Post date: Nov 20, 2010 6:51:25 AM
Medical Loss Ratio (MLR) is in the news again and curiosity struck me when one of the articles from an insurer's perspective mentioned that care coordination would likely be sacrificed as this was part of their administrative expenses. Perhaps others have had different experiences but I don't recall much care coordination between providers going on. In fact, I'm often the one who has to put the insurer in touch with the right medical office. One time I questioned the hospital operating room charges $50,000+ and the insurer says not my problem*. All of this to ask what is the role of Healthcare Information Technology (HCIT or HIT) in the medical loss ratio debate?
A quick review of the articles and limited literature on medical loss ratio shows that the definition of medical expenses and administrative expenses is murky. No one seems to know if an expense like subsidizing e-prescribing applications to physicians would count as medical expense or not. Same goes with disease management programs and from an HCIT perspective the applications to manage such programs.
I'm not sure how this will all play out but it will likely get tangled in meaningful use.
*As an aside - the hospital was just as unresponsive. I finally found the name of the CEO which provoked the expected response - we billed you correctly (but of course they avoided my questions) - well at least I got some response.