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What are the expected benefits to the doctors and what are the




What are the expected benefits to the doctors and what are the expected benefits to the insurers?;Attachment Preview;Doctors Get Dose of Technology From Insurers.docx;Doctors Get Dose of Technology From Insurers;Health-insurance companies including Humana Inc. and Aetna Inc. are stepping into the race to;equip doctors with high-tech patient records.;The lure: the estimated 80% of U.S. physicians and 90% of hospitals whose records are still on;paper, and the $27 billion in federal stimulus money available to help these holdouts switch. The;Obama administration last month outlined how doctors can qualify for the funds starting next;year. Come 2015, doctors will be penalized under Medicare if they haven't computerized their;records.;Fabrizio Costantini for the Wall Street Journal;Dr. Alexander Ruthven of Port Huron, Mich., recently switched his practice to electronic patient;records.;Insurers are jumping into a feeding frenzy among companies that peddle health information;technology. They are rushing to be picked by regional centers set up by the government to help;doctors adopt technology, and by the American Medical Association, which is promoting a few;preferred providers. Quality Systems Inc.'s NextGen Healthcare unit last week won a preferred;designation from AMA. But the first solution picked was one from Ingenix, the IT unit of insurer;UnitedHealth Group Inc.;It is also an opportunity for insurers to diversify their operations as the federal health overhaul;presents new challenges to their core business of collecting premiums and paying claims. In;some cases, it is also an opportunity to link doctors more closely to systems to aid in;reimbursement or disease management. Electronic health records, which are digital ways of;storing patients' medical data, differ from the billing, claim-management and patient-scheduling;systems used by many doctors and insurance companies.;Fabrizio Costantini for the Wall Street Journal;Dr. Ruthven has been using the software system for about two months.;On Monday, Humana is teaming up with health-IT company athenahealth Inc. to offer subsidized;electronic medical records for about 100 primary-care practices in the insurer's network. Humana;will cover 85% of the product's implementation costs, roughly $4,000, and pay doctors as much;as 20% more if the records show they are meeting certain performance standards, such as;dispensing generic drugs or ensuring preventative screenings.;Aetna and International Business Machines Corp. are launching a Web-based, or cloud, system;that will pool patient records as well as lab and claims data, and help doctors measure their care;against national quality standards. Aetna says the data will belong to the doctors and the insurer;won't have access. The system will be sold to doctors outside of the Aetna network as well as;within.;WellPoint Inc., meanwhile, plans to help rural hospitals finance health-IT infrastructure;contributing hundreds of millions of dollars to the effort, said Charles Kennedy, the company's;vice president for health information technology. WellPoint says it has no plans to tie its billing;system into whatever health records the hospitals buy.;Insurers' involvement is likely to raise questions among consumer advocates of how patient;information will be used. Already, the health-IT arena is dogged with worries about patient;privacy. Insurers are frequent targets of criticism that they seek ways to curb care or raise prices;for sick people.;Insurers "have a conflict of interest, since they want to know about you so they can better price;products to you or deny you products," said Deborah Peel, a psychiatrist who runs a nonprofit;watchdog group in Austin, Texas, called Patient Privacy Rights.;The programs are "absolutely not" intended to deny care, said Bruce Perkins, Humana's senior;vice president of health-care delivery systems and clinical processes. "Our objective here is to;help physicians and patients improve outcomes, and when outcomes improve costs go down,;Mr. Perkins said.;Some observers say that insurers, because of their relationships with doctors and their reams of;claims data, can help accomplish a key goal of the federal overhaul: reducing costs while;improving quality. "In many places insurers are the keepers of the birds-eye viewthe best data;we've got," said Len Nichols, a health-care economist at George Mason University.;Even though hundreds of solutions exist that aim to get doctors online, right now usage is patchy;at best. Even Allscripts-Misys Healthcare Solutions Inc., one of the biggest competitors in the;electronic health-records industry, says just 60,000 of the estimated 800,000 providers in the U.S.;use its electronic medical-record systems. The uptake is even worse among small practices. The;company estimates that just 5% overall use computerized health records.;AllScripts' chief executive, Glen Tullman, says the stimulus funding will trigger "the singlefastest transformation of any industry in the history of the U.S.;Getting doctors to sign up is still going to be a challenge. UnitedHealth is teaming up with the;American Medical Association to set up a pilot with "model physician offices" in Michigan.;Ingenix is giving doctors its patient-record software and consulting services for free. The;program's goal is to find out what doctors struggle with and ideally iron out wrinkles.;For doctors who aren't part of the pilot, UnitedHealth will subsidize purchase of the software;until they get stimulus funding next year. The Ingenix solution is Web-based and physicians pay;about $590 a month, the company said.;Alexander Ruthven, a Port Huron, Mich., family-medicine physician who has been using the;software for about two months, is a case-in-point for why solo practitioners have been slow to;sign up. Dr. Ruthven said he pared back his schedule to allow time to get used to the new system;which required medical assistants to enter large amounts of data about each patient. He had to;increase his payroll from about $26,000 a month to $34,000 to handle all the extra work.;On the plus side, the system has resulted in at least one quality improvement. It was able to flag a;patient who was told to get a mass in her breast examined further and hadn't. That patient was;persuaded to undergo the procedure, which resulted in catching a cancer early and getting;treatment.;It's difficult and time-consuming and you have to be prepared for lost revenue," Dr. Ruthven;said. "But it is not as hard as I thought it would be.;More;The Health blog;A major complaint doctors and hospitals have about electronic patient records is that the;information is siloed in one system, which often can't talk to other systems or tap into the;growing array of other health-IT offerings, such as disease-management software.;Aetna and IBM's new venture aims to address some of those issues. The companies are collating;data from multiple sourcesincluding electronic health records sold by other vendors and;Aetna's claims datato form an enhanced patient record. They are then comparing information;in that record with medical guidelines to identify gaps in treatment.;We're getting all the available data from all sources to make a much more robust product," said;Greg Steinberg, CEO of Aetna's ActiveHealth unit, which is leading the IBM partnership.;John Jenrette, CEO of Sharp Community Medical Group in San Diego, which has recently;started using the system, said he wanted something that would help his 650 doctors sift through;the "data dumpster." He added: "We want to get those systems to talk to each other and give;clinical information to improve care and quality


Paper#34345 | Written in 18-Jul-2015

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