Integrated Healthcare Creates Efficiencies

Barak Obama’s administration is expected to spend $50 billion to modernize the health care system, focusing in part on upgrading information technology for EHR for electronic health record, and PHR for personal [fusion_builder_container hundred_percent=”yes” overflow=”visible”][fusion_builder_row][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”][electronic] health record.

Business process engineering will be a critical component.  Before IT can change, a clear understanding of existing or as is process modeling, and a new to be, or future state vision, must be determined.  As you can imagine, if health care claims are currently being processed via paper, and in the future you expect to process them electronically, the workflow of health insurance company staff, as well as health providers and patients will have to change.  The ability to facilitate meetings with key stakeholders and produce Process Models that enable simulation and what if scenarios are key competencies to help health insurers meet this challenge.

Emergence of a Retail Market in Healthcare

A retail market is rapidly emerging in healthcare as consumers pay a greater share of total costs. Per-person health spending in the United States has reached $7,110 in 2006 and is expected to climb to $12,320 in 2015. More than 46 million Americans are uninsured and growing numbers of employers are dropping coverage or thinning benefits.

With healthcare spending rapidly approaching 20 percent of the U.S. Gross National Product, healthcare has reached a crossroads. Either free-market forces will solve the current affordability crisis or the federal government may impose a solution. If the industry hopes to solve the affordability crisis, healthcare payer organizations will have to rethink their roles and fundamentally change the way they provide value in the supply chain. To sustain their role at the center of the healthcare supply chain, payers must lead the industry’s transformation by deploying solutions that enhance their revenue growth and improve the customer experience.

The Need for Innovation in Health Care

The emergence of a retail market necessitates that companies currently offering healthcare solutions undertake innovative integration with new entrants to the value chain (such as financial institutions and payment processors) in order to offer viable, enabling solutions. If payers fail to keep pace with the changing market, they risk losing business to market leaders. Or worse, as healthcare and financial services converge, payers eventually could find themselves replaced. If payers do remain at the center of the supply chain, they can ensure that all stakeholders work in an efficient, streamlined fashion to not only administer claims, but also to facilitate transactions, reduce costs, pay providers and ultimately enhance the health of plan members.

Integrated Healthcare Management (see IHA) is the systematic application of processes and shared information to optimize the coordination of benefits and care for the healthcare consumer.  No World Borders applies our talent and process knowledge to help improve the flow of information from doctors to payers and funds from payers to doctors, in partnership with leading health care solutions firms.

U.S. healthcare includes significant variability in how healthcare is delivered and in the results it achieves, largely due to divisions among the constituents in the healthcare supply chain: the consumers who use the system, the providers who give care, the employers and consumers who purchase healthcare, and the health plans that pay for services.

Integrated Healthcare Management is a framework that connects all of the healthcare supply chain constituents so that they can collaborate on and coordinate benefits and care.No World Borders is partnering with companies to provide its consulting services to give payers the software, services, and blueprint required to power Integrated Healthcare Management, and lead the transformation of healthcare.  

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Michael F. Arrigo

Michael Arrigo brings four decades of experience in the software, financial services, and healthcare industries. In 2000, Mr. Arrigo founded No World Borders, a healthcare data, regulations, and economics firm with clients in the pharmaceutical, medical device, hospital, surgical center, physician group, diagnostic imaging, genetic testing, health IT, and health insurance markets. His expertise spans the federal health programs Medicare and Medicaid and private insurance. He advises Medicare Advantage Organizations who provide health insurance under Part C of the Medicare Act. Mr. Arrigo serves as an expert witness regarding medical coding and medical billing, fraud damages, as well as electronic health record software for the U.S. Department of Justice. He has valued well over $1 billion in medical billings in personal injury liens, medical malpractice, insurance fraud cases. The U.S. Court of Appeals considered Mr. Arrigo's opinion regarding loss amounts, vacating, and remanding sentencing in a fraud case. Mr. Arrigo provides expertise in the Medicare Secondary Payer Act, Medicare LCDs, anti-trust litigation, medical intellectual property and trade secrets, HIPAA privacy, health care electronic claim data Standards, physician compensation, Anti-Kickback Statute, Stark law, the Affordable Care Act, False Claims Act, and the ARRA HITECH Act. Arrigo advises investors on merger and acquisition (M&A) diligence in the healthcare industry on transactions cumulatively valued at over $1 billion. Mr. Arrigo spent over ten years in Silicon Valley software firms in roles from Product Manager to CEO. He was product manager for a leading-edge database technology joint venture that became commercialized as Microsoft SQL Server, Vice President of Marketing for a software company when it grew from under $2 million in revenue to a $50 million acquisition by a company now merged into Cincom Systems, hired by private equity investors to serve as Vice President of Marketing for a secure email software company until its acquisition and multi $million investor exit by a company now merged into Axway Software SA (Euronext: AXW.PA), and CEO of one of the first cloud-based billing software companies, licensing its technology to Citrix Systems (NASDAQ: CTXS). Later, before entering the healthcare industry, he joined Fortune 500 company Fidelity National Financial (NYSE: FNF) as a Vice President, overseeing eCommerce solutions for the mortgage banking industry. While serving as a Vice President at Fortune 500 company First American Financial (NYSE: FAF), he oversaw eCommerce and regulatory compliance technology initiatives for top ten mortgage banks and led the Sarbanes Oxley Act Section 302 internal controls IT audit for the company, supporting Section 404 of the Sarbanes Oxley Act. Mr. Arrigo earned his Bachelor of Science in Business Administration from the University of Southern California. Before that, he studied computer science, statistics, and economics at the University of California, Irvine. His post-graduate studies include biomedical ethics at Harvard Medical School, biomedical informatics at Stanford Medical School, blockchain and crypto economics at the Massachusetts Institute of Technology, and training as a Certified Professional Medical Auditor (CPMA). Mr. Arrigo is qualified to serve as a director due to his experience in healthcare data, regulations, and economics, his leadership roles in software and financial services public companies, and his healthcare M&A diligence and public company regulatory experience. Mr. Arrigo is quoted in The Wall Street Journal, Fortune Magazine, Kaiser Health News, Consumer Affairs, National Public Radio (NPR), NBC News Houston, USA Today / Milwaukee Journal Sentinel, Medical Economics, Capitol ForumThe Daily Beast, the Lund Report, Inside Higher Ed, New England Psychologist, and other press and media outlets. He authored a peer-reviewed article regarding clinical documentation quality to support accurate medical coding, billing, and good patient care, published by Healthcare Financial Management Association (HFMA) and is published in Healthcare IT News.

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