Payers keen for ‘right' data

By Patty Enrado
12:00 AM

IT vendors, fresh from the National Managed Health Care Congress, are focusing on providing greater integration and added functionality to their managed care products this year.

The need to capture critical data, turn it into actionable data and disseminate it to the right people at the right time is driving next-generation IT systems, said Steve O'Dell, managing director of health plan practice for First Consulting Group.

Payers want their core administration systems to be flexible enough to integrate with other peripheral systems to provide a complete package that covers front- and back-end business processes.

Now that information is becoming more transparent, managed-care systems need business-intelligence and data warehousing tools to cleanse data.

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With the ubiquity of the Internet, O'Dell said, "It is crucial for plans to offer Web self-services through their information systems."

Holly Toomey, director of McKesson's CareEnhance Clinical Management Software (CCMS) product, said that CCMS 3.0 now has the ability for intra- and extra-product integration. CCMS triggers the appropriate workflow action, which offers better customer experience and dispenses the right information to providers, employers and their employees at the right time.

Its case identification tools for disease management have been enhanced, giving plans and employer groups the ability to focus efforts on individuals or entire populations.

"This lets customers drive their own business," said Toomey.

Richard Pico, CMO and CTO of healthcare, said that Perot Systems has focused on delivering a highly integrated platform that provides benchmarking capabilities, B2B functionality and real-time transaction capabilities to Web portals for B2B and B2C connectivity. Val Dean, vice president of care management and network management for the TriZetto Group, said that its CareAdvance Enterprise system was developed to be member centric, as opposed to plan centric, delivering clinical content and self-management tools tailored for consumers.

The system has the ability to auto-populate personal health records and allow for the interactive exchange of data on a single, secure platform through multiple communication channels.

"Effective care management should be a collaboration among members, providers and health plans," said Dean.

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