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Revamping Apps For Payers
July 1, 2008
MEDecision Inc. hopes its introduction of next-generation applications will give it a boost in the competitive health insurance software market.
The Wayne, Pa.-based company is seeking to rebound from tough times in 2007 when it lost nearly $6 million and saw revenue grow only 1% to $44.8 million.
Many insurers that previously outsourced disease, case and utilization management functions increasingly are bringing them back in-house to have better control over the programs, says David St.Clair, founder and CEO of MEDecision.
To reach those payers, “We needed to re-architect our products,” St.Clair acknowledges. “We fell behind in the underlying technology.”
The new disease, case and utilization management applications, branded as Alineo, are written entirely in Java, enabling tighter integration and more uniform screens than in earlier versions.
The various Alineo applications now have the same look and feel when a user moves between the applications.
The Alineo products also integrate easier with other applications, such as customer relationship management software, St.Clair says. Another improvement gives case managers a view on one screen of all information on a member in a particular program.
The Alineo products also are database-independent, which could ease closing some sales, the CEO contends. MEDecision’s older software ran only on a Cache database from Cambridge, Mass.-based InterSystems Corp.
“It really was a complete front-to-back redevelopment of our technology,” St.Clair says.
The company continues to support its legacy disease, case and utilization management products, but the Alineo applications now are the only ones being marketed.
New Opportunities
MEDecision also recently introduced Nexalign, which St.Clair calls a “collaborative health data exchange.” That opens opportunities for offering new services or improving existing ones.
For instance, the company will use Nexalign’s features to enhance the Patient Clinical Summary software that it has marketed for several years. The summary software enables insurers to send back to physicians a basic medical history—based on claims data—when responding to electronic insurance eligibility inquiries.
Thirteen insurers in 11 states covering 5% of the nation’s population now offer physicians the Patient Clinical Summary. But these insurers have found it challenging to get physicians to actually use the information because that requires changing practice patterns to incorporate the summaries in their workflow, St.Clair says.
Using Nexalign’s data exchange service, MEDecision now can enhance the information in the summaries—increasing their value—by pulling data from other sources, such as pharmacy benefit management firms and laboratories.
The vendor also hopes to partner with multiple electronic health records vendors to enable physician practices to request and receive Patient Clinical Summaries when appointments are made, which could further increase utilization. NextGen Healthcare Information Systems Inc., Horsham, Pa., is the first partner and expects this summer to start offering the service, St.Clair says.
Slow Start
Another initiative that hasn’t yet seen market acceptance is MEDecision’s leadership of the CollaboraCare Consortium, a group of vendors that joined forces in 2005 to bid on contracts with regional health information organizations and health information exchanges.
Although the consortium has not yet signed any contracts, St.Clair says the effort was worthwhile because it led MEDecision to new vendor partners. Physician Web site vendor Medem Inc. of San Francisco, for instance, now enables physicians to get Patient Clinical Summaries via their practice’s Web site.
St.Clair hopes that opportunities will come from the CollaboraCare Consortium as sustainable RHIOs and HIEs with more realistic business models emerge.
With the new products, St.Clair expects MEDecision to break even in 2008 with revenue growth of 10% to 15%, despite tough times in the economy.
“Our prospective customers always get more worried during economic downturns because they have to control premiums,” St.Clair says. “And to control premiums, they have to control costs.”
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