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Let’s get started January 30, 2010

Posted by medvision in Cancer Care, Healthcare Costs, Healthcare Reform, Uncategorized.
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Corporate health plan strategies which lower costs while sequentially improving the quality of member health care. It almost sounds too good to be true? After all, if we listen to the pundits it’s impossible to have a positive effect in healthcare? This blog will relay some of the hard-earned truths I’ve derived from an eight year journey in helping employers save money and improve quality.

My journey essentially started in early 2001 after a 17 year career at one of the major group insurance companies. I was fortunate enough to be introduced to one of the founders, Jeff Gasser, of a Boston-based medical software company, D2 Hawkkeye, Inc.

Jeff, a CPA, entrepreneur and medical finance expert with years of experience managing medical IPAs, showed me the company’s new software product, D2 Hawkeye Explorer. Throughout my years of despair while trying to break in to this consulting business, Jeff was always a source of common sense, incredible knowledge and support. Each time I thought I may have misjudged the opportunity to improve outcomes, Jeff provided added support about the need, the data fragmentation and the disarray inpatient services. Prior to HIPAA, the application ran on Microsoft Access. It combined the various codes in medical claims, diagnosis, procedure, provider and place of service with employer eligibility files and prescription drug codes. The data format was anchored by a HIPAA compliant longitudinal virtual medical record for each member covered. Engineers and physicians then wrote algorithms & queries dealing with clinical quality of care.

I was stunned! Wow, now health plan administrators and self-funded employer sponsors would have population/member data in order help prevent some of the terrible medical events which inflation/trend and perhaps mitigate members suffering. Severance pay in hand I left CIGNA Group Insurance to learn the large employer market with a fine information tool in hand.

I start this story from the beginning as I believe my learnings show the state of the relationship between self-funded plan managers, health plans, TPAs, member groups and, importantly, the ability to make productive change. The following are some of the main tenets I feel this discussion needs to deal with:

(1) What causes trend/inflation? Is it possible the answers deal with subjects not discussed by the industry?

(2) Who are the players/vendors and what motives could be in play to explain healthcare inflation?

(3) What are the employer sponsor practices and attitudes? Why are they not more involved?

(4) What are the characteristics and motivations of the actual customers/employee/dependent health plan members we serve?

(5) How do we incent all the players, services, strategies, communications and customers together to produce good health, good medical outcomes and lower cost?

As I look back at successes and failures, I find a remarkable gravitation to solutions supported by, just sound common sense. I will try to keep future posts to some type of synchronization. The older I become the more I realize my ability to learn is of tantamount importance and appreciate comments.

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Hello World, January 28, 2010

Posted by medvision in Uncategorized.
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My name is Dan Ross, and I am the President and Founder of Med-Vision.  I’m looking forward to sharing some of my thoughts, insights on healthcare, and news about Med-Vision’s accomplishments.  Thanks in advance for your interest in my posts, which will primarily be focussed on healthcare planning, risk management, wellness, and industry news.
   ~ Dan

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