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Managing Managed Care Integrations – What’s the Problem?
11/10/2003
By David A. Kelly, Analyst, ebizQ

Remember the old children’s game called “Telephone?” Where you whisper something into the ear of one of your friends, and they turn around and whisper it into the next child’s ear, and so on down the line until the last person recites the secret message and everyone laughs because the final message bears so little resemblance to the starting message?

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Well, that might be fun out on the playground, but it’s no laughing matter when it comes to healthcare. As a patient, if you’ve ever been in for multiple visits with different specialists for a health-related problem, you may have wondered if something similar wasn’t happening in the communications process when different laboratories, clinics, and healthcare workers tried to exchange information about your ailments, conditions, or treatments. It makes you begin to think about what application and data integration can do in the healthcare world — especially from a patient’s perspective.

What if all your doctors, nurses, and specialists could operate off a single medical record that consolidates your broad range of medical history and multiple clinical tests? Even managed care organizations such as HMOs that have built a network of physicians, hospitals, and health care centers often find they aren’t able to easily integrate and share information across these resources.

In the 1980s, banks consolidated their financial information and customer management systems around customers, not accounts, in order to capture a greater share of the market and hold onto more customers as the industry evolved. In the 1990s, integrating applications, data, and the supply chain made a lot of sense for manufacturing companies that wanted to reduce cycle times, reduce costs, and streamline their business processes. Today, integrating enterprise information makes a lot of sense for Fortune 500 companies, as well as just about all other sizes of companies.

What about the managed care portion of the healthcare community? Is the time ripe for managed organizations to take advantage of integration technologies and new Internet capabilities in order to provide patients, doctors, and managed care providers a complete and unified view of a person’s medical history?

In fact, while managed care organizations have invested billions of dollars in best-of-breed applications designed to help contain costs and increase the quality of care delivered to their members, they’re also finding that automation by itself is critical, but insufficient. They must broaden their focus to look at today’s available technology to integrate their separate systems and automate the processes supporting the entire continuum of care. By leveraging their investments in automation to create an integrated platform and extending it to their providers, managed care organizations have the opportunity to lead the healthcare industry to new levels of collaboration.

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