Clinical Information Systems

Health Insurers Proceed On IT Aspects Of 'Obamacare'

Regardless of the Supreme Court's decision on the Affordable Care Act, health plans likely will implement the technology needed to meet its objectives, predicts one prominent IT consultant.
9 Health IT Tools Patients Should Understand
9 Health IT Tools Patients Should Understand
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Even if the Supreme Court decides to strike down the Patient Protection and Affordable Care Act, Eric Paternoster is sure that health insurers will implement many of the objectives outlined in the law, as well as the technology to support these goals.

Paternoster is CEO of Infosys Public Services (IPS), a U.S.-based subsidiary of Infosys Ltd., and a company that helps healthcare organizations implement technology for their business operations. In an interview with InformationWeek Healthcare, Paternoster said many payers contacted his company after the Supreme Court hearings to share their thoughts on how they will move forward if the Supreme Court struck down the law, and with it the provision for the development of state health insurance exchanges (HIXs).

According to Paternoster, several payers who had set aside the idea of a private exchange now think there might be an opening to develop such a model.

"Given their reading of what happened during the hearings, their thinking [is that if] the mandate is removed and the state exchanges fall, [they will] go ahead with a private exchange or a hybrid model where the state would license private exchanges," Paternoster said.

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Certainly, health plans recognize that the trajectory of healthcare costs as a percentage of Gross Domestic Product (GDP) is unsustainable, and although the fate of the Affordable Care Act hangs in the balance--the Supreme Court is expected to rule on the constitutionality of the law this summer--Paternoster said health insurers are still pushing ahead with integrating health systems that support many of the accountable care initiatives the law outlines.

In fact, results from a recently published study by Infosys Public Services (IPS), entitled Healthcare Reform – Priorities for 2012, suggests just that, although it was taken before the Supreme Court heard arguments. The poll, which relied on 100 executives from 20 health plans, revealed that 80% of respondents said their health plans are going ahead and implementing initiatives related to the Affordable Care Act.

The poll, which was taken in November, also found that more than 80% of respondents said they are still in the planning stages of participating in a state health insurance exchange, which the study noted is not surprising given the judicial and legislative uncertainty that surrounds these exchanges. The deadline for implementing state HIXs is January 1, 2014.

Additionally, 92% of respondents already have embarked on putting in motion their plans to implement an Accountable Care Organization (ACO), with 53% saying they are in the planning stage, 35% saying they are currently implementing an ACO, and 4% reporting they will implement an ACO this year.

Respondents also were asked to rank the technologies they thought could advance their top-priority initiatives, such as improving provider collaboration and enhancing the consumer experience.

On a scale of one to four, with one being the lowest and four the highest, analytics tools received the top score of 3.20, with respondents reporting that data analysis can help stakeholders make informed decisions and can be used in multiple areas such as member, care delivery, and health and wellness. Mobile device technology came in second at 2.90. Respondents agreed that smartphones and tablets can be used to help customers access information more easily. Social media tools ranked third at 2.05 and cloud computing came in fourth at 1.85.

Although health IT executives say they will find ways to incorporate new technology tools into their health IT enterprise, Paternoster said health insurers face many technology challenges. Part of the problem is meeting federal mandates such as the code conversion work around ICD-10, which requires implementing technology and testing systems with provider organizations and business associates.

Another challenge is to support customers who are using multiple technologies such as social media sites and mobile technology to get their information. Implementing analytics tools that can quickly process information in a way that advances a health plans' business objectives also can be difficult.

"There is no lack of information inside the typical health plan, but being able to drive insights from that data in a timely manner and be able to achieve an intervention [such as providing an alert for a conflict in medications] or achieving some kind of advantage in the market is still a challenge," he said.

The 2012 InformationWeek Healthcare IT Priorities Survey finds that grabbing federal incentive dollars and meeting pay-for-performance mandates are the top issues facing IT execs. Find out more in the new, all-digital Time To Deliver issue of InformationWeek Healthcare. (Free registration required.)