The health insurance industry, especially the HMOs and PPOs providing managed care, are strategically poised to realize the greatest direct benefit from centralizing clinical information of their members as provided through the immediately accessible health record network that is Medisyn Systems.

Today’s health insurers are highly regulated by government and highly scrutinized by accreditation agencies and the public. As the payor of health care services, the managed care organization must constantly seek methods to reduce costs while remaining constantly focused on maintaining and improving the quality of the care provided by their panel of physicians and hospitals.

The opportunities for Medisyn Systems to provide value to the health insurance industry are many and will result in significant cost reductions.

Managed care organizations will see a reduction in medical expenses
with the use of Medisyn Systems by:

• Eliminating the costs of duplicate and unnecessary diagnostic testing.
  
  
• Reducing costs associated with the work-up of an unfamiliar patient.
  
  
• Reducing ER costs by sending patients, through triage, to more appropriate care settings.
  
  
• Eliminating unnecessary hospital admissions with availability of historical clinical information.
  
  
• Reducing hospital inpatient bed days because the care is better-coordinated with the ambulatory setting.
  
  
• Facilitating all of the functions of utilization review with immediately available clinical information.

Managed care organizations will promote coordinated patient care with the use of Medisyn Systems through:

• Improved communication of clinical information between the care providers of chronically ill patients as they move between multiple clinical settings.
  
  
• Expedited referrals, authorizations and pre-certifications to effect timely treatment.
  

Managed care organizations will experience expense reductions associated with multiple compliance functions required to meet established accreditation standards and government regulations with the use of Medisyn Systems by:

• Facilitating the administration of effective disease management protocols.
  
  
• Providing easy access to the documentation required for HEDIS audits and reporting.
  
  
• Providing clinical information to document other quality management and improvement functions.
  
  
• Assisting with the quality audits required when credentialing providers.
  
  
• Expediting prompt payment of claims within regulatory time constraints.
  
  
• Assisting with grievance resolutions.