Wednesday, December 20, 2006

Real-time, point-of-service financial settlement: why health plans will lead the next revolution in healthcare

Real-time, point-of-service financial settlement: why health plans will lead the next revolution in healthcare : "Doctors are already requesting tools from health plans to help them with accounts receivables issues. Ultimately, health plans will bear the responsibility of providing the technology to make retail healthcare transactions a reality. This is because while the practice of medicine still takes place in the provider's office, the business of medicine now rests squarely in a health plan's information systems. And, as providers demand real-time patient and financial transactions, plans will feel pressure to provide these tools to keep the best providers in their networks, and to support members as they navigate the complex healthcare system.

Because health plans are uniquely positioned in the center of the healthcare supply chain, their IT systems must provide the backbone for real-time information exchanges with virtually every major healthcare constituent. That said, the technological challenges that health plans face are tremendous. Plans will need to deliver enormous amounts of administrative, clinical and financial information through software that is readily accessible to providers, yet secure. Data transparency—across medical records, members' financial accounts, claims history, and more—will be crucial.

Electronic health records are critical to this piece of the puzzle. These include two different kinds of records. The first is the patient's electronic medical record, which contains comprehensive medical information that can be updated from a variety of provider sources throughout the health plan network. The second is the member's personal health record, which is owned by the individual and maintained within the health plan's system."

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