) which provides an overview and discussion of the background, underlying challenges, and current best practices being implemented by health management programs in the U.S healthcare payer market segment.  As the U.S. Centers for Medicare and Medicaid Services (CMS) continue to develop and implement new payment structures, leaders in both payer and provider organizations are rethinking their traditional care delivery models, health management programs, and related quality measurement programs in order to accommodate these new payment structures.  The new report outlines the best practices to successfully do so.  

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According to payers surveyed by IDC Health Insights, 51% of responding organizations planned a new investment in care and disease management applications in 2014. This fact illustrates both an acknowledged and funded need for the required technology to support these programs moving forward. This fact also illustrates a market opportunity for the vendors developing these applications.

Health management programs, and the supporting IT applications, are important tools in supporting emerging reimbursement models  - including value-based reimbursement (VBR), pay for performance (P4P) - while concurrently increasing the effectiveness and efficiency of care. Best practices are found in small to large organizations across the payer and purchasing organization spectrum and incorporate the following components into their health management programs:

• Assessment of medical conditions and cases to determine what reimbursement models make the most sense for specific conditions and providers (e.g., the adoption of a bundled payment approach for higher-cost, definable episodes)
• High-performing, integrated teaming relationships with a coordinated team of providers of all types (Payers can take the lead on initiatives and negotiations to create true partnerships with forward-thinking providers that are committed to understanding and implementing shared responsibility and performance-based reimbursement for health management programs.)

Health program managers are also challenged to understand and identify where exactly the best opportunities are for overall cost reduction, and this challenge can be directly supported through the selection and implementation of relevant analytical capabilities. Cost transparency initiatives – explaining to providers, other relevant stakeholders and members what drives costs and where costs can be better managed – are evolving and program managers need to assess and implement these as well.  Finally, IDC Health Insights suggests that successful programs need to organize interdisciplinary teams of physicians, nurses, inpatient and outpatient case managers, home health, palliative care professionals that can all work in concert and use, real-time IT applications to review all readmissions and develop improvement strategies to improve the quality of care.

According to Deanne Kasim, Research Director, IDC Health Insights, “Health management program managers need to review their overall programs and approaches to view members as a whole patient, rather than independent, soiled episodes of care. It is this fundamental shift in program philosophy, program, and related IT application design that will enable care and disease management initiatives to become more efficient, lower expenses, and prevent unnecessary readmissions and admissions.”

For additional information about this report or to arrange a one-on-one briefing with Deanne Kasim, please contact Sarah Murray at 781-378-2674 or sarah@attunecommunications.com. Reports are available to qualified members of the media. For information on purchasing reports, contact insights@idc.com; reporters should email sarah@attunecommunications.com.

About IDC Health Insights                                     

IDC Health Insights assists health businesses and IT leaders, as well as the suppliers who serve them, in making more effective technology decisions by providing accurate, timely, and insightful fact-based research and consulting services. Staffed by senior analysts with decades of industry experience, our global research analyzes and advises on business and technology issues facing the payer, provider and life sciences industries. International Data Corporation (IDC) is the premier global provider of market intelligence, advisory services, and events for the information technology market. IDC is a subsidiary of IDG, the world’s leading technology, media, research, and events company. For more information, please visit www.idc-hi.com, email info@idc-hi.com, or call 508-935-4445. Visit the IDC Health Insights Community at http://idc-community.com/health.

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