Healthcare Innovation/The Business Side
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To help crack down on Medicaid fraud, as required under Senate Bill 1986 passed by the Florida Legislature in 2009, the Agency for Health Care Administration last year implemented a home health telephonic monitoring system to help verify that home health services in Miami-Dade County are actually being provided to Medicaid recipients. Sandata, a New York-based company provides monitoring services. At the beginning and end of each home health visit, home health agency personnel (such as nurses and home health aides) confirm they're providing services.
The 2010 federal Small Business Jobs Act law includes an amendment by former Sen. George LeMieux that requires the Centers for Medicare & Medicaid Services (CMS) to use modeling technology to help the Medicare and Medicaid programs detect fraud, waste and abuse before it pays for services.
"CMS has not implemented that program yet, but presumably there will be a degree of focus on Florida," says Craig Smith, a partner with Hogan Lovells and former general counsel for the Agency for Health Care Administration. Smith recently testified before Congress that the federal government should use predictive modeling and technologies that the credit card industry uses to prevent fraud.
» Cost Savers
With the help from Med-Vision, a 6-year-old Tampa-based medical consulting company that uses data analytics to create wellness and disease management programs, Sarasota County government was able to pass on a 3% decrease in health insurance premiums to its employees this year. One key aspect of Med-Vision's work with the county was honing in on cost drivers. To manage the costs of cancer care Med-Vision partners with Biologics, a North Carolina-based cancer management service provider that relies on "evidence-based guidelines" and "integrated clinical oncology professionals" to achieve lower costs for payers and higher rates of patient satisfaction.
» Dental Tools
Intelimedix, a Lakeland-based healthcare analytics provider, has launched a reporting tool that allows companies to integrate and analyze dental, medical and pharmacy information with an eye toward reducing overall healthcare costs. Oral health can provide important clues about a patient's overall condition, and early treatment of periodontal disease can help lower the risk and reduce the costs of chronic diseases such as diabetes, coronary artery disease and cerebrovascular disease.
» Premium on Efficiency
AAJ Technologies, a Fort Lauderdale-based healthcare consulting firm, has introduced JET InsureFuse, an automated medical underwriting process system to help insurance companies quickly process applications of the millions of new customers who'll be seeking coverage under the individual health insurance mandate. Under the new law, health insurers are now required to spend 80% to 85% of the premiums collected on medical care, as opposed to administrative costs.
» über Operations
As public and private entities in the healthcare arena look to get better connected, Über Operations, an 8-year-old Tallahassee-based IT consulting firm, has worked closely with clients like the Florida Department of Health to automate their information exchange capabilities. Mercy Hospital in Miami will use a product called ÜberXchange to electronically report cases of "notifiable" diseases such as tuberculosis and influenza to the Florida Department of Health. Über Operations has also been leading the Florida and Texas pandemic influenza project, which is aimed at preventing or delaying the spread of illnesses by electronically sharing data, such as influenza surveillance laboratory test orders and results.
» Retail Health
Blue Cross Blue Shield of Florida plans to open four more "Florida Blue" retail stores this year in Fort Lauderdale, Pensacola, Fort Myers and Tallahassee. The health insurance provider launched its first "Florida Blue" store four years ago in Jacksonville and has since opened stores in Miami, Tampa, Winter Park and Pembroke Pines. At the stores, customers can shop for a policy, speak with a nurse/care consultant about treatment options, find out how their benefit plan works, compare costs on healthcare services and prescriptions or take a personal health assessment.