Wednesday, July 27, 2011

Achieving Neutrality in your ICD-10 Solution Design

People who’ve been involved with ICD-10 assessment and remediation projects gain a quick understanding of the depth and breadth of the challenge they are facing.   While the transition to ICD-10 offers many strategic opportunities for payers and providers, the immediate challenge is to achieve compliance while maintaining the status quo of existing business processes and financials through the Oct 2013 transition date.

This post identifies some of the primary areas of focus for achieving neutrality in your ICD-10 solution design.  Also included are key challenges to overcome in order to achieve neutrality in your ICD-10 solution design.

Focus Areas

1.       Financial Neutrality

Financial Neutrality means maintaining reasonably equivalent financial outcomes with your trading partners both before and after the conversion to ICD-10 is completed. Member benefits and provider contracting/pricing are two key business areas to neutralize.

2.       Process Stabilization

Process Stabilization means that your internal and external business processes can be carried out on a consistent basis before and after the transition date.  Key areas to ensure stabilization include Case Management, Utilization Management, Disease Management and Reporting.

Challenges

1.       Defining a Remediation Solution for existing business processes and software components that maintain existing operational performance and financial metrics.

2.       Ensuring that business processes, software components and trading partner interactions are predictable and consistent.

3.       Defining a framework to ensure integrity of the solution design BEFORE and AFTER the transition date.

4.       Identifying and creating contingency plans and the gates and levers that trigger these plans.

In future posts, I’ll share additional knowledge, perspective and insight into the topic of solution design neutrality with the hope that others share their ideas, concerns and perceptions. Like a good relationship, a little give and take goes a long way toward pleasing everyone involved.

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