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From the April 2003 Issue Deploying Secure, Reliable Wireless LANs in the Healthcare Environment |
Opening the Lines of Communication Blue Cross health plan uses the Internet to connect providers and streamline their transactions. In today’s paper- and phone-dependent healthcare industry, few managed care companies and health plans have properly taken advantage of the Internet to work with physician offices. Independence Blue Cross (IBC) in Philadelphia is an exception. PROBLEM IBC serves more than 3.3 million members in southeastern Pennsylvania, New Jersey and Delaware. With a network of more than 20,000 physicians and 100 hospitals, the company and its subsidiaries process more than 31 million claims annually. Like many health plans nationwide, we traditionally employed a phone- and paper-based system for its providers to process inquiries and conduct transactions related to patient care and treatment reimbursements. The manual, labor-intensive processes associated with this system left many providers drowning in paperwork and increasingly frustrated. On the back end, the millions of transactions weighed heavily on IBC’s efficiency. Only hospitals could access eligibility records, and the health plan was processing less than 1 percent of referrals electronically. Referrals were a taxing aspect of the phone- and paper-based system. We process an estimated 3.2 million referrals annually. A bottleneck occurred when IBC received a specialist’s claims before receiving the actual referral from a primary care physician. This common scenario involved back-and-forth phone calls between physician offices that resulted in claims being suspended or denied unnecessarily, requiring additional documentation and follow-up from the providers to resolve the claims. To maintain IBC’s commitment to high-quality member and provider service, we knew we needed to change. SOLUTION In 2000, we kicked off an e-commerce initiative to address the paper and phone inefficiencies distracting the health plan and its providers. The primary objective of this strategy was to improve our members’ satisfaction and confidence in the health plan. A second goal was to make it easier for IBC’s providers to interact and communicate with the health plan in daily administrative functions. Our senior management team decided that the cornerstone of the e-commerce plan would be Internet-based connectivity—technology to link providers with the health plan’s information systems and simultaneously create opportunities for IBC to better serve its members. IBC created a wish list of functionality for its ideal solution. Workflow and return on investment topped the list of priorities. We knew the solution would have to streamline, automate and simplify workflow processes for users. We also knew that thousands of providers and their staff members would use this solution, so it required flexibility to fit within the unique workflows of individual physician offices and hospitals, as well as the capability of infusing value-added services into their daily administrative routines while integrating with IBC’s own managed care transaction systems. IBC set high expectations for provider adoption and utilization. We aimed to convert 3,000 providers to the Web-based system within the first four months of operation. With internal resources already strapped, IBC needed a technology partner that could jump-start the project by automating high-volume transactions right away while delivering training and support on-site. IBC evaluated a number of healthcare technology vendors, consulted with fellow Blue Cross health plans and, most importantly, gathered feedback from providers. In the end, we selected NaviNet, a Web-based connectivity solution that transcended disjointed electronic data interchange and static portal solutions, from Boston-based NaviMedix Inc. Through a customized user interface, providers would be able to access member information drawn from IBC’s proprietary and legacy systems. The Web-based system combined ease of use for providers with the customer service and health plan branding priorities we had previously identified as objectives. IMPLEMENTATION NaviMedix identified eligibility and benefits inquiries as the transaction sets in most immediate need of automation. On the user side, NaviMedix helped IBC select multiple beta sites for provider rollout, installed NaviNet and covered all aspects of training with beta users. In August 2001, less than 90 days after implementation began, IBC went live with its new solution for Internet-based provider connectivity. By October 2001, IBC was already extending the functionality of the Web-based connectivity system to include claim status, referral submissions, batch eligibility, medical policies and network search capabilities. By December 2001, more than 4,500 providers were signed on as users. The health plan has added functionality to the system each quarter since implementation; in 2002, IBC implemented nine additional transactions including claims pre-processing, electronic prescription processing, authorization status inquiry, encounter submission and pre-authorization submission. RESULTS Less than 18 months following implementation, more than 11,000 IBC-affiliated physicians and nearly 100 hospitals in the Philadelphia area were using NaviNet to automate more than 20 back-office processes including eligibility and benefits, claims processing, referral inquiries and processing, employer notifications and authorizations. IBC estimates that it will add between 500 and 1,000 providers monthly in 2003, an adoption rate that far surpasses our earlier predictions for provider use. Using NaviNet, we have wholly exceeded our goals for processing Internet-based transactions. In 2002, IBC completed 3 million real-time, Web-based transactions, including more than 1 million eligibility inquiries, previously triaged through a call center, that were processed online. Electronic referrals rose dramatically to 500,000 during 2002, and in 2003, we anticipate processing 40 percent of referrals electronically, as well as 40 percent of emergency room notifications. On the claims side, in 2002, IBC converted more than 500,000 claims from paper and eliminated the manual processes for imaging and entry of those claims. IBC leverages NaviNet’s ability to conduct claims pre-processing transactions, where common errors such as eligibility, provider and member identification numbers and billing codes are spotted and corrected before the claim is submitted by the provider office. In 2002, these transactions numbered 200,000; we anticipate processing as many as 30,000 of these claims daily by the end of 2003. From the provider perspective, Tracey Clark, senior manager of payer relations at Drexel University College of Medicine, has experienced similar results. Clark manages the central billing office for 400 physicians at Drexel and measures their success by the volume of inquiries made to IBC. The accounts receivable department, formerly limited to the standard three transactions per call, now logs approximately 3,500 hits each month via NaviNet with an unlimited number of transactions processed in real-time and with no waiting. “Our everyday operations are more efficient,” says Clark. “We have greatly improved productivity in accounts receivable, and our relationship with IBC is better than ever.” Using self-service transactions to submit cleaner claims, Clark’s office cut the claims review period from 15 days down to seven days. With instant access to patient benefit information, the Drexel practices have not only made dramatic reductions in days in accounts receivable, but they also improved the collections process and financial bottom line. This, in turn, has reduced the overall number of invoices issued, generating a savings of $21.50 per invoice. NaviNet has also helped Drexel’s front-office staff process referrals overnight or even before the patient leaves the office. Now that IBC has tackled the administrative aspects of its provider relationships, we are looking for more opportunities to take advantage of Web-based connectivity. Based on feedback from end-users at physician offices and hospitals, we believe there are more clinical benefits to be explored. In January 2003, IBC introduced the capability to handle electronic prescriptions including renewals, electronic transmissions to pharmacies, real-time access to patient prescription records, and formulary, eligibility and drug interaction information. Medical management and provider profiling are additional areas where real-time, Web-based transactions could reduce costs, improve efficiencies and enhance relationships throughout IBC’s provider network and, most importantly, with its members—and they will be explored in our future. For more information about NaviNet from NaviMedix, www.rsleads.com/304ht-207 SOURCE PRODUCT/COMPANY © 2003 Nelson Publishing, Inc |
NaviNet