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An electronic network strategy for managed care.

K C Norman1, J J Moynihan

  • 1Health Communication Services, Glen Allen, VA.

Managed Care Quarterly
|December 4, 1994
PubMed
Summary

Electronic networks enable efficient healthcare reform by facilitating direct data exchange between payors and providers. Establishing these systems offers immediate benefits for managed care organizations ready for electronic data transfer.

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Area of Science:

  • Health Informatics
  • Healthcare Management

Background:

  • Healthcare reform necessitates improved efficiency through electronic data exchange.
  • Current systems often lack seamless integration between payors and providers.

Purpose of the Study:

  • To highlight the importance of establishing electronic networks for healthcare efficiency.
  • To discuss the development and testing of standards for healthcare transactions.
  • To identify immediate benefits for managed care companies.

Main Methods:

  • Development of standards for various healthcare transactions.
  • Large-scale pilot programs to test feasibility and practicality of electronic networks.

Main Results:

  • Electronic networks allow direct computer-to-computer exchange of clinical and financial information.
  • Pilot programs are evaluating the practical application of these networks.

Conclusions:

  • Significant development is still required for widespread adoption of electronic networks.
  • Managed care companies can gain immediate advantages by preparing for electronic data movement.

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