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Payers Using I.T. to Give and Receive
February 2006
Managed care organizations and physicians historically have had a tense relationship. But some payers are trying to use information technology to improve relations as well as cut some of the fat out of their budgets by decreasing the costs of doing business with providers.
Many hospitals have been hesitant to offer financial assistance to physicians and group practices to adopt I.T. because of anti-kickback laws and other legal hurdles. There is a movement to create exemptions in federal laws to clear the way for hospitals to lend physicians an I.T. hand. But for now, payers, which face few legal hurdles, have a clear shot at winning the hearts and minds of physicians by helping them automate their practices.
A few payers responded early to the call for I.T. assistance and implemented programs several years ago that now are being expanded.
Other payers, such as Highmark Inc., a Pittsburgh-based Blue Cross and Blue Shield licensee, in recent months have taken bold new steps to get physicians to automate. Some payers also are kicking off programs to host personal health records for patients to enable them to take a bigger role in their health care (see story, page 102).
But the effort to lend a helping I.T. hand is not an entirely altruistic gesture on the part of payers, says Simmi Singh, vice president of the health care industry practice at Cognizant Technology Solutions Corp, a Teaneck, N.J.-based consulting and outsourcing firm.
Increasing automation at group practices-such as via electronic prescribing-can help reduce transaction costs for payers as well as increase adherence to drug formularies, Singh notes.
But there is a larger game being played out in the marketplace, she says. Payers and large providers, such as integrated delivery systems, are trying to find ways to own the relationships with patients and become the trusted advisor to independent consumers, she says.
"Patients will take advice from the organization they trust for quality, and that trusted organization is going to be able to offer a host of fee-based services," she says.
Singh adds that becoming a trusted health care advisor supports payers' efforts to entice patients into consumer-directed health plans, high-deductible products that many payers believe have the potential to substantially lower their coverage costs.
"If you look under the hood, there are a lot of motives and incentives for payers to start supporting physicians trying to adopt I.T.," she says.
True believers
Whatever their motivations, some payers have entered the I.T. ring in a big way.
Three years ago, Hawaii Medical Service Association, the state's Blue Cross and Blue Shield licensee, believed electronic prescribing and electronic medical records were catching on, says Richard Chung, M.D., senior vice president in the health services division. "We thought we could facilitate this by supporting an e-prescribing platform," he adds.
Since then, the plan has spent about $3 million to outfit 600 physicians with e-prescribing software; mobile computing devices or desktop workstations; servers; and high-speed Internet connections. The physicians paid a $50 monthly licensing fee for the prescribing software, which is a module of the TouchWorks electronic medical records product of Allscripts LLC, Chicago.
Under a recently expanded deal with the vendor, the Blues plan will offer the e-prescribing software to another 100 physicians-this time remotely hosted via the application service provider computing model.
Further, these new physician users and the original 600 will pay a lower $35 monthly software license fee and can purchase other clinical modules from the TouchWorks suite at a 40% discount.
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