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Biotech / Medical : WebMD Health Corp -- Ignore unavailable to you. Want to Upgrade?

To: Michael Olds who wrote (248)	2/26/2001 7:12:39 PM
From: tech101	Respond to of 326

MD-insurer link slow to meld Insurance firms reluctant to yield databases central to online transactions BY ANDREA KNOX \| PHILADELPHIA INQUIRER Taming the tangle of transactions between physicians and insurance companies is a job that would seem to be a natural for the Internet. But that's if the nation's welter of insurance companies can agree on how to do it. Despite society's feverish embrace of the Internet for everything from downloading music to doing homework to communicating with business customers -- and despite the huge cost savings anticipated when the health-care industry goes online -- Web transactions between physicians and insurance companies have been slow in coming. Although Healtheon was founded five years ago with the boast that it would become the Internet communications hub for health-care transactions, that idea never got off the ground and today only a handful of the country's insurance companies use the Internet for a few basic services such as claims processing and eligibility checks. Fewer than 1,000 of the nation's 200,000 physician practices use those Internet services, and most of those have online links with only one of the many insurers each must deal with. The reason: While insurers know that online transactions are inevitable and money-saving, moving to the Internet strikes at the very heart of their business, which is transaction processing, says Chris Downey, a Los Angeles partner in the health services practice of Accenture, formerly Andersen Consulting. Accenture has advised many big insurance companies on e-commerce strategy, Downey says. In the non-Internet world, the combined cost to insurers and physicians of processing a single transaction is between $8.50 and $18, according to a study by PricewaterhouseCoopers and Milliman & Robertson. The savings possible from using Internet processing could be billions of dollars a year, if the experience of Partners National Health Plans in North Carolina is any guide. Partners said in December that it was saving about $1.43 on every transaction it moved to the Web. The industry handles nearly 5 billion claims annually, according to RealMed, an Indianapolis company that develops Internet portals for insurers. But for some insurance companies, those savings must be weighed implicitly against the possible loss of corporate identity. ``They have hundreds of people in oceans of cubicles in huge warehouses administering claims,'' Downey said. ``Their angst is that if all this administration happens automatically, then what business will they be in? What will be their core competency?'' If health plans might prefer to make haste slowly, they are being goaded forward by software companies eager to create the necessary Internet links but unable to do so unless they team up with insurance companies that will provide access to their databases. The payoff for the software developers, who will also manage the systems, will be the fee they collect for each transaction. So far, only a few health plans have signed on with developers, and much of the software is still being created or in pilot stage. However, the tempo of Internet deals has picked up speed in the past year. Since May, Boston software house NaviMedix has put five insurers online, including Highmark Blue Cross Blue Shield in western Pennsylvania. Highmark is extending the system to handle Blue Shield transactions for physicians in central and northeastern Pennsylvania, and expects to roll it out for Blue Shield use in the Philadelphia area in March or April, executive vice president Kenneth R. Melani said. MedUnite, a consortium of seven insurers that's developing its own software, says it plans to begin pilot programs in California and in the New York area this spring. Both RealMed and HealthTrio, in Nashville, have signed up a handful of health plan clients and have put a small number of doctor's offices online. Bringing up the rear is Healtheon, now part of WebMD, an Elmwood Park, N.J., company that does batch processing of claims for 1,000 health plans. The company says it will try to move that work onto the Internet, but is vague about its timetable. Batch processing is a method for submitting claims electronically that doesn't use the Internet and doesn't let the doctor track claim status online. The start of Internet transactions can only be good news for physicians and their office managers, who are impatient for the day when point and click will replace today's ceaseless shuttle of mailed and faxed documents and endless round of phone calls. The advantages to doctors and patients would include: Knowing in minutes instead of weeks whether a claim is approved and how much the insurance company will pay. Being able to tell a patient at the end of a visit how much she owes. In one pilot program, 60 percent paid on the spot, great for the physician's cash flow. Running patient eligibility checks in 30 seconds instead of having to wait on hold for 20 minutes to talk with a customer service representative. ``The great thing about submitting electronically is the faster payment turnaround,'' said Jackie Waruszewski, a billing manager at Triangle Urology Associates in Pittsburgh. ``We get paid in eight to 10 days. With paper claims it's a six-week turnaround.'' Andrea Knox can be reached at aknox@phillynews.com. www0.mercurycenter.com