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From the December 2003 Issue |
Transaction Portal Cuts Costs New York payers and providers discover that IT collaboration and the sharing of information affords savings that no organization could achieve on its own. By Robert Quinn
One of the members, Buffalo, N.Y.-based Kaleida Health System, is recovering $120,000 a month—$1.44 million annualized—in copays that were previously not collected due to the lack of information about member eligibility and copays, reports Fran Meyer, chief information officer at Kaleida Health System. Also, Catholic Health System in western New York is recovering $82,000 a month—$984,000 annualized—in copays that were previously lost, says Jeffrey Baughan, chief information officer at Catholic Health System. Kaleida and Catholic Health Systems achieved these benefits by participating in a unique collaboration with four provider organizations and three payer organizations in western New York. The result of the collaboration is Western New York HealtheNet (WNYHealtheNet), an organization with a mission to leverage shared infrastructure, technology and intellectual capital to optimize the delivery of patient information to the healthcare community. Roughly two-thirds of western New York providers are signed up and using WNYHealtheNet, which represents nearly 7,500 provider users on the system. Achieving Individual Missions Payer organizations also benefit from WNYHealtheNet. HealthNow, a WNYHealtheNet payer participant, realized a significant increase in transactions while reducing the amount of calls and costs associated with its call center volume for inquiries by enabling additional access to online information, according to Gary Kerl, chief information officer of HealthNow and BlueCross BlueShield of Western New York. The improved efficiency of this new system, and the reduced volume that needed to be handled by the call centers, enabled HealthNow to avoid call center costs of nearly $20,000 a month and eliminated the need for $8,600 a month in dial-up lines. Combined, these efforts reduced annual costs to date by more than $340,000. Independent Health, another WNYHealtheNet payer participant, reduced its cost of handling provider eligibility inquiries by 31 percent. “Being part of WNYHealtheNet helps its members achieve their missions of delivering care on a communitywide level,” says Robert Krenitsky, chief technical officer of Excellus Health Plans Inc. Creating for Collaboration “The impetus behind WNY- HealtheNet was to form a collaborative organization that could help all participants comply with the transaction and code set standards mandated by the Health Insurance Portability and Accountability Act (HIPAA). Each of the founding organizations agreed to share knowledge and the costs of development and implementation,” says Deborah Cancilla, chief information officer at Erie County Medical Center Healthcare Network, one of WNY- HealtheNet’s founding organizations. Cancilla also is a member of the WNYHealtheNet steering committee. “One of the primary goals was to create and adopt consistent transaction standards, which at the time were still being established by the Centers for Medicare and Medicaid Services, so WNYHealtheNet participants could gain access to HIPAA transactions and other healthcare information,” Cancilla adds. Collaboration on the transaction standards created the foundation of WNYHealtheNet. With the standards in place, information could be shared among the organizations and the financial benefits of online transactions could be realized. For example, it costs a provider organization from $7 to $12 to file a paper-based claim, but it only costs $1.50 to $3 to file the same claim electronically, according to the white paper, “The Latest on HIPAA Administrative Simplification,” published by First Consulting Group. Traditional customer service inquiries typically cost from $5 to $7 each, while an electronic inquiry costs 5 cents to 25 cents, according to the white paper. The development of WNYHealtheNet began in early 2001, with the initial rollout of online eligibility checking starting in June 2002. WNYHealtheNet now links more than 3,000 physicians within the community and has processed 5 million transactions for membership and benefit plan details (HIPAA 270/271 transactions). Online claims status inquiry (HIPAA 276/277 transactions) became available in March 2003 and is ramping up steadily, with nearly 70,000 transactions to date. WNYHealtheNet is managed by a steering committee with representatives from each of the seven founding partners, which include payers Blue Cross Blue Shield of Western New York, Univera Healthcare (an Excellus Company) and Independent Health, and provider organizations Catholic Health System, Erie County Medical Center Healthcare Network, Roswell Park Cancer Institute and Kaleida Health System. Other participants of WNYHealtheNet include HealthNow and BlueShield of Northeastern New York, both of which are payers serving the upstate New York area. A study funded by WNYHealtheNet estimates that the seven partners combined save upward of $6.3 million a year by sharing the costs associated with salaries, benefits, infrastructure, software licenses and system maintenance. It is estimated that the participating organizations would have spent as much as $17 million to develop their own solutions if they would not have collaborated on the project, says Thomas Unger of healthcare consulting firm GrapeVine Co., Buffalo, N.Y., who serves as the program manager of WNYHealtheNet. In contrast, the seven founding members of WNYHealtheNet have spent slightly less than $5 million to develop the solution. The Enabling Technology The technology driver behind WNYHealtheNet is the Eliginet Healthcare Transaction Portal from APP Design Inc., Itasca, Ill. Eliginet is a healthcare portal solution that provides a single point of access to information from multiple, disparate data sources. It securely handles clinical and financial transactions to meet HIPAA requirements for data formats and privacy. Although used by WNYHealtheNet as a portal to connect multiple external organizations, it also can be used as a platform for large enterprises to share information within their organizations. Eliginet’s handling of transactions enables WNYHealtheNet participants to share information while simultaneously maintaining the confidentiality of transactions. Rather than being a repository of membership information, Eliginet functions as a transaction exchange portal. Although the WNYHealtheNet portal functions as a single point of contact for healthcare information, no patient-identifiable information is stored by the Eliginet solution, other than the audit trails that are maintained for each transaction. Eligibility and other inquiries access the Eliginet portal, which then simultaneously searches multiple data sources in real time to answer the query. The results from the query are passed along to the user via the Web browser. “All the functionality offered by WNYHealtheNet takes place within a Web-browser environment, so user training is minimal, which is a real benefit to our organization,” Cancilla says. Online Referrals and Authorizations WNYHealtheNet is currently expanding its services to offer online referrals and pre-authorizations communitywide, with the initial rollout of these services expected before the end of the year. The online referral solution is integrated in the overall solution and also was developed by APP Design. Some of the participants previously had legacy electronic referral and authorization systems. WNYHealtheNet anticipates that it will experience similar successes communitywide when it goes online with its referral and pre-authorization solution. As an example, previously handling referral inquiries by phone used to cost $2.50 each, but now costs 50 cents per inquiry when inquiries are handled electronically. The benefits of online referrals can be demonstrated by an example from one of the participants, Independent Health. Its current solution has processed nearly 10 million transactions, including more than 700,000 referrals in the last three years. The online referral system reduced Independent Health’s rework on referral transactions by 75 percent and has substantially improved provider relationships. Robert Quinn is the president of APP Design, Itasca, Ill. Contact him at robert.quinn@appdesign.com. For more information about products from APP Design, www.rsleads.com/312ht-209 © 2003 Nelson Publishing, Inc |
Saving more than $2.4 million during the past year, two provider organizations exemplify how participating in a community health portal can result in a sizable return on their technology investments. These savings are the result of an online portal used by the organizations to access member healthcare information.