Healthcare News February 23, 2013

  • Study: Health Insurance Exchanges Represent Immense Opportunity and Potential Risk for Health Insurers

    Survey of 2013 Healthcare Mandate Summit Attendees Reveals Major Concerns, Though the Vast Majority Still Plan to Participate as Early as 2014

    Bellevue, WA (PRWEB) February 20, 2013

    Coming on the heels of last week’s deadline for states to inform the federal government of whether they intend to leverage a partnership health insurance exchange (HIX) or participate on the federally facilitated exchange, a study released today by Edifecs, Inc., shows that health insurers recognize both the promise and peril of HIXs. At the recent 2013 Healthcare Mandate Summit, more than 95 percent of senior healthcare professionals surveyed said they plan to participate in at least one HIX. Of those, a surprisingly large majority—80 percent—will do so in 2014. However, the study also reveals skepticism among respondents that state or federal exchanges will be ready to launch by the October 1, 2013 deadline. And once HIXs are up and running, respondents fear potential disruption to existing IT infrastructure and the difficulties in reconciling premium, enrollment and payment records from the HIXs.

    Healthcare industry experts view HIXs as central to the effectiveness of the Affordable Care Act (ACA) because they provide an online marketplace where consumers can shop for, compare and purchase health insurance. The Congressional Budget Office projects that nearly 12 million Americans will buy health insurance via an HIX in 2014(1).

    The potential upside for a health insurer participating in an HIX is significant. According to a November 2011 PwC Health Research Institute report, the 12 million people who buy insurance through an HIX in 2014 will together pay approximately $60 billion in premiums. By 2019, those figures will grow to 28 million consumers paying nearly $200 billion in premiums(2).

    The special report, “HIX Insights from the 2013 Healthcare Mandate Summit,” includes survey results from more than 125 senior healthcare professionals attending the 2013 Healthcare Mandate Summit that took place February 4-6 in Austin, Texas. The report reveals that while HIX participation will be high and the country’s health insurers are confident they will be ready by the launch deadline, they also have reservations about how HIXs will be implemented and run.

    Key findings from the 2013 Healthcare Mandate Summit special report on HIX include:

      • Health insurers recognize the HIX opportunity and are taking preparations very seriously. When asked about their plans for participating in an HIX, 80 percent reported they plan to participate on an exchange in 2014—the first year HIXs will offer coverage and expected to be one of the largest open enrollments in history. When asked about meeting the October 2013 deadline, 70 percent of respondents said they were “very confident” or “somewhat confident” that their organization would be ready.



      • There is an urgent, immediate need for more information sharing and collaboration among health insurers and the HIXs they plan to join. Like any major business or technology project, transparency with stakeholders is imperative. However, most of the survey respondents reported a lack of good information coming from the state exchanges they are targeting for participation. Sixty-nine percent rate the quality of information as “poor” or “very poor.” In addition, an overwhelming 93 percent expressed a strong desire for exchanges to solicit input from them on how to define and operate their enrollment processes.



    • Health insurers are far more concerned about the ongoing challenges of operating on an exchange than the process of actually joining one. Each state has considerable leeway in determining how it will run its exchange, which means health insurers operating on multiple state exchanges face the daunting task of supporting multiple exchange formats and added levels of complexity. Just over 31 percent of those surveyed indicated they plan to participate on three to five exchanges, with another 15 percent planning to participate on more than eight.


    “The message we heard from Summit attendees is that while compliance with mandates such as Health Insurance Exchanges is no easy feat, there are considerable benefits to be gained, including increasing member enrollment,” said Jamie Gier, vice president of Corporate Marketing for Edifecs. “The value of the Healthcare Mandate Summit was in helping healthcare organizations confirm whether they are on the right path toward compliance and where they can improve. And as the results of the survey demonstrate, many health insurers are embracing the opportunities that exchanges can provide.”

    To download the report, visit .

    About the Report: “HIX Insights from the 2013 Healthcare Mandate Summit”
    The survey was conducted among health insurers and healthcare provider attendees of the 2013 Healthcare Mandate Summit, an industry conference hosted by Edifecs that took place February 4-6, 2013 in Austin, Texas. The results are from a survey of more than 125 senior healthcare professionals—each of whom self-selected which questions they chose to answer, and this accounts for the variation in sample size by question. All respondents are actively involved in their organization’s compliance initiatives and carry significant responsibility for ensuring compliance with government mandates. Attendees represented a wide range of healthcare organizations, including commercial health insurers (68%), healthcare providers (11%), government entities and agencies (9%), and other healthcare industry organizations (12%).

    The survey is not based on a probability sample, and therefore, no estimate of theoretical sampling error can be calculated. All decimals in this report are rounded to the nearest percentage point. This may result in certain numerical totals adding up to slightly more or slightly less than 100 percent.

    The estimates and opinions expressed in this report are based on the survey results only, and the results do not purport to represent all entities or professionals in the healthcare industry.

    About Edifecs, Inc.
    An industry leader since 1996, Edifecs provides healthcare software solutions that improve operational performance by streamlining the exchange of information among health plans, hospitals, and other healthcare organizations, while enabling compliance with current mandates such as HIPAA, Operating Rules and ICD-10.

    Today, more than 250 healthcare customers use Edifecs technology to unify transactions from any information channel source and input mechanism, while automating manual business processes such as enrollment, claims and payments management.

    Edifecs is currently recognized as one of the 100 Fastest Growing Private Companies in the state of Washington, 100 Best Places to Work in the state of Washington, an Inc. 5000 fastest-growing private company and one of the 500 Fastest Growing Companies in North America by Deloitte. Edifecs is headquartered in Bellevue, WA. For more information, please visit

  • New Hampshire Health Information Organization (NHHIO) Selects Massachusetts eHealth Collaborative (MAeHC) as State HIE Executive Director and Orion Health as Technical Vendor

    New Hampshire Health Information Organization (NHHIO) Selects Massachusetts eHealth Collaborative (MAeHC) as State HIE Executive Director and Orion Health as Technical Vendor

    MAeHC to Develop and Manage NH’s HIE, Connecting Key Healthcare Entities to Increase Efficiencies and Improve Patient Safety Outcomes; Orion Health HIE to Provide HIE Platform and Solutions

    Waltham, Mass., February 20, 2013– The Massachusetts eHealth Collaborative (MAeHC), a non-profit pioneer and leader in healthcare delivery through health information technology, announced today that it has been selected by the New Hampshire Health Information Organization (NHHIO) to provide Executive Director Management services for the implementation of the statewide Health Information Exchange (HIE).  The NHHIO, a non-profit organization created by New Hampshire legislation in 2011 to establish a statewide electronic health network for healthcare providers, selected MAeHC to help them lead the State’s HIE initiatives based on the organization’s national reputation and experience working with the New Hampshire healthcare provider community via the Department of Health and Human Services (DHHS) and as the operator of the Regional Extension Center of New Hampshire (RECNH).  As the NHHIO Executive Director of Management services, MAeHC will assist the NHHIO board of directors in providing the overall executive leadership, strategic direction and management for the State’s HIE initiatives which will allow healthcare providers to exchange electronic health information in a secure environment.  The NHHIO also selected Orion Health as the technical vendor to provide the HIE technology backbone and solutions that will enable statewide clinical data sharing.

    “We are excited to move forward with MAeHC as the State’s HIE Executive Director. They have a strong reputation for their HIE efforts throughout the country and offer years of experience that will help us achieve our vision to leverage existing resources and close the gaps on information exchange,” said Denise Purington, Chair of the NHHIO. “And Orion Health has long been a trusted partner of the State, where its solutions are being utilized within The New Hampshire Department of Health and Human Services and in several of the state’s hospitals and other healthcare organizations. Together, we’re certain that we will be able to create a secure and robust Statewide HIE which will reduce costs in healthcare while improving the quality, efficiency and safety of patient care.”

    “This project promises to deliver a significant and lasting benefit to the health and safety of the citizens of New Hampshire, and we are thrilled to have such able and respected partners working with us to ensure the success of this critical initiative,” said Nick Toumpas, Commissioner, New Hampshire Department of Health and Human Services. “MAeHC and Orion Health have worked closely with stakeholders from the earliest stages of this process, ensuring that our community gets the most utility and benefit from the NHHIO right from the start.  We are very pleased with the progress so far and are looking forward to the next phase.”

    MAeHC will help the NHHIO board of directors develop a platform of core services necessary to facilitate the secure routing of data between existing private, local and regional HIE partners. Such information includes summary of care documents such as hospital discharge summaries, referral and consultation notes, as well as lab results and imaging reports.  To support the delivery of these documents and data, the NHHIO will also implement security services such as secure messaging that will be built in alignment with national specifications as well as provider addressing and auditing. Future phases may include an electronic master patient index, record locator services and the expansion of services to other healthcare stakeholders.

    “We are honored to have been selected for such a key role in one of the nation’s most advanced state HIE infrastructures,” said Micky Tripathi, CEO of the Massachusetts eHealth Collaborative.  “The New Hampshire initiative is a great example of a private HIE that will be operated differently from the state run initiatives throughout the country. By doing a few things well for a few key constituents, we hope to incrementally build confidence in and utilization of HIE resources for future growth.”

    About New Hampshire Health Information Organization (NHHIO)
    NHHIO is a 501 (c) 3 non-profit organization created by legislation that is establishing a statewide electronic health network to share patient health information between health care providers in a timely, secure, and confidential manner. Our goal is to collaborate with hospitals, physicians, community health centers, long term care providers, home care providers and other clinicians involved in the delivery of healthcare. Our vision is to design and implement a secure and robust health information exchange which will lead to the reduction in healthcare cost and improve quality, efficiency, and safety of patient care. In 2010 multi-stakeholder workgroups were formed to address six Health Information Exchange (HIE) planning and operational domains:  Governance, Finance, Technical Infrastructure, Business & Technical Operations, Legal & Policy and Public Health workgroup members were instrumental in the collaborative process that resulted in a Strategic and Operational Plan for Health Information Exchange in New Hampshire that was approved by the Office of the National Coordinator in December of 2010.   This multi stakeholder effort also resulted in legislation that created the NHHIO effective July 5, 2011. To learn more about NHHIO and its board of directors, please visit us at

    About Orion Health Inc.
    Founded in 1993 in Auckland, New Zealand, Orion Health is the only global, independently owned eHealth technology company. With an inherent ability to interconnect a wide variety of healthcare information systems, Orion Health has become the world’s leading provider of health information exchange (HIE) and healthcare integration solutions. Orion Health has extensive experience in the design and installation of complex systems within demanding healthcare environments. Today, Orion Health products and solutions are implemented in more than 30 countries, used by hundreds of thousands of clinicians, and help facilitate care for tens of millions of patients. Clinicians, provider facilities and OEM partners rely on Orion Health to facilitate data exchange between hospitals, health systems, HIEs, and affiliated providers and medical devices, resulting in improved care coordination, increased cost savings and efficiencies, and enhanced quality of care.

    In the U.S., Orion Health™ HIE provides the technology backbone for state and regional HIEs across the country. Orion Health Rhapsody® Integration Engine is used by nearly all state and local health departments for public health reporting. Customers include Catholic Health Initiatives, the Centers for Disease Control and Prevention, Beacon Community of the Inland Northwest, Geisinger Health System, Inland Empire HIE, Kaiser Permanente, Lahey Clinic, Louisiana Health Care Quality Forum, Lehigh Valley Health Network, Maine HealthInfoNet, Massachusetts Health Information Highway and St. Vincent’s HealthCare. For more information, visit Connect with us on Twitter, facebook and LinkedIn.

    About Massachusetts eHealth Collaborative (MAeHC)
    The Massachusetts eHealth Collaborative is a national leader in the facilitation and management of electronic health record deployment, health information exchange and quality measure reporting. MAeHC is an independent non-profit corporation with a charitable mission to improve the delivery of health care by promoting the use of health IT.  Formed in 2004 as a collaboration of non-profit health care stakeholders to demonstrate the most effective ways to deploy EHRs and HIE to improve the quality, safety, efficiency, and affordability of care in Massachusetts, MAeHC now works across the United States with a wide range of physician practices, hospitals, state governments, contracting networks, management services organizations, HIE organizations, technology vendors, and consulting firms.  To learn more about the Massachusetts eHealth Collaborative, please visit

  • CareCloud Reports Record Growth in 2012; Drives Adoption of Cloud-Based Solutions by Physicians Nationwide

    Company Accelerates Market Momentum with Launch of New Clinical and Patient Applications, Enterprise Customer Wins, and Leadership Expansion

    MIAMI–(BUSINESS WIRE)–CareCloud, a leading provider of cloud-based practice management, electronic health records (EHR), and medical billing software and services, today announced that the company concluded 2012 with its 12th quarter of consecutive revenue growth. Highlights included: the expansion of CareCloud’s customer base of medical groups into 45 states; the achievement of more than $1.5 billion in annualized accounts receivables under management; the inclusion of more than 4.5 million patients on its platform; and the addition of key executives, many from its leading competitors. Across the board, accelerating market demand was driven by practices migrating from outdated client-server technologies to the company’s modern cloud-based clinical and financial applications and services.

    “In just three years, CareCloud has made substantial progress in its mission to replace the outdated core of healthcare technology that burdens US medical groups. We experienced our most rapid growth to date during 2012 and concluded the year with more than 2,000 providers in 45 states representing more than 50 specialties, all while securing a 96% client retention rate,” said Albert Santalo, Chairman and CEO of CareCloud. “We also completed a full suite of what is now the industry’s most modern and flexible clinical, financial, and administrative applications. Along the way, CareCloud on-boarded smaller practices at a record pace while also securing significant enterprise accounts.”

    Product and Platform Expansion Support Growth

    This past year saw CareCloud make substantial innovations to its core software applications and services. The company launched CareCloud Charts, its cloud-based EHR; introduced its new Mobile Patient Portal offering, enabling patients to access their health records through iPhones and iPads; and invested in operational improvements to help practices implement faster, collect more, and run their operations more efficiently. The launch of Charts completed CareCloud’s powerful suite of fully integrated clinical, financial, and administrative applications, accessible by practices 24/7 from any browser, platform, and location. Furthermore, its flexible platform allowed these applications to be made available to practices either as a full suite or on a standalone basis – reflecting a growing market demand.

    Company Bolsters Senior Leadership

    CareCloud significantly expanded its senior leadership team across sales, marketing, product development, operations, and technology in 2012. The year began with the addition of Paul Henry and Brad Blakey as Vice Presidents of Small Practice and Group Sales, respectively. Mr. Henry, formerly the Vice President of Sales for ADP/AdvancedMD, now oversees CareCloud’s growing small practice sales team. Mr. Blakey leads CareCloud’s group practice sales efforts, leveraging more than two decades of sales operational experience from leadership positions at Nextgen Healthcare Solutions and athenahealth. With the addition of these executives and a growing national sales team, CareCloud was able to experience tremendous momentum across all its product lines, achieving more than a 300% increase in year over year new sales bookings.

    2012 also saw major strides in CareCloud’s ability to market its cloud-based solutions, generate qualified leads, and drive overall awareness. Joe Sawyer joined as Vice President of Marketing, bringing significant enterprise software and healthcare-specific marketing experience. Mr. Sawyer had previously worked as Vice President of Marketing for American Well, a Boston-based leader in telemedicine technology, as well as at SAP, Accenture, and Forrester Research. CareCloud also experienced an increase in its public relations and overall awareness capabilities during the year with the addition of John Hallock as its Vice President of Corporate Communications. Mr. Hallock was formerly head of corporate communications for athenahealth.

    To fuel product, operational, and technology excellence, CareCloud secured a leader in clinical software applications while expanding its account management and support functions. Edwin Miller joined the company as Vice President of Product Management. Mr. Miller, who most recently held leadership positions at Practice Fusion and athenahealth, is now responsible for the design and rollout of CareCloud’s entire product set. In November, Ralph Catalano joined the company as the new Vice President of Operations. He came to CareCloud after spending nearly 10 years at athenahealth where he held various operational leadership positions, including leading all operations. The year concluded with the hiring of John Walsh as Chief Technology Officer. Prior to CareCloud, Mr. Walsh was Senior Vice President, Engineering and Operations for Constant Contact®, Inc., a leading online marketing company offering email, social media, survey and event marketing tools. He brings unique experience with web-scaling in business-to-business environments that will play a central role in evolving CareCloud’s product architecture moving forward.

    Santalo continued, “Heading into 2012, it was critical for CareCloud to recruit and assemble some of the most talented and experienced executives both inside and outside of our industry. I feel we now have an unparalleled senior leadership team. It’s these leaders and their respective teams that will allow us to continue experiencing tremendous growth in all phases of operations, disrupt legacy healthcare IT vendors, and evangelize the ‘cloud’ in healthcare.”

    Physicians Making the Switch to the “Cloud”

    In 2012, 93 percent of CareCloud’s new customers signed up because they were looking to replace outdated practice management and billing systems, feeling it was critical to maintaining their financial success. During the past year, the government implemented a series of regulations that significantly impact the way doctors and their staffs administer care and gain reimbursement. As a result, these practices discovered that their previous systems – many developed in the 1980s and 1990s – would not easily accommodate the changes.

    “As a medical clinic supporting a continuing care retirement community, our patients’ healthcare needs range from routine wellness visits to traditional primary care, as well as coordination with external specialists. This requires us to have the best possible care coordination in place. Having the latest technology to assist us is critical,” said Bill Cohen, Director of the Horizon House Medical Clinic, Seattle, Washington.

    “Our clinic needs to stay as current as possible with the changing reimbursement requirements relating to Medicare and other commercial insurance. We found that our client server electronic health record and practice management system was cost prohibitive and the outsourced management of the system was insufficiently responsive to our needs,” added Cohen. “Our switch to a cloud-based system has already allowed us to cut costs while positioning our clinic to stay current with changes in the healthcare system that impact both us and our patients.”

    In late 2012, CareCloud made available a guide designed to assist care providers and their staff through the process of assessing practice management needs, finding a new practice management and billing software system, and successfully replacing old systems. The intention was to educate and assist physician practices as they look to learn more about cloud-based technologies.

    This white paper and practice management guide, “Time to Switch: Your Complete Guide to Practice Management System Replacement” is available online and marks the beginning of a series of forthcoming market research and analysis focused on improving practice profitability.

    About CareCloud

    CareCloud is a leading provider of cloud-based practice management, electronic health record (EHR) and medical billing software and services for medical groups. The company’s products are connecting providers to one another – and to their patients – through a fully integrated digital healthcare ecosystem that can be accessed on any browser or device.

    CareCloud is helping over 2,000 thousand providers increase collections, streamline operations and improve patient care in more than 45 states. The company received over $20 million in Series A funding from Intel Capital and Norwest Venture Partners in 2011. To learn more about CareCloud, please visit

  • Planned Parenthood praises injunction against Ariz. law

    Planned Parenthood’s political arm claimed victory Friday as a federal judge chose to permanently block an Arizona law aiming at barring the group from Medicaid.

    Arizona’s GOP governor, Jan Brewer, had declared it a priority to ensure no state dollars flowed to abortion providers that also offer women’s health services. State and federal law prohibit public funds from supporting abortion procedures.

    But the law became entangled in the courts, with Planned Parenthood arguing that it was discriminatory and neglectful to low-income women. 

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