Getting It Right for Providers - Venture Health Partnership Group - Industry Trend or Event

Health Management Technology, August, 2001 by Barry S. Scheur

Louisiana-based health plan successfully puts managed care providers online and efficiency at the top of everyone's list.

It's no secret that provider adoption of Web technology has presented a challenge to the healthcare industry--particularly to companies trying to market it to providers.

Health plans are skeptical about committing resources to improve information access for providers because they fear being first, coupled with lack of proof of impact and efficiency. Healthcare plan management, which is known to be technophobic anyway, is reluctant to bear the disproportionate expense of implementing technology that mainly benefits providers.

Yet the only way to change the perception of managed care within the medical and business communities is to deliver information and to act on it with integrity. How managed care can continue to place roadblocks in the path of those who control its financial future and perception of quality--i.e., providers--is a mystery I have never understood.

In establishing Venture Health Partnership Group, the parent company of the health plans known as The OATH, our mission has been to reshape the face of managed care by focusing on a common sense operational core vision of accountability, integrity and communication with those who make the health plan work most effectively.

Most health plans have established their technology priorities and applications without significant input or attention to either provider office workflow needs or the data that providers require to conduct business. These are primary requisites of any Internet strategy if a health plan has any hope of getting docs and their staffs to commit the time and energy to learn how to use a new set of tools. Too often, health plans have changed their policies around authorizations, referrals and claims submissions, only to be told that the processes revamped in the name of efficiency actually cause physicians and their office staff to waste more time than they already have. Providers have shown time and again that unless a new technology actually saves them time, they are apt to ignore it. Service, efficiency, hassle elimination, and accurate and timely data coupled with payment are the keys to provider support, which will ultimately determine a health plan's success. These were the primary factors that The OATH for Louisiana wanted to address when it implemented a communications platform for its providers. Our goal was to use e-health as part of a strategy to make managed care work better for the providers on whom we depend for survival.

Health plan providers need to access health plan information to conduct business and manage cash flow. Traditionally, providers used the telephone for these purposes, where both provider and health plan incurred per phone call costs averaging $1 to $5 per call--to say nothing of lost time and the "annoyance" factor that goes with inefficiency. While Internet technology promises demonstrated cost savings and increased efficiency, those benefits are not achievable without provider buy-in.

Back to the Basics

In the spring 2000, The OATH for Louisiana, a 125,000-member, 6,500-provider health plan based in New Orleans, began to consider what mechanism for provider information sharing and data access it would use. Our goal was to choose an e-health application that matched our mission statement of "no run arounds, no bureaucracy and no hassles." We wanted to use the Web to facilitate putting medical necessity back in the hands of providers.

We used a detailed vendor evaluation and selection process, and ultimately chose HealthTrio because we felt they most closely matched and mirrored our criteria:

Successful provider adoption experience. This was the only way to ensure the technology actually worked and offered real value to providers. Most e-health vendors were still beta-testing applications in 1999 and 2000, so we limited our search to the few that could provide demonstrable evidence of a successful implementation.

We wanted a vendor that could offer strong incentives to encourage providers to adopt the application. Foremost is that The OATH sponsors (and pays for) the services provided by HealthTrio, which are free of charge to providers. Providers need nothing more than Internet access to begin transacting. Once connected, providers have 24-hour, real-time access to accurate, up-to-date member information directly from The OATH.

Provider workflow and communications match. We wanted a product that would match provider office workflow and facilitate two-way communication. Many health plans have implemented e-health initiatives based on their own needs, initiatives that created more hassle for providers than convenience and efficiency. For example, one solution allowed providers to search for claims information based only on date of service, as opposed to member, provider, health plan or claim number.

Multiple functions. HealthTrio's solution is based on a managed care rules engine that was incorporated into previous information systems products that operated as the backbone of managed care plans. It allows for more than just inquiry functions; providers can submit referrals and claims and have real-time interaction to correct errors or omissions before the claim is sent to the health plan. It also benefits the health plan because provider information is received in an accurate electronic format that doesn't require the need for a clearinghouse.