Next phase of medical management systems: automating administrative transactions to integrate payors and providers.

Today, medical management is burdened by the cost and hassle of manual administrative tasks. Manual intensive processing (that is, phone and fax) of referral requests and institutional authorization transactions results in significant unnecessary costs for the providers and payors, delays in approval, and problems with errors. To address these administrative burdens, the next phase of online (Internet- and wireless-enabled) medical management applications will focus on the administrative and transaction side, including self-service referral and authorization processing between the payor and provider. The advent of the Health Insurance Portability and Accountability Act (HIPAA) greatly improves the ability to gain widespread adoption of these online applications thanks to mandated standardization of many routine transactions. This article explores this next phase of online administrative and transaction medical management applications from the payors' perspective and explores their connectivity with providers. Payors are striving to meet several objectives as they implement these online administrative and transaction medical management systems: reducing the administrative burden and cost, changing traditional medical policies, increasing provider adoption of connective technologies, addressing HIPAA compliance, and achieving higher levels of system integration.

The next iteration of managed care? Panel discussion.

What did our five panelists predict for the next iteration of managed care? What do they see happening now? What will the health care industry look like in ten years? Employers will shift an increasing share of rising medical and prescription drug costs to consumers through higher co-pays and defined contributions. Some providers may market their services to attract these consumers. Tightly managed HMOs will provide access to lower-income consumers. So for, e-health is helping managed care organizations cut administrative costs, but not medical expenses. Genetic testing and therapies will not be commercially available for ten to 15 years. Based on demographic trends and labor shortages, demand is likely to exceed the capacity of the health care system within the next three decades. Our five experts caution that managed care is as unpredictable and chaotic as ever, but they do their best to tell you how they think it'll all play out in the near term.

State of managed care in the United States.

Today's managed care companies face numerous challenges. There is no longer any question that managed health care is the dominant option, with more than 80 percent of the United States population enrolled in some type of managed care offering. But dominance brings other issues to the surface such as profitability, market share and public criticism.