KANSAS CITY, MO – Although healthcare reform dominates the payer world, payers need to start working on a game plan for the major transition to ICD-10, industry consultants said.
“The biggest mistake payers can make is not addressing the impact assessment quickly,” said Pamela Ruebelmann, vice president of healthcare solutions for HighPoint Solutions.
An assessment, which provides a full understanding of all the impacted components of people, process and technology, will help payers develop a multi-year, organization-wide roadmap, she said.
Payers need to get started by the end of the year at the latest. “Many of the impacted items will have long lead times to remediate, and there is considerable testing that will need to be done from an individual component, integrated and user-acceptance testing perspective,” Ruebelmann said.
PricewaterhouseCoopers has seen significant rise in activity from payers asking for help, said Mark Williams, partner and lead on ICD-10 services for the payer practice. Payers can either work toward basic compliance or align their ICD-10 transition with strategic initiatives. Updating and replacing applications and systems delivers immediate business savings, he pointed out.
Data derived from ICD-10 code is much more granular than IDC-9. If payers structure their data well in their data warehouses, they can leverage that data to do more, such as more effective predictive modeling and identification for disease, care and utilization management, he said.
With HighPoint Solutions, Blue Cross Blue Shield of Kansas City (BCBSKC) began a preliminary analysis of the impact of ICD-10 on its organization after the publication of the final rules in early 2009, said Jane Hamerle, director of Integrated Health Management Technology Solutions Group.
“It was a high priority,” she said.
Having gone through regulatory changes in the past with HIPAA and the National Patient Identifier, BCBSKC knew it needed to start the planning process to determine how big the project would be and to prepare the organization, she said.
BCBSKC plans to kick off its project “in earnest” in January, Hamerle said. The first order will be getting senior department managers on board, she said. A by-product of the assessment is the awareness and understanding gained within the company of the business processes that need to be changed, making buy-in much easier to obtain, she said.
