Small Health Plans Sharpen Their IT Strategies

Medecision identified four strategic initiatives common to the responding health plans:

Cost containment

Reducing these overhead expenses through automation and analytics was of particular interest.

Provider communications

Participants pointed to the need for enhanced collaboration with providers, such as providing guidance and education on healthcare reform, sharing data and analytics, and bringing them into risk/reward sharing programs.

Accountable Care Organizations

Health plans recognize that they may need to lead the way in developing new care delivery models, and/or providing the tools and support for health systems and hospitals to pursue the affordable care organization model.

Market share/member retention

Health plans are figuring out the best ways to position themselves in the market given the potential effects of the presidential and congressional elections. Donahue-Dalton says they are looking at using automation to grow membership, connect care, and reduce costs.

That means making sure their care management, disease management, and utilization management is "really robust" so they can scale membership—add commercial or government membership—without needing to increase staffing such as nurses or care managers.

"They really want their core systems to do more for less," she explained.