It's time for payors to become partners.
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The process would have been highly costly and cumbersome, if not impossible, a couple of years ago. But a powerful combination of Internet technology and entrepreneurial enterprise is quickly connecting doctors and hospitals, slashing the time and expense it takes to share information and leading to quick, easy reaction by providers.
A patient registry for disease management identifies and tracks key information concerning identified patients enrolled in a care management program. The software tool makes the proactive tracking and outreach of population-based management feasible. It is highly focused on the limited patient demographic and clinical information needed for this purpose. Automated medical records are beyond the reach of most physician practices, and many of those in use lack the features necessary for population-based management. We believe the patient registry will meet both the needs for disease-management focused support and the budget of the typical physician practice.
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Three of the major issues affecting health care today are global in nature: poverty, violence and the aging of the American population. In the absence of a concerted national effort to deal with them, communities across the country are experimenting with their own local solutions. The Valencia County Coalition in New Mexico, for instance, is breaking down the barriers between low-income residents and the state's Medicaid managed care program. Another example: The DeKalb Medical Center in Decatur, Ga., opened a unit to treat elderly patients' acute medical problems and keep them functional so they can go straight home from the hospital rather than to subacute or skilled nursing care.
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Keeping on top of constantly changing managed care policy requirements can be labor intensive and prone to error. At the University of Missouri Health Sciences Center, over 20 percent of patients are under managed care arrangements for services. The center maintains over 50 contracts with insurers. The medical center thus faces the logistical nightmare of keeping information regarding insurer contact information, pre-certification and prior-authorization policies up-to-date and accessible to front-line clerical and nursing support staff. The medical center is trying to solve the problem by keeping real-time information stored on an easily accessible, searchable Web site.
OBJECTIVE: To examine the effects of selective contracting on California hospital costs and revenues over the 1983-1997 period. DATA SOURCES/STUDY SETTING: Annual disclosure data and discharge data sets for 421 California general acute care hospitals from 1980 to 1997. ANALYSIS: Using measures of competition developed from patient-level discharge data, and financial and utilization measures from the disclosure data, we estimated a fixed effect multivariate regression model of hospital costs and revenues. FINDINGS: We found that hospitals in more competitive areas had a substantially lower rate of increase in both costs and revenues over this extended period of time. For-profit hospitals lowered their costs and revenues after selective contracting was initiated relative to the cost and revenue levels of not-for-profit hospitals. The Medicare PPS has also led high-cost hospitals to lower their costs. CONCLUSIONS: The more competitive the hospital's market, the greater degree to which it has had to lower the rate of increase in costs. A similar pattern exists with regard to hospital revenues. Both of these trends appear to result from the growth of selective contracting. It remains unclear to what extent these cost reductions were the result of increased efficiency or of reduced quality. Since hospital cost growth is sensitive to the competitiveness of its market, antitrust enforcement is a critical element in any cost containment policy.
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