Report: Health Insurance Companies to Use IT to Influence Doctors, Patients

Increasingly, health plans will use the Internet to reach out to patients directly with tips for staying healthy and keeping costs down, a report shows.

A new report released by First Consulting Group predicts that health insurers are using health IT to expand their influence over doctors and patients.

Increasingly, health plans will use the Internet to reach out to patients directly with tips for staying healthy and keeping costs down.

Additionally, health plans help health care providers acquire technology and use information collected by that technology to steer patients toward particular doctors.

The FCG report "Health Plan Predictions" finds that data collected as part of programs to pay physicians for better care will be used to "aggressively steer members [for example, patients] to high-quality, low-cost providers."

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As evidence, the report describes Aetnas Aexcel network, which consists of analytic software and a database system "to evaluate providers relative costs compared to other doctors providing similar services."

Under the program, which covers about 300,000 patients in 10 states, doctors in specialties including cardiology, obstetrics, and orthopedics, are Aexcel-designated.

Different employer plans can provide an array of financial incentives to encourage patients to use these doctors.

Other health plans, including Blue Shield of California, Cigna, Premera and Massachusetts-based Tufts Health Plan, also offer so-called "tiered systems", says the report, though it does not describe how technology is used to select health care providers.

As employers force more health costs on to patients, online tools to tell patients the cost of services provided are also becoming more abundant, says the report. Similarly, health plans and consumer groups are pushing to put information online about the quality and performance of doctors and hospitals.

However, the American Medical Association has said that such disclosures could be harmful and misleading because measuring quality is not clear cut and can be influenced by factors outside a physicians control.

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In addition to encouraging patients to use the Internet, health plans will also encourage health care providers to use information technology.

In particular, community physicians can expect health plans to invest more in electronic prescribing programs.

For example, Highmark plans to spend $26.5 million to cover as much as three-quarters of physicians costs for hardware, software, and connectivity.

Several e-prescribing plans give physicians financial incentives to exchange a paper prescription pad for one electronically connected to pharmacies.

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