Among 10 IT teams transforming parts of the U.S. healthcare system, you'll find important lessons in innovation and persistence.
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Centene, a managed healthcare business that provides insurance to state-funded programs such as Medicaid and foster care, aims to differentiate and grade its physicians, hospitals, pharmacies, and other clinicians to ensure the best health outcomes at a reasonable operational and medical cost.
During the last several years, Centene has invested in a portfolio of technologies that includes a core enterprise data warehouse based on Teradata technology called Centelligence; a statistical predictive modeling system based on a portfolio of Microstrategy, Microsoft, IBM, and Optum technologies; and Web portals. The Web portals have become an important vehicle through which the company provides training webinars, multimedia content, and secure messaging.
Among the recent tools offered through the provider portal:
-- Administrative indexes and information products, which include an online member panel roster; claims history; authorization history and status; and the provider administrative efficiency index, which measures--compared to peers--the relative cost to do business with a given provider (based on electronic vs. telephone vs. paper transactions).
-- A clinical portal, which includes clinical practice guidelines; clinical quality reporting; an electronic summary member health record; online care gap notification; and health risk identification support, targeted at conditions and diseases addressed by the primary care provider and "health-home" designated providers. (A health home provider offers integrated care, which can range from a primary care doctor to dentist to behavioral health professional who all share the same information and coordinate treatment based on that information.)
-- Clinical applications available to network primary care providers and health-home designated providers. These apps deliver regular risk-adjusted, practice-level clinical quality, utilization, and administrative cost reporting information.
The Centelligence reporting system that produces the information for these systems is powered by proprietary statistical software, fully integrated using clinical and operations data, and housed in the Teradata data warehouse.
Operationally, the company has found that this comprehensive communication strategy is effective for both small and large providers. Those who perform well, from an administrative, clinical, and utilization perspective, are often interested in risk-based incentive programs that can make doing business with Centene very attractive. Providers who are not performing as well as their community peers are given assistance to boost their overall outcomes.