In support of decision support for IPAs: California MSO brings Web technology and automated efficiency to West Coast medical groups - Managed Care - individual practice association, managed services organization

Health Management Technology, August, 2002

Making It Real

The year 2000 was eventful for PPMSI. In May, after six months of software development and then passing muster with beta sites, PPMSI replaced its intranet system in SCCIPA physician offices with its new Web-based product. The organization made technical staff available by phone and through on-site visits to help physician offices with downloading Microsoft Internet Explorer 5.x when necessary. It provided system demonstrations and personal meetings with SCCIPA physicians and their office personnel, plus an online manual and a self-paced online demo.

After three months of utilization, almost 70 percent of referral/authorization requests from SCCIPA physicians, representing 120,000 HMO members, were handled via the Web-based system, surpassing the less than 40 percent automation rate achieved with the intranet-based process.

Randall D. Frakes, executive vice president and chief operating officer of PPMSI, says that more than half of all referral and authorization requests are now handled completely through automated protocols and automated responses back to physician offices. The result is that PPMSI's own medical review staff can dedicate its time to those requests that genuinely require medical officer review. UM protocols are also integrated with reviewer queuing, allowing medical directors, nurses and authorization representatives to administer authorization work queues efficiently by priority. Concurrent review can be managed from hospitals, care centers or corporate facilities

As a managed services organization, PPMSI was able to reduce its own customer service and utilization management staff by more than 20 percent, dropping from the industry standard of 0.9 to 1.0 FTEs per thousand commercial HMO members to .73 FTEs per thousand, representing an administrative efficiency for IPAs that contract with the company for management services. Profiting from its own automation development, PPMSI today requires 34 percent fewer authorization staff, 43 percent fewer nurses and 25 percent fewer medical directors (per thousand commercial HMO members) than it did in 1997.

Nowhere is efficiency a two-way street more than with IPAs and their administrators. Efficiency created at the MSO level inevitably translates to efficiency at the physician office level, and that saves time and money for everyone.

Technically Speaking:
PPMSI Online

Operating System:         Windows 2000 Server

Database:                 SQL Server

Web server:               IIS 5.0

Client browser:           IE 5.x and above

Programming               HTML and ASP
languages:

Security:                 All communication over
                          SSL using 128-bit encryption
                          to securely transfer information
                          over the Internet.

Integration:              Integrates with most legacy
                          claims systems including IDX[R],
                          OAO[R] and EZ-CAP[R].
                          Uses standard relational
                          database technology, with data
                          import and export via any
                          ODBC-compliant data source.