Last year’s health reform bill forced open access to health benefits to all. This year, IT leaders among health care providers and payers are charged with the task of building an infrastructure than can support all that access.
One company, Social Interest Solutions (SIS), has been conducting IT gap analyses for states looking get a grasp on how current IT assets can be used for meeting federal health care reform mandates — many of which go into effect in 2014 — and to determine what new systems and applications will need implementation.
SIS shared one such gap analysis — for the state of New York — with SearchHealthIT.com, and if it’s typical of many states, the report shows that while the state has some very usable IT assets to apply toward these mandates (such as its Medicaid Data Warehouse and infrastructure already in place to support eMedNY, the electronic side of the state Medicaid program), there are a few significant gaps yet to fill before a public-private state health insurance exchange can be set up:
- A sophisticated customer service Web portal enabling real-time transactions and the exchange of information seamlessly across a number of programs.
- The limitations of the state’s Welfare Management System, or WMS will not be able to support the inclusion of additional lives anticipated in 2013 and beyond; New York will need to determine how to handle the information currently in the WMS system, which will ultimately be valuable to the insurance exchange.
- On the commercial insurance side of the house, the public-private players in the exchange will have to agree upon and implement ratings and management rules for the policies offered on the exchange, which will serve both consumers and small employers.
They’re pretty simple bullet points, and they don’t necessarily directly impact health care providers, but they represent large projects that haven’t been built. Just reading them probably would give a hospital CIO a headache, thinking about the implementation of such large-scale, public projects. Providers — and their IT leaders — can rest assured that this country’s broad health IT revolution they’re reading about is actually happening. And clearly from SIS’s report, the federal government is spreading the bill out among themselves, private payers and state governments.
The health insurance IT projects will affect those on the clinical side in a positive way: These exchanges will capture a lot more data from a lot more patients and — leveraging this new electronic infrastructure — give all-payer claims databases a lot more health information to parse and will give researchers and clinicians interested in quality-of-care benchmarking a lot more granular, timely data to examine. This, in turn, can potentially speed innovation and help realize the less-expensive, better-quality health care these laws are designed to create.
It’s going to take a lot of IT work to get it done. It’s time for your peers working for payers to roll up their sleeves.