Managed Care Project
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Health care industry leaders at the Third Annual Health Legacy Partnership (HELP) Conference and eHealth Initiative Annual Meeting (Oct, 2002),   noted that the nation's health care is in "Critical Condition". Part of the problem is that the health sector lags significantly behind the financial and retail sectors in using existing information technology. This is in spite of major investments made in health care information systems throughout the nineties. There is a need for an interconnected electronic health information infrastructure supporting payer-provider transactions (e.g., eligibility, referral, claims) and electronic health records. This system would offer the potential for significant increases in provider revenue, reductions in transaction costs, and improvements in service quality to patients and providers. Industry leaders estimate savings up to $80 billion per year.

HIPAA has mandated EDI transaction standards with a timetable for compliance. But, there is a tremendous effort still required to get different information systems successfully interconnected on a national level. At this point the primary beneficiaries are claims clearing houses who massage each claim to make it compliant with HIPAA requirements at a charge of 35 cents and $1 per transaction. This is partly because many of the systems still being used were built in the late 70's and early 80's. Another factor is that many of the initiatives undertaken in the nineties were expensive failures.

TriLon Information Services intends to assist in solving the current health care crisis by enhancing the effectiveness, efficiency, cost, and usability of managed health care applications used by the HMO, TPA, PPO, and self-insured industries.

 

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