Posts Tagged ‘Managed Care’

Managed Care includes ID&stratification, UM, Case Management, Condition Management and/or Disease Management, and Wellness

Member-centric Care: Not without Business & Architectural RoadMap

If I had a dollar every time an Enterprise Architect said, “I have a Road Map,” and handed me the future state IT architecture (which is 5 years out) and proceeded to verbalize current to future IT while I madly wrote every word down in preparation for a Business Transformation Session to prioritize/re-prioritize initiatives, well […]

Member-centric Care: Open source to the rescue?

A must read from my colleague, Martin Sizemore, entitled, “Is it time for open source in healthcare?” Wow! This Business/Process with system enablement person, me, can understand this architecture stack. Yes, now more than ever we need open source. Prototyping Open Source for testing ICD-9 to ICD-10 with on the fly remediation before going to […]

ICD-10 Revenue Neutrality Will Drive Collaborative Testing

I was reading my collegue Mike Berard’s blog, on ICD-10 Revenue Neutrality: A Strategic Approach. We have discussed the importance of testing before production between Payer and Provider (e.g., Physicians and facilities). In his 2nd to last paragraph Mike proposes the following: “The reality is that Revenue Neutrality verification is still subject to the availability […]

ACO – A Brave New Enterprise: Are you ready?

Racing towards an ACO and Population Management this year is a huge challenge. A new enterprise platform is a must for an ACO to coordinate the changing of Provider and Payer processes and behavior not to mention the Shared Savings contracts which require new measurements and reporting: a shared dashboard. Check out Martin Sizemore’s take […]

Member-Centric Care: Are we enabling the Next Generation of SMEs?

A struggle for the Payer/Provider Industry is how to prepare the next generation of Subject Matter Experts (SMEs). Now more than ever you need the experienced Medical Directors, Clinicians, and Non-Clinicians on your multiple #1 initiatives. Are you preparing your next generation of SMEs? Yes, you do need the 20-25 years EE on the project […]

Member-Centric Care: Have we over turned every rock?

In my previous posts about the Member-Centric Care team, I posed several questions and gave my opinions to support them. Here is a review of what was discussed, as well as new thoughts: Have we over turned every rock (e.g., process, operation, and IT enablement) to allow for member-centric care? It Depends – Sorry, I […]

Member-Centric Care: Are we working on the correct priorities?

In my previous blogs, I asked if we were missing a key player in member-centric care and then provided my opinion. Here is a recap of questions and answers I discussed, as well as some new points: Are we, business and information technology professionals, clinicians, and non-clinicians, working on the correct priorities for member-centric care […]

Member-centric Care: Missing a Core Team Member

In my last blog post I asked if we have missed a core team member in member-centric care. My answer: In Sales there are the Health, Life and Supplemental Insurance Agents for employers and members that are responsible for mentoring members on plans, eligibility and benefits as well as understanding claims. These individuals make a […]

Member-centric Care: Have we missed a core team member?

Recently rolled off a large payer, I am sitting back and reflecting on what is facing the healthcare industry today and what has happened over the past 15+ years (Looking at the forest rather than the trees). 1) Are we, all business and information technology professionals, clinicians, and non-clinicians, working on the correct priorities for […]