health plans

HIT leaders defend private federal plans

Anne Zieger — Sat, 16 Aug 2008 00:53:35 -0400

Health industry executives are often critical of what the government does, particularly when it involves their income. But in this case, apparently, things are a bit different. Health IT industry execs are coming to the defense of the government's health IT plans in response to a research report calling the ONCHIT five-year plan "poorly conceived." In an unusual move, many execs are saying that government is in a much better place than private enterprise to make such plans. Article

NJ Blue plan invests $500K in med history tech for hospitals

Anne Zieger — Sun, 13 Jul 2008 11:48:34 -0400

Horizon Blue Cross Blue Shield of New Jersey has set aside $500,000 to help some of the hospitals in its network bring up electronic medical history technology. Early registrants for the program include Chilton Memorial Hospital of Pompton Plains, NJ, which will receive 85 percent of the costs of the technology--up to $40,000--for participating in the network. To roll out its part of the effort, Chilton will use technology vendor DrFirst's RcopiaAC system. During the remainder of 2008, as many as eight hospitals are expected to join the Blue plan's program. Amounts given to the various hospitals will vary.

Horizon believes that it is the first health plan in the U.S. to offer such a program. Even if that's true, however, it's unlikely to be alone for long. Health plans have a tremendous incentive to help hospitals avoid medication errors, which are costly, damaging and frequently, avoidable.

To learn more about this project:
- read this Healthcare IT News piece

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Study: E-prescribing cuts med errors 66%
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Joint Commission issues warning on child med errors

Cigna rolls out Second Life community

Anne Zieger — Sun, 06 Jul 2008 00:10:29 -0400

In an interesting case of an insurance company doing something (moderately) cutting-edge, Cigna has launched a pilot project that includes a virtual healthcare community based on virtual world Second Life. Previous companies with an interest promoting healthcare interests on SL include IBM, which debuted its own healthcare island promoting its HIE architecture at this year's HIMSS conference. As FierceHealthIT users are likely to know, SL is a 3-D virtual world where users interact in a realistic landscape using avatars to represent them. Cigna's SL community, which is being promoted in both the U.K. and the U.S., will offer virtual health seminars, educational games focused on preventative care and programs designed to improve and sustain health behaviors. Cigna hasn't yet decided whether the SL content will be provided to employers as a standard part of health plans, or as a free option for plan members.

To learn more about Cigna's offering:
- read this Healthcare IT News article

Want EMRs to succeed? Pay doctors to use them

Tue, 27 May 2008 06:59:59 -0400

You know, sometimes an answer is right in front of us. The American College of Physicians is handing you the cheat sheet, guys, so you don't need to furrow your brows anymore. If you want to get doctors started using EMRs, pay them for the time they spend using them!

I know, you're saying "Hey, nobody pays doctors to use telephones or review charts." And yes, I hear you--those activities have become part of a practice's overhead, rightly or wrongly. In recent years, handling incessant transactions with managed care companies has, too.

Should EMR/PHR reading, interpreting, analyzing and what-have-you be reimbursable activities, as the ACP suggests? Well, according to the old school of thought--which classifies those activities along with making phone calls--definitely not. But when you consider the way overhead has expanded and pay has dropped, that argument just doesn't make sense any more.

I've said this in prior columns but it bears repeating: Let's face it, health plans, at this point in the game, you have more to gain from getting doctors online and using EMRs than they do. You're the ones who'll get the quality data to take to your employer customers. You're the ones who will have an easier time satisfying the NCQA. You're the ones who'll look good in business coalition report cards.

Yes, doctors want to provide quality care, but many know how to do that pretty darned well using old-fashioned methods. Perhaps they can do better, but so much better that they need to turn their professional workflow upside down, risk coding their claims wrong and spend a fortune to boot? That's understandably a hard sell.

So, for heaven's sake, get off your duff and begin paying them a few shekels for the time they spend on this new business model. If you can't swallow paying for what feels like clerical work, consider it some sort of blended clinical/administrative fee for a new age. Call it consulting on the side. I don't know how you'll justify it. Just do it.

My guess is that you'll see huge changes if you do. Hey, what if we all woke up one day and the big, bad EMR adoption problem went away? - Anne

Primary care group wants pay for online work

Tue, 27 May 2008 06:59:56 -0400

The American College of Physicians has taken a position that shouldn't be much of a surprise. It's suggesting that payers should reimburse physicians for added work needed to take part in new digital relationships, including using and analyzing PHRs, and conducting online communications with patients.

In a new report, the internal medicine group argues that physicians should be reimbursed for time spent accepting, reviewing, validating and analyzing PHR data, as well as responding to or modifying the records' contents. The group would also like to see payers reimburse doctors for reviewing websites to select for accurate sources of consumer health information.

Along with seeking pay for physicians conducting e-health activities, the ACP is also recommending the use of secure web messaging infrastructure (rather than standard email) for use in communications between doctors and patients.

To learn more about the ACP's proposals:
- read this report (.pdf)
- read this Modern Healthcare piece (reg. req.)

Related Articles:
Trend: Health plans begin reimbursing for 'virtual visits'
Insurers keep getting on Web visit bandwagon
Physicians offer "e-care"
Study: MD e-mails could drain physician income

Kaiser finishes major phase of costly EMR project

Mon, 12 May 2008 06:59:58 -0400

Kaiser has put the finishing touches on a major phase of its costly, high-profile EMR project, giving all of its 8.7 million enrollees and 13,000 physicians access to its outpatient system. To date, Kaiser has spent $4 billion on the EMR installation, which has been in progress for years. In recent times the project has been dogged by allegations that it had been botched, so much so that last year the California Department of Managed Health Care formally requested information on its progress.

Despite reaching an important milestone, the Kaiser EMR project still has a ways to go, given that it's got miles to travel on its inpatient rollout. To date, only 13 of the system's 36 hospitals have put Kaiser's Epic EMR system in place. It expects to see 14 hospitals to bring up the system this year, with the remaining nine hospitals slated for implementations in 2009 and early 2010. No word yet as to how much that $4 billion number will increase over the next year or two, but I doubt the remaining inpatient installs are going to be cheap.

To learn more about the Kaiser EMR project:
- read this Healthcare IT News article
- read this Pacific Business News article

Related Articles:
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Controversy topples top Kaiser IT executive
The whistleblower speaks: the Kaiser EMR drama

Case study: NH Blue plan offers mobile EMR access

Mon, 12 May 2008 06:59:54 -0400

New Hampshire's Anthem Blue Cross Blue Shield of New Hampshire plans to begin offering physicians access to patients' electronic health records via mobile phones. The new capabilities also allow doctors to e-prescribe using the phones, as well as through any appropriate Internet connection. Available data includes both clinical data and medical histories.

The announcement comes as part of Anthem's e-prescribing program, rather than an EMR rollout. New Hampshire actually has been a hotbed of e-prescribing activity, driven in part by an Anthem initiative. Late last year, the plan partnered with the NJ Citizens Health Initiative to kick off a statewide e-prescribing program for all of the state's doctors.

To learn more about the program:
- read this Healthcare IT News piece

Related Articles:
Trend: EMR-on-cellphone interest grows
NH governor backs e-prescribing
Study: E-prescribing cuts med errors 66 percent
Ohio health system rolls out e-prescribing

Trend: Few US doctors respond to patient email

Mon, 28 Apr 2008 06:59:54 -0400

Not only are physicians struggling with implementing EMRs, few are even exchanging email with their patients, it seems. While many patients say that they'd love to use email to handle routine chores such as scheduling a visit, getting lab results or requesting medication refills, only 31 percent of physicians were emailing back and forth with patients as of first quarter 2007, when Manhattan Research conducted a survey on this subject. Even fewer have begun offering "e-visits" via email and web, though insurers seem increasingly inclined to reimburse them for such care.

Physicians who don't use email say that they can't afford to invest the time to write email, an activity for which they aren't paid, and also fear that patients will abuse the medium. Others--particularly those whose institutions have built portals that simplify the process of communication--say that email is no different than responding to phone calls, and moreover, that it makes them more efficient. However, it seems that it will be quite some time before they're in the majority.

To learn more about this trend:
- read this Associated Press article

Related Articles:
Duke launches doctor-patient portal
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Insurers keep getting on web visit bandwagon
Trend: Health plans begin reimbursing for 'virtual visits'

Insurers keep getting on web visit bandwagon

Mon, 07 Apr 2008 06:59:55 -0400

A growing number of health plans have begun to pay for patients to participate in online visits with their doctor. In recent months Aetna and Cigna have started paying for some doctors' visits on the web, and given their industry status as being influential, others are sure to follow soon. In both cases, patients have to pay a co-pay to have an e-visit, just as they would if they saw the doctor in person. Meanwhile, players like McKesson-owned Relay Health is slowly but surely gathering subscribers for its secure web site tailored to delivering e-visits, signing up 16,000 physician subscribers to date. Aetna and Cigna both contract with Relay Health.

All that being said, one major player remains on the sidelines to date. Things will get really interesting when Medicare pays for online visits. However, there's currently no word as to how soon that might happen, if at all, though it is experimenting with other telemedicine options.

To learn more about this trend:
- read this Philadelphia Inquirer piece

Related Articles:
Health plans begin reimbursing for 'virtual visits.' Report
Study: MD e-mails could drain physician income. Report
Physicians offer 'e-care.' Report

Revenue cycle management options growing

Thu, 21 Feb 2008 06:59:56 -0500

Let's face it, when your income is derived from billing dodgy insurance companies, collecting is going to be a major challenge. However, of late there's been a growing number of vendors and consultants who say they can more or less resolve the issue--and many of them are putting a stake in the ground this year at HiMSS. Unlike many other types of vendors, many RCM technology developers have actually been in the healthcare delivery business themselves--so if nothing else, you can expect to have an educated conversation with most of them.

Most RCM vendors focus on making your facility or practice smarter in its dealings with insurers. Among the players are companies like athenahealth, a hosted service which allows office-based physicians to outsource the claims management and collections process more or less completely. Some vendors are touting practice management systems that have functions like eligibility, claims submission and editing built into the back end. Some EMR vendors say that they can help with this process too (though I'm skeptical that they have the payer knowledge base to do that just because they're handling your clinical data).

Other exhibitors, meanwhile, give you a leg up in collecting the portion of bills patients must pay directly. One particularly interesting example is Bluemark, whose platform helps providers assess the financial status of uninsured patients and qualify them for Medicaid or charity care programs. Another patient-collections option is hosted application services provider mPay Gateway, which helps providers collect patients' portion of their bill at the time of service. And there's options like Craneware's Patient Charge Estimator, which digs into a hospital's claims databases and helps prepare price quotes for procedures.

As patients pick up more of your bill, patient-collections platforms are likely to become as common as those targeting the health plan management process. Better patient collections is definitely worth exploring further at the show. After all, there's only so much you can do to speed up claims processing--so getting more on-the-spot cash from patients is worth a closer look.