Many provisions of the health reform law will compel insurance companies to make changes to their information systems. That's the view of Bob Barry, senior vice president of product and market strategy at Connecture Inc., an Atlanta-based vendor of payer information systems.

"State based exchanges will require new points of integration for passing plan and rate data through these new distribution channels," he notes in an e-mail interview with Health Data Management. The creation of broad plan categories called for in the bill will necessitate creation of new plans, getting approval from states, and implementing these plans into distribution and administrative systems.

Multiple new mandates, including elimination of lifetime limits, limited waiting periods, elimination of pre-existing conditions, and covering dependent children up to age 26, among others, will require new rate structures. And these structures must then be supported in administrative and distribution systems. Further, new mandates on tightening HIPAA transactions will require changes to transactions processing systems.

The reform bill will result in significant funding of disease management and wellness programs, Barry says. "The future with guarantee issue will be about managing risk versus underwriting and avoiding risk. It will be even more important to gather information about prospective members so carriers can appropriately intervene to improve care and prevent hospitalizations."

--Gary Baldwin and Joe Goedert

 

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