MEDecision Introduces E-book — Medical Loss Ratios: Important Implications for Care Management

WAYNE, Pa.--(BUSINESS WIRE)-- MEDecision, Inc., a leading provider of collaborative health management solutions, today 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. The complimentary publication can be downloaded at

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.

“The MLR mandates are designed to reduce waste and costs and therefore strongly encourage investments in health IT,” said Eric Demers, senior vice president, health and life science for MEDecision. “We launched this book to shed light on the important role health IT can play in delivering actionable information closer to the point of care and in the coordination of care among payers, providers and members. These are key considerations for health plans as they prepare for patient-centered medical home models, accountable care organizations and all the implications health reform has for the way care will be managed, administered and received.”

Collaborative health management has long been MEDecision’s forte. Now it has become the backdrop for health plans’ growing need to engage consumers and providers with knowledge that optimizes consumers’ health, improves outcomes, eliminates redundant tasks and reduces the cost of care. MEDecision’s solutions can serve as a strategic foundation for health plans building the differentiated programs and models they need for a competitive advantage in this new era of healthcare. The company’s solutions classify as a medical expense — health information technology related to health improvement and/or quality improvement — under the MLR definitions.

For more information about MEDecision, please visit Follow the company on Twitter at @MEDecision and on Facebook at

About MEDecision

MEDecision offers collaborative health management solutions that provide a simple and smart way for payers and providers to harness the power of knowledge to enable the best clinical decisions, engage patients and improve health outcomes. Designed around a patient-aware health management philosophy, MEDecision’s solutions include Alineo®, a health management platform for delivering outcome-driven case, disease, utilization and behavioral health management; InFrame™, a set of tools that facilitate the health and performance management processes for physicians and accountable care organizations; and Nexalign®, MEDecision’s health decision support service that applies analytics to information gathered from multiple sources to foster better business and clinical decisions on a patient’s behalf. For more information, visit

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

Tags: MEDecision, Medical Loss Ratio, MLR, healthcare, healthcare reform, collaborative healthcare management, health content, health content management, healthcare quality


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