Collaboration and Cooperation Playing Role in Health Care Reform


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The American Recovery and Reinvestment Act (ARRA) has given the health IT industry a pretty good idea of what will be expected from it once a more formal health care reform plan is released in the fall. The industry has already begun to mobilize in anticipation, and it’s been interesting to see some of the activity that has taken place. There has been some movement in the way of new products, plans or services intended to get a head start on the collaborative approach that will undoubtedly be necessary to meet the goals of the reform bill. Just last week, one company announced that it will empower some of its payer customers to make claims data available to providers free of charge. The belief is that doing so will help improve the coordination of benefits and care.

It’s tremendously encouraging to see growing enthusiasm for openness, cooperation and collaboration. Without a doubt, this is precisely the spirit that will be necessary for health IT to fulfill the expectations of reform and, ultimately, to improve the system for all. I’ve been advocating this approach since its inception in 1988 and am proud to have taken some pioneering steps with it throughout that time. It’s very rewarding to see the whole of the industry appreciating the potential I’ve long believed this concept holds. Similarly, I hope the discoveries made on my journey can expedite progress for the entire system.

What began as an innovative way to automate case, disease and utilization management two decades ago ultimately led us to the development of the integrated medical management model several years ago. However, it has become obvious that fostering collaboration and integration within the walls of the payer organization simply isn’t enough. The government’s reform efforts are necessitating that we further develop that approach to foster increased collaboration among all stakeholders. This is precisely what some of the newest innovations are designed to do: enable the open, bi-directional flow of data between all health care entities. Market needs are calling for us to replace the transaction-based health care management model of the past with a richer and more rewarding interaction-based approach.

While furnishing users with raw claims data is a well-intentioned step in the right direction, experience over the past two decades has shown that it’s simply the first rung on a very high ladder. Today, more than ever, our industry needs to focus on putting smart data into the hands of users; data that offers clinical decision support, highlights gaps in care and intuitively leads users to the best possible care options for each individual patient. We must be able to deliver this data where people need it, when they need it and through whatever platform they wish to receive it. This is where my long journey has led, and it is exactly what ARRA is relying on the industry to do. The best news is that this isn’t some futuristic, long-term concept. This is what is being offered today, and there are plans for some very exciting additional enhancements — think real-time diagnostic imaging data — in the very near future.

I’ve stated in several recent blogs that the next few months will be both intriguing and exciting for HIT. If the previous few weeks and present times are any indication, they may be even more worth watching than I thought.

David St. Clair
David St.Clair founded MEDecision in 1988 to provide healthcare organizations with collaborative healthcare management solutions that provide a simplified and smart way to manage the health of members and member populations. The ultimate aim of MEDecision's technologies is to improve the quality and affordability of care. MEDecision believes that, in the aggregate, its customers insure or manage care for approximately one in every six people in the U.S. with health insurance


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