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Study: Health Insurance Exchanges Represent Immense Opportunity and Potential Risk for Health Insurers

Survey of 2013 Healthcare Mandate Summit Attendees Reveals Major Concerns, Though the Vast Majority Still Plan to Participate as Early as 2014

Bellevue, WA (PRWEB) February 20, 2013

Coming on the heels of last week’s deadline for states to inform the federal government of whether they intend to leverage a partnership health insurance exchange (HIX) or participate on the federally facilitated exchange, a study released today by Edifecs, Inc., shows that health insurers recognize both the promise and peril of HIXs. At the recent 2013 Healthcare Mandate Summit, more than 95 percent of senior healthcare professionals surveyed said they plan to participate in at least one HIX. Of those, a surprisingly large majority—80 percent—will do so in 2014. However, the study also reveals skepticism among respondents that state or federal exchanges will be ready to launch by the October 1, 2013 deadline. And once HIXs are up and running, respondents fear potential disruption to existing IT infrastructure and the difficulties in reconciling premium, enrollment and payment records from the HIXs.

Healthcare industry experts view HIXs as central to the effectiveness of the Affordable Care Act (ACA) because they provide an online marketplace where consumers can shop for, compare and purchase health insurance. The Congressional Budget Office projects that nearly 12 million Americans will buy health insurance via an HIX in 2014(1).

The potential upside for a health insurer participating in an HIX is significant. According to a November 2011 PwC Health Research Institute report, the 12 million people who buy insurance through an HIX in 2014 will together pay approximately $60 billion in premiums. By 2019, those figures will grow to 28 million consumers paying nearly $200 billion in premiums(2).

The special report, “HIX Insights from the 2013 Healthcare Mandate Summit,” includes survey results from more than 125 senior healthcare professionals attending the 2013 Healthcare Mandate Summit that took place February 4-6 in Austin, Texas. The report reveals that while HIX participation will be high and the country’s health insurers are confident they will be ready by the launch deadline, they also have reservations about how HIXs will be implemented and run.

Key findings from the 2013 Healthcare Mandate Summit special report on HIX include:

    • Health insurers recognize the HIX opportunity and are taking preparations very seriously. When asked about their plans for participating in an HIX, 80 percent reported they plan to participate on an exchange in 2014—the first year HIXs will offer coverage and expected to be one of the largest open enrollments in history. When asked about meeting the October 2013 deadline, 70 percent of respondents said they were “very confident” or “somewhat confident” that their organization would be ready.

 

 

    • There is an urgent, immediate need for more information sharing and collaboration among health insurers and the HIXs they plan to join. Like any major business or technology project, transparency with stakeholders is imperative. However, most of the survey respondents reported a lack of good information coming from the state exchanges they are targeting for participation. Sixty-nine percent rate the quality of information as “poor” or “very poor.” In addition, an overwhelming 93 percent expressed a strong desire for exchanges to solicit input from them on how to define and operate their enrollment processes.

 

 

  • Health insurers are far more concerned about the ongoing challenges of operating on an exchange than the process of actually joining one. Each state has considerable leeway in determining how it will run its exchange, which means health insurers operating on multiple state exchanges face the daunting task of supporting multiple exchange formats and added levels of complexity. Just over 31 percent of those surveyed indicated they plan to participate on three to five exchanges, with another 15 percent planning to participate on more than eight.

 

“The message we heard from Summit attendees is that while compliance with mandates such as Health Insurance Exchanges is no easy feat, there are considerable benefits to be gained, including increasing member enrollment,” said Jamie Gier, vice president of Corporate Marketing for Edifecs. “The value of the Healthcare Mandate Summit was in helping healthcare organizations confirm whether they are on the right path toward compliance and where they can improve. And as the results of the survey demonstrate, many health insurers are embracing the opportunities that exchanges can provide.”

To download the report, visit http://www.edifecs.com/downloads/2013SummitSpecialReport_HIXs.pdf .

About the Report: “HIX Insights from the 2013 Healthcare Mandate Summit”
The survey was conducted among health insurers and healthcare provider attendees of the 2013 Healthcare Mandate Summit, an industry conference hosted by Edifecs that took place February 4-6, 2013 in Austin, Texas. The results are from a survey of more than 125 senior healthcare professionals—each of whom self-selected which questions they chose to answer, and this accounts for the variation in sample size by question. All respondents are actively involved in their organization’s compliance initiatives and carry significant responsibility for ensuring compliance with government mandates. Attendees represented a wide range of healthcare organizations, including commercial health insurers (68%), healthcare providers (11%), government entities and agencies (9%), and other healthcare industry organizations (12%).

The survey is not based on a probability sample, and therefore, no estimate of theoretical sampling error can be calculated. All decimals in this report are rounded to the nearest percentage point. This may result in certain numerical totals adding up to slightly more or slightly less than 100 percent.

The estimates and opinions expressed in this report are based on the survey results only, and the results do not purport to represent all entities or professionals in the healthcare industry.

About Edifecs, Inc.
An industry leader since 1996, Edifecs provides healthcare software solutions that improve operational performance by streamlining the exchange of information among health plans, hospitals, and other healthcare organizations, while enabling compliance with current mandates such as HIPAA, Operating Rules and ICD-10.

Today, more than 250 healthcare customers use Edifecs technology to unify transactions from any information channel source and input mechanism, while automating manual business processes such as enrollment, claims and payments management.

Edifecs is currently recognized as one of the 100 Fastest Growing Private Companies in the state of Washington, 100 Best Places to Work in the state of Washington, an Inc. 5000 fastest-growing private company and one of the 500 Fastest Growing Companies in North America by Deloitte. Edifecs is headquartered in Bellevue, WA. For more information, please visit http://www.edifecs.com.

February 22, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Digital Overload of Healthcare Information and Looming Deadlines Driving New Challenges for IT Executives

Independent Study Commissioned by Level 3 Reveals Confidence Lacking in Network Security as Infrastructure Demands Continue to Increase

Broomfield, CO — Network security issues, vital infrastructure upgrades, Electronic Health Record (EHR) implementation and impending federal deadlines will guide priorities this year, according to an independent research study of 100 healthcare provider CIOs and senior IT executives commissioned by Level 3 Communications, Inc. (NYSE: LVLT). At the same time, healthcare CIOs and IT executives are less inclined to focus on mobile-enabled healthcare (mHealth) and slow to adopt cloud computing based on survey responses.

Research highlights and IT challenges for 2013 include:

—56 percent were only “somewhat confident” in their ability to prevent a privacy or security breach on their network
—76 percent of respondents are planning to upgrade their network infrastructure in the next two years
—24 percent reported they are using cloud-based computing, much lower than other industries
—Only 17 percent believe mHealth will have a significant impact on the healthcare industry
—80 percent agree that EHR-based systems will improve patient care
—More than 60 percent of respondents suggest EHR and Meaningful Use mandates are a “good idea” to support better quality patient care

Confidence in Security Lacking
The research study found that many healthcare organizations might not be prepared to deal with the scale of the security challenges headed their way, as more and more critical patient information is digitized. (Reference Exhibits 1 & 2.)

While 80 percent reported their organization had not experienced a security breach in the past 12 months, more than half (56 percent) of those respondents were only “somewhat confident” in their ability to prevent a security breach on their network. This indicates a strong lack of confidence for an industry that experiences a significant number of security breaches each year. In fact, a 2012 survey of 80 healthcare organizations from the Ponemon Institute found that 94 percent of the organizations had a least one data breach in the past two years, at an average cost of $2.4 million per data breach.

Security concerns are also a critical component of EHR implementations. Seventy-seven percent of respondents cited security breaches as either a major or moderate EHR implementation issue. The second top-rated concern with EHRs is patient safety, followed third by privacy issues. Security breaches and patients’ privacy issues were slightly more likely to be of “major concern” among large organizations, due to the sheer volume of patient information at risk. Lower on the list of EHR implementation concerns was penalty costs – 35 percent said security and compliance-related penalties were of little to no concern. (Reference Exhibit 3.)

“Patient privacy and the security of health records are weighing on the minds of healthcare CIOs,” said Karl Strohmeyer, Level 3 group vice president. “The ‘Future of Healthcare IT’ study reinforces that there is no room to take chances when patients’ privacy is at risk – ensuring the confidentiality of patient data should be a top priority. As more and more healthcare-related information is digitized and shared remotely, the need for secure networks and services to protect this data will continue to grow.”

Slow to Adopt Cloud Computing
Although many respondents recognized that cloud computing can offer cost-savings and capacity benefits, just 24 percent reported they are using cloud-based computing, which is a relatively low uptake compared to other industries.

Little Traction For mHealth
An even smaller percentage – 17 percent – believes mobile-enabled healthcare will have a significant impact on the healthcare industry, suggesting the healthcare IT industry may not yet be fully primed for a widespread move to mHealth technology and applications.

Telehealth Care Still Growing Trend
The survey results showed that telehealth is a growing trend, with two-thirds (67 percent) of organizations indicating that they currently have telehealth capabilities. The driving factor behind telehealth is patient care. Respondents believe these capabilities will offer both providers and patients better access to EHRs and, as a result, improve patient care. (Reference Exhibit 4.)

Additionally, more than one-third (37 percent) of respondents believe interconnectivity of healthcare facilities will have the greatest impact on the healthcare industry, and another one-quarter (27 percent) believes EHRs themselves will have the greatest impact.

Constant Infrastructure Upgrades In the Works
The study also showed that network infrastructure demands will continue to grow as healthcare organizations try to prepare for increased interconnectivity of healthcare facilities, security demands and other healthcare-related technology advancements. More than three-quarters (76 percent) of respondents are planning to upgrade their network infrastructure in the next two years driven by implementation of EHRs, interconnectivity between providers and facilities, and medical imaging demands. (Reference Exhibit 5.)

“The expansion of network infrastructure that we anticipate will allow healthcare organizations to store massive amounts of patient information securely,” said Strohmeyer. “Providers can access digitized information from any location in real time, ultimately resulting in substantial efficiencies in patient care. Interconnectivity and network security are essential to meeting the growing demands of the digital healthcare world.”

“EHR Deadline is Feasible”
The research also revealed that, despite feeling pressure to implement EHRs to meet new federal regulations under the Patient Protection and Affordable Care Act (ACA), most healthcare CIOs and senior executives support the efforts and believe ACA timeframes are feasible. More than 60 percent of respondents suggest EHR and Meaningful Use mandates are a “good idea” – due primarily to the fact that EHRs are expected to support better quality patient care with increased access to medical records and information by providers. In addition, 79 percent believe the 2015 EHR deadline is feasible.

Study Methodology & Demographics
Level 3 commissioned Corona Insights to conduct the “Future of Healthcare IT” study in November 2012. The 100-person respondent base was comprised of CIOs and other c-level and senior IT executives who are employed by hospitals, medical centers and physicians’ offices. The size of the organizations managed by these CIOs and executives range in revenues from $10 million to $1 billion.

To Learn More
To learn more about the research findings and Level 3’s solutions for the healthcare industry, please visit http://www.level3.com/en/solutions/industry/healthcare/.

About Level 3 Communications
Level 3 Communications, Inc. (NYSE: LVLT) provides local, national and global communications services to enterprise, government and carrier customers. Level 3’s comprehensive portfolio of secure, managed solutions includes fiber and infrastructure solutions; IP-based voice and data communications; wide-area Ethernet services; video and content distribution; data center and cloud-based solutions. Level 3 serves customers in more than 450 markets in 45 countries over a global services platform anchored by owned fiber networks on three continents and connected by extensive undersea facilities. For more information, please visit www.level3.com

February 9, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

California HealthCare Foundation President Mark Smith to Step Down

Founding leader of Oakland philanthropy will depart in late 2013

Dr. Mark D. Smith, who has led the California HealthCare Foundation (CHCF) since its founding, plans to step down as president and CEO at the end of year, the foundation announced today.

“It has been a great honor to lead the California HealthCare Foundation in its mission to improve the quality of health care for all Californians,” Smith said. “I leave the foundation knowing it is well positioned to continue this important work.”

During his tenure, Smith focused CHCF on catalyzing efforts to improve health care quality, promote greater access, and reduce the cost of care for the state’s most vulnerable and underserved residents. The Oakland-based philanthropy makes grants totaling approximately $37 million annually from a fund of $700 million. CHCF has granted over $500 million since Smith became the founding president and CEO in 1996.

“Mark Smith’s remarkable leadership over the last 16 years has focused the California HealthCare Foundation on a vision to improve the health care system where it matters most: in the clinics, the hospitals, doctors’ offices, and wherever Californians go to find care,” said Ian Morrison, PhD, chair of the CHCF Board of Directors. “While he recognized that the problems in health care are huge, Mark and his team were smart and innovative in targeting the foundation’s resources where they could most make a difference.”

Smith, 61, a physician and expert on state and national health policy, will continue his work as a member of the clinical faculty at the University of California, San Francisco, and as an attending physician at the Positive Health Program for AIDS care at San Francisco General Hospital, where he has practiced since 1992, including during his tenure at CHCF.

Under Smith’s leadership, CHCF focused on improving the way health care is delivered and financed in California through a number of initiatives, including:

Promoting research and policy analysis. From its founding, CHCF has supported sound decisionmaking using evidenced-based research and nonpartisan policy analysis. CHCF has become a prolific publisher on issues of quality, access, and the financing of care covering both the commercial and public sectors.

Promoting transparency. The foundation has made significant investments in supporting transparency in health care delivery through publicly reporting quality data on hospitals, nursing homes, and long term care facilities, and building public websites that allow consumers to compare local facilities and provide health care leaders with benchmarks for improvement.

Improving clinical care. Smith focused attention on innovative ways to improve care delivery, including being an early proponent of using information technology at the point of care, challenging providers to deliver high-quality and cost-effective care, and promoting disruptive innovations like retail clinics and process redesign. He has also championed redefining the scope of work among clinical team members, to help ameliorate the need to train more doctors to do work that lower-cost members of the clinical team can deliver safely and effectively.

Training new leaders. The foundation initiated the CHCF Health Care Leadership Program at UC San Francisco in 2001. The two-year, part-time fellowship has trained 355 clinicians in management and leadership skills required to lead the state’s health care institutions in a rapidly changing and challenging environment. The program’s alumni now occupy leading positions in hospitals, clinics, medical groups, and government throughout the state.

Fostering innovation. The $10 million CHCF Health Innovation Fund helps accelerate innovation in care delivery by investing in new and emerging companies focused on lowering costs and improving access to care. While supporting improvements to the health delivery system, CHCF also has focused on the rise of alternative care delivery models such as retail clinics and the adoption and effective use of information technology.

Modernizing enrollment. CHCF has been a leader in promoting more efficient and consumer-friendly ways for eligible Californians to enroll in public programs. In 1999 the foundation supported the development of the first web-based eligibility and enrollment application in the United States, which it licensed at no cost to the State of California. More recently CHCF led the successful national public-private development of a first-class user experience design to streamline enrollment under the Affordable Care Act (C. The foundation has also recently focused on supporting the implementation of the ACA in California, and continues to monitor and report on its progress.

Supporting health care reporting. Recognizing the important role that the media has in promoting improvements in health care, CHCF has devoted significant resources to supporting health care journalism. Since 1998, the foundation has produced California Healthline, a daily digest of news, analysis, and opinion on the state’s health care system. In 2009, the foundation established the CHCF Center for Health Reporting at the USC Annenberg School of Communication and Journalism, which collaborates with media across the state on in-depth, explanatory journalism on critical health care issues.

“Mark has built a strong staff that is set on a steady course, focusing on the medical delivery and financing systems in California, with an emphasis on quality improvement, increasing both access and efficiency, and addressing the unsustainable cost of care to individuals and society,” Morrison said. “The board expects the foundation to continue building on its successes in these areas.”

“There is still a lot of work to be done. While I will assist the board and staff in making a smooth transition to a new leader, I will also continue to look for ways to make our health care system work better for the people of California,” Smith said.

A native of New York City, Smith earned his bachelor’s degree in Afro-American studies at Harvard (1979), his medical doctorate from the University of North Carolina at Chapel Hill (1983), and a master’s in business administration with a concentration in health care administration from the Wharton School at the University of Pennsylvania (1989).

Prior to joining CHCF, Smith was executive vice president at the Henry J. Kaiser Family Foundation. He previously served as associate director of the AIDS Service and assistant professor of medicine and of health policy and management at Johns Hopkins University. He has served on the board of the National Business Group on Health, the performance measurement committee of the National Committee for Quality Assurance, and the editorial board of the Annals of Internal Medicine.

He was elected to the Institute of Medicine (IOM) of the National Academy of Sciences in 2001 and recently completed service as the chair of an IOM committee on “The Learning Health Care System in America,” which issued its report Best Care at Lower Cost in September 2012.

Smith will continue serving as CHCF’s president and CEO until a new leader is in place, which is expected by the end of 2013. The search for Smith’s successor will be conducted by the foundation’s board of directors. Inquiries should be directed to Carol Emmott of Russell Reynolds Associates at cemmott@russellreynolds.com or 415-352-3363.

About the California HealthCare Foundation

The California HealthCare Foundation works as a catalyst to fulfill the promise of better health care for all Californians. We support ideas and innovations that improve quality, increase efficiency, and lower the costs of care.

February 1, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

HIMSS Responds to the Supreme Court Decision on Patient Protection and Affordable Care Act

ARLINGTON, Va. (June 28, 2012) - After months of uncertainty, the U.S. Supreme Court today announced its decision on the constitutionality of the Patient Protection and Affordable Care Act of 2010 (ACA).  The Court ruled that the law is constitutional by a 5-4 vote.

H. Stephen Lieber, CAE, HIMSS President and CEO, stated that, “HIMSS, like the rest of the country, is relieved that questions about the healthcare reform law have now been settled and the nation can move forward with the essential work of transforming healthcare in America.  Health information technology is critical to the ongoing transformation in our nation.”

As HIMSS has emphasized in the past, while there are many potential implications for health IT in the ACA, the Medicare and Medicaid Electronic Health Records Incentive Program was never in jeopardy regardless of the outcome of this case; that program was authorized by the HITECH Act, which was part of the American Recovery and Reinvestment Act (ARRA) of 2009, and not ACA, which was separate legislation passed in 2010.

Dave Roberts, MPA, FHIMSS, HIMSS Vice President, Government Relations, said, “Now that the uncertainty around ACA has been settled, it is critical that we continue the momentum to transform healthcare, including the use of information technology.”

Roberts continued, “We are pleased that congressional support for nationwide adoption of health IT on both sides of the aisle remains strong, and has been unaffected by the debate on the healthcare reform law.  Despite differences of opinion on the Healthcare Reform Law, members of both parties in Congress recognize the need to transform healthcare in this country, and the important role health IT will play in that transformation. We anticipate that the benefits of health IT will continue to receive bipartisan support as our nation establishes the infrastructure necessary for improving patient care and take strides to enhance the cost effectiveness of care delivery in the U.S.”

The Supreme Court decision in the ACA case is posted on the Court’s website.  HIMSS offers several resources on the case, including a Fact Sheet and a July 12th webinar.

About HIMSS
HIMSS is a cause-based, not-for-profit organization exclusively focused on providing global leadership for the optimal use of information technology (IT) and management systems for the betterment of healthcare. Founded 51 years ago, HIMSS and its related organizations are headquartered in Chicago with additional offices in the United States, Europe and Asia. HIMSS represents more than 44,000 individual members, of which more than two thirds work in healthcare provider, governmental and not-for-profit organizations. HIMSS also includes over 570 corporate members and more than 170 not-for-profit organizations that share our mission of transforming healthcare through the effective use of information technology and management systems. HIMSS frames and leads healthcare practices and public policy through its content expertise, professional development, research initiatives, and media vehicles designed to promote information and management systems’ contributions to improving the quality, safety, access, and cost-effectiveness of patient care. To learn more about HIMSS and to find out how to join us and our members in advancing our cause, please visit our website at www.himss.org.

June 28, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.