MEDecision Delivers Integrated Medical Management; Optimizes Health Care, Lowers MLR, Slashes Administrative Costs

WAYNE, Pa., Feb. 10, 2003 -- MEDecision Inc., a software and services leader in care management, today announced Integrated Medical Management, a comprehensive care management solution developed to meet the exacting, complex and ever-evolving needs of healthcare management professionals. MEDecision is exhibiting Integrated Medical Management at the 2003 Annual HIMSS Conference and Exhibition, Booth #1437, through February 13, in San Diego, California.

By tightly integrating field-proven MEDecision applications with industry-standard clinical criteria and rules, Integrated Medical Management (IMM) emerges as the industry's first fully integrated care management solution to employ a consistent rule set across all components. In doing so, IMM establishes an unsurpassed degree of consistency across all care management decisions. For the managed care organization (MCO), IMM reduces clinical and financial risk by ensuring delivery of appropriate and timely care and by precisely targeting care for at-risk patients, increasing administrative efficiencies, and decreasing medical loss ratios.

"The MCO's mission is to provide the highest quality health care at the lowest possible cost," said John H. Capobianco, executive vice president and chief marketing officer at MEDecision, "and that mission is often compromised when discrete medical processes are automated by standalone systems employing disparate rules. IMM takes a holistic approach to the MCO's mission, uniting all care management solutions under one set of rules to generate a consistent view of MCO operations and actionable plans for improvement."

Integrated medical management has been over-promised and under-delivered for the past 15 years as vendors focused on providing standalone, process-specific systems that address critical tasks, such as claims management, utilization management, population stratification, and authorization automation. "Typically, MCOs have been left holding the integration bag only to find the benefits of discrete systems automation countered by the costs of their in-house efforts to establish inter-system communications," added Capobianco.

The Integration Imperative

The care management industry has long struggled with the challenges of automating manual procedures to achieve the benefits of reduced medical and administrative expenses, improved quality of care, and increased member and provider satisfaction. Until now, healthcare technology approaches have primarily addressed specific problem areas, resulting in a myriad of disparate systems that inhibit the efficient use and flow of vital healthcare information between patients, providers and payers. Such silos of information not only hinder the ability of MCOs to improve quality of care and decrease costs, but also diminish the effectiveness of the entire healthcare system.

To remedy this situation, MCOs need to share information across all care management areas and establish integration with both internal and external data sources and systems. Additionally, MCOs need to improve their ability to conduct proactive case and disease management, while increasing their levels of automation to drive down administrative costs. Finally, MCOs must establish stronger provider relationships and continually strive for higher levels of member satisfaction.

Integrated Medical Management (IMM) is MEDecision's response to the MCO challenge. IMM lets MCOs identify areas of financial and clinical risk, implement programs to manage these risks, and continuously evaluate the effectiveness of these programs. In action, IMM provides the analytics environment that feeds the rules engine and care management information center with important patient and provider information, thereby enabling more judicious care for the highest at-risk patients.

For example, IMM lets an MCO analyze its patient population to identify at-risk groups, such as diabetics, and establish a preventative care program. After reviewing utilization data for its diabetic population, IMM can take automated action for those patients who have not taken advantage of the MCO's preventative programs, perhaps generating patient correspondence or assigning them to care managers. Similarly, IMM integration automates the authorization process. By taking rules associated with diabetics and applying them to incoming authorization requests, IMM can automatically approve those requests that meet the rules and pend those that merit further investigation. Finally, IMM lets the MCO optimize the preventative program through on-going review of clinical and financial outcome data, modifying the treatment plan based on current and historical information.

MEDecision's Integrated Medical Management

With Integrated Medical Management (IMM), MEDecision dramatically improves the relationship between providers, patients and managed care organizations to create the greatest impact on the quality and cost of care. IMM gives MCOs the tools to identify high-risk, high-cost members, diseases and conditions, and then implement the programs needed to improve patient care and optimize costs. Further, IMM automates healthcare transactions between MCOs and providers, and drives a consistent clinical philosophy throughout the entire care management process.

The MEDecision IMM solution relies on three tightly coupled components to help MCOs identify areas of financial and clinical risk, implement programs to manage these risks, and continuously evaluate the effectiveness of these programs.

-- Analytics and Disease Management provides the predictive capabilities, clinical picture, management tools, and data analysis, enabling MCOs to create the right programs, target the right members and provide the appropriate feedback to providers.

-- Advanced Medical Management unites clinical staff with care management processes through automated workflow and detection tools. MCOs can thereby manage their population across the continuum of care and assess the clinical and financial outcomes of care management programs.

-- Transactioning and Automated Authorizations creates the necessary bridge to electronically link physicians, hospitals and MCOs, supporting the direct submission and processing of healthcare transactions, including referrals, authorizations and extensions.

Working together, these three components place all the data, both historical and current, in the hands of the care managers and provide comprehensive, automated tools that ensure the most efficient handling of information and consistent application of rules throughout the medical management decision-making process.

With IMM, MEDecision takes a fundamentally different approach to traditional care management, treating the integration of individual IMM components as a core design element, rather than an afterthought. The result is a solution that closely mirrors the way chief medical officers and MCO executives intuitively think about their business and their health care responsibility, where the interdependencies of care management, analytics, and transactions/authorizations are recognized and leveraged.

Continued Capobianco, "The ad-hoc integration required to unite discrete medical systems tends to generate a system-induced schizophrenia that can lead an MCO to approve a service request, yet pend the subsequent service claim. Our extreme degree of integration means that IMM works for the MCO, not against it."

The MEDecision Advantage

Since its founding in 1988, MEDecision has been exclusively focused on medical management products for MCOs. The company's history of successful integration projects and solid customer base confirms its position as an industry leader in utilization, case management, and disease management solutions. Similarly, MEDecision has established itself as an innovator in patient and provider analytics, as well as automated authorizations and referrals.

Today, 47 MCOs rely on MEDecision solutions to manage care for over 33 million lives, approximately one in every seven insured Americans. Cumulatively, MEDecision clients have logged over 28,000 user-years of experience on the company's applications. MEDecision's continuing product success within MCOs, as well as its financial success in the care management market, verifies its status as an experienced, knowledgeable vendor with a pioneering spirit. With its legacy of success, MEDecision stands as the vendor most capable of delivering integrated medical management.

"For more than 15 years, MCOs have been working hard automating their care management procedures to lower medical loss ratios and reduce administrative costs. By taking a top down approach, and creating a truly integrated care management solution, MEDecision has broken new ground and advanced the industry with IMM. The MCO now can focus on quality of care and member satisfaction, and the solution attributes will automatically deliver higher efficiency and better utilization," concluded MEDecision's Capobianco.

About MEDecision

MEDecision is a leading software and services provider of integrated care management solutions. Founded in 1988, the firm specializes in linking patients, providers and payers in an information network to improve overall health outcomes and reduce costs. MEDecision customers include multiple Blue Cross and Blue Shield organizations, complex health management organizations, integrated delivery networks, Medicaid managed care organizations, major insurance carriers and specialty managed care firms.

MEDecision's software products are being used at 47 managed care organizations to improve the quality of healthcare and reduce both administrative and unnecessary clinical costs for over 33 million people -- approximately one in every seven Americans with health insurance. MEDecision's solutions include integrated case, disease and utilization management, high-risk patient identification, automated authorizations, provider profiling and quality analysis.

For more information about MEDecision and Integrated Medical Management, please call 610/254-0202, email or visit

Note to Editors: MEDecision is a trademark of MEDecision, Inc. The MEDecision logo and product names are also trademarks or registered trademarks of MEDecision, Inc. Other products and brand names are trademarks of their respective owners.


      CONTACT: MEDecision
               Laura Paden, 650/344-1260