The report, IDC MarketScape: U.S. Care Management Solutions for Healthcare Payers 2012 Vendor Assessment--A Market in Transition to Health Engagement, analyzes the impact of health reform on the care management market. The study suggests that care management software vendors are adding new features designed to meet the new needs of health plans, but none of the companies are yet standout market leaders.
Many of the changes in care management don't affect just the way clinicians and caregivers deliver care, noted Janice Young, program director at IDC Health Insights and author of the report. Changes in healthcare also affect the technology needed to organize clinical, financial, and population health management data in a way that drives the required collaboration and efficiency among providers, payers, and patients.
In previous years, traditional care management and the technology to support it focused on processes related to the period of time that patients received treatment at a hospital, said Young in an interview with InformationWeek Healthcare. These old-school care management systems typically would verify a patient's personal information, document the care received, and identify how long the patient should be in the hospital. Health plan reps validated that services were administered based on the quality and payment guidelines of the insurance company. However, these procedures limited stakeholders' ability to work together. "In this context, there was very little collaboration between the patient, the physician, and the payer," said Young.
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Today, health reform and the provisions outlined under the Patient Protection and Affordable Care Act are forcing providers and health plans to monitor patients more intensely. Both camps aim to avoid emergency care or prevent illness in the first place, said Young, with the ultimate goal of keeping the general population healthier and reducing overall healthcare costs.
Recognizing these shifts, IDC evaluated and ranked the current technology and marketing strategy of nine vendors. McKesson, Landacorp, ZeOmega, Medecision, TriZetto, Click4Care, and CaseNet all were cited as major players and ranked second. DST Health Solutions and ikaSystems were described as contenders and ranked in a third tier. No vendor placed in the top tier "leaders" category because many still are working on developing the new capabilities required by the health reform market, said Young. Therefore it's too early to tell which companies and which technologies will be the trailblazers in a new care management model.
"In the context of the reform market, each vendor we examined is still executing on reform market strategies and didn't yet meet requirements to be included in the leadership category," she said.
Currently, vendors are feverishly working toward enhancing their existing tools as they seek to integrate consumer and provider engagement tools, electronic health records, personal health records, payment and revenue cycle management software and business intelligence systems, noted Young. Over the next two years payers will be busy as well, investing in the new business intelligence tools that will help them meet mandated health and wellness programs. Already, health plans are either leveraging the systems they already have with new tools, or replacing their care management systems altogether, she said, investing in a slew of new technologies including embedded and integrated analytics, patient monitoring systems, and real-time triggers and alerts. They also are working to integrate clinical data managed on several platforms including cloud computing and iPads.
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