MEDecision Inc., a Wayne, Pa.-based provider of collaborative health management solutions, published an e-book, “Medical Loss Ratios: Important Implications for Care Management,” which examines the impact that healthcare reform and the new U.S. Department of Health and Human Services (HHS) medical loss ratio (MLR) mandates have on care delivery models. The e-book also explores the critical role of health information technology (IT) as health plans work to meet the new requirements, improve the quality of care and drive down costs.
MLR is defined by the 2010 Patient Protection and Affordable Care Act (health reform) as the minimum percentage of premiums health plans must devote to clinical services and quality improvement efforts. Starting this year, health plans must meet the new MLR ratios or refund the difference to policyholders beginning in 2012.
The e-book outlines what the HHS considers to be medical and quality-related activities for health plans within the MLR parameters. Investments in health IT qualify as such and should be considered an important part of the equation to not only help health plans work to meet the MLR requirements but also to improve the overall quality and cost of care for their members.