WASHINGTON – The Medicare Improvement for Patients and Providers Act, or MIPAA, of 2008 was passed by Congress to increase plan transparency and federal oversight, and limit costs of Medicare Advantage, also known as MA plans.

MIPAA is a leading indicator of what MA plans should expect and prepare for – more regulations that will require tracking and reporting for transparency requirements, said Jordan Battani, principal at Computer Sciences Corp.
With 562 Medicare Advantage plans across the country as of January 2009 and 10.1 million enrollees, or 23 percent of Medicare beneficiaries, reported in July 2008, according to the Kaiser Family Foundation, MIPAA’s impact is widespread, Battani said.

Healthcare IT can help health plans meet transparency requirements, as well as cost, she said. “The bulk of healthcare cost is not under the control of health plans,” Battani said. “What they can control is administrative overhead. A lot of health plans have room for administrative cost improvement.”

Battani noted that IT solutions can implement process and work changes in business practices, particularly sales and marketing, which has been a target of criticism and an area that MIPAA is pursuing closer scrutiny.

Universal American Insurance, which is the third largest Part D plan in the country and whose MA plans comprise slightly below 50 percent of the company’s overall revenue, is expecting to be impacted by legislation.

William Krenz, executive vice president and chief administrative officer for Medicare Advantage operations for Universal American Insurance, said his company has been preparing for the impact through IT investments aimed at lowering administrative costs.

 “This is an opportunity to aggressively pursue strategies to automate and streamline,” he said.

Universal American Insurance will be migrating from multi-platforms to a single platform in early 2010. Plans are well under way to invest in medical management tools that will give physicians tools for disease management and wellness.

The company is also creating an IT organization command center that will measure the throughput of all processes and systems.

In addition, Universal American Insurance is putting in place tracking tools and other applications for regulatory compliance.

“Our strategy is to be a low-cost provider with good, consistent quality and transparency for compliance,” Krenz said.