Healthcare Reform, on the Cusp of Passage, Presents Challenges and Opportunities for the Nation`s Health Plans

Early Adopters of New Technologies Can Not Only Sustain Operational
Profitability but Thrive Through Greater Accountability and Risk Management
SOUTHBOROUGH, Mass.--(Business Wire)--
The United States moved a step closer to major healthcare reform this weekend as
the House of Representatives voted 220 to 215 to approve a plan that will, among
other goals, extend coverage to an estimated 36 million people without
insurance, create a government health insurance option and prohibit such
contentious insurance company practices as denying coverage for those with
pre-existing conditions and rescinding coverage without clear and convincing
evidence of fraud. The nation`s health plans - particularly those with targeted
offerings for the individual insurance market - should see in this an incredible
opportunity to gain market share, according to Ravi Ika, chief executive officer
of ikaSystems.

"In a year marked by raucous debate over the U.S. government`s appropriate role
in healthcare, signs of consensus are finally starting to emerge with this bill,
which will now move to the Senate for the final stage of battle," said Ika.
"Innovative insurance companies have not stood idly by during the debate but
instead have turned to ikaSystems in growing numbers to help them prepare for
momentous change. These innovators understand that the time is now to rethink
their technology and medical management strategies, because only agile,
enterprise-wide systems such as ikaEnterprise can help them contain medical
costs by doing what is truly best for health plan members."

As Ika explained, "ikaEnterprise is a single Web-based technology platform that
can be used to increase automation and intelligence management across every
health plan line of business: government and commercial, individual and employer
sponsored. What does that really mean? First, we can help significantly lower
administrative costs through more efficient data sharing and distributed
transaction workflows. However, over 80 percent of the premium goes toward
medical expenses."

The decision about how those dollars are allocated rests largely in the hands of
primary care physicians, who are billing for services, referring to specialists,
ordering lab tests, prescribing pharmaceuticals and so on. The primary care
physician, therefore, serves as an important gatekeeper of care usage, according
to Ika: "Systems such as ikaEnterprise provide actionable, real-time
intelligence to physicians about how their practice patterns affect both the
cost and quality of care. Programs such as pay-for-performance, risk
contracting, tiered networks based on cost and quality, and hospital contracts
that use both cost and quality information are all important techniques to
address the estimated 30 percent of medical expenses that are avoidable. All can
be automated through ikaEnterprise."

As health plans are aware, perhaps the most significant opportunity lies with
managing member risk. The goal has been to seamlessly share the same processes
and information between health plan administrative and care management staff,
healthcare providers, plan members, employers and, as necessary, state and
federal governments - all while reducing every process to the fewest possible
human "touches."

"This goal was impossible to achieve before technologies such as ikaEnterprise
emerged, yet it is precisely what is needed to ensure that the healthcare needs
of every American are clearly, quickly and efficiently understood and addressed
in a way that makes sense for the healthcare ecosystem as a whole," said Ika.

The key for health plans is to intelligently draw forth the health conditions of
prospective members during the sales process and identify existing risk, then
proactively measure Healthcare Effectiveness Data and Information Set (HEDIS)
and other quality metrics to proactively determine changes to a member`s health
risk over time. The amount and type of care management support that will
optimize outcomes can vary widely, which is why ikaEnterprise was designed to
keep a constant, electronic finger on the pulse of each member, detecting subtle
shifts that might require a member to transfer seamlessly from system or
wellness management to disease management to case management and back again, Ika
explained.

Even when a high-touch intervention is required, the system is a constant
presence, encouraging communication among the care team, alerting members to
required tests, forwarding relevant educational information, and supporting
physicians and care managers through nonintrusive reminders.

"Better healthcare at a lower cost - ultimately, this is what healthcare reform
is striving to achieve. ikaSystems was founded on the belief that controlling
healthcare costs is about intelligent, efficient and collaborative health
management. With ikaEnterprise, health plans have the power to be major players
in healthcare`s transformation and maintain their profitability," concluded Ika.

About ikaSystems Corp.

ikaSystemsis healthcare payers` premier provider of enterprise-level Web-based
technologies for commercial, Medicare and Medicaid lines of business.
ikaEnterprise, the company`s flagship product, automates all key processes in
the payer business cycle - from marketing and sales through claims
administration and customer service to care and quality management - all on a
single integrated platform. Using our agile, modular technology, organizations
can proactively move to lower administrative and medical care expenses and
thrive in even the most challenging environments. To learn more, please visit
www.ikasystems.com.

ikaSystems Corp.
Sandy Cummings, 774-760-1694
Vice President, Marketing
scummings@ikasystems.com

Copyright Business Wire 2009