Monday, 8 September, 2008

Revenue management in Healthcare


Process mapping allows you to identify productivity opportunities, best practices, and root causes of problems, create workflow consistency, and determine who owns an action item within the process and who's accountable for it."

1. Identify the critical business opportunity. "If you're going to put 10+ key people in a room all day long, which is what it will take for most mapping exercises, there better be a darn good business reason for doing so--improving your ROI, for example," says Trusten. This step should be taken by the organization's financial leaders.
2. Identify key processes with the greatest influence on that opportunity. This will be either all or some of the key areas of revenue cycle management, such as patient access or charge capture.
3. Create a project team. Trusten recommends that you start by identifying the executive sponsor for the project, often the CFO, who will establish expectations and priorities, coach the team, break down any organizational barriers, and assume overall accountability.
4. Do the "is" map prework. Prework includes developing the business purpose or value proposition for the mapping project, defining the scope of the project, identifying subject matter experts who actually perform the steps in the process on a daily basis, and pinning down meeting logistics.
5. Develop "is" map. Once everyone meets and goals are communicated, the actual process of identifying process steps may begin. "You might say to the team of subject matter experts, 'OK, walk me through what occurs in the revenue cycle management process when someone has a lab test,'" says Trusten. "Start with admitting. Write each step on a Post-it[R] note and put it under the appropriate function on a large sheet of paper on the wall."
6. Look for disconnects and opportunities. This is where you put on your Sherlock Holmes hat. Areas with greatest potential for improvement typically include those with too many go/no-go decision points, too many feedback loops, duplication, non-value-added steps, role or authority ambiguity, bottlenecks, and places where you are misusing or, more likely, underusing the available technology. Why are we doing Step C? How is it different from Step J? Is there a different technology we could purchase to make that step easier or faster? These are the types of questions that typically arise at this stage. Make sure everyone involved with the process in any way has a chance to review and discuss the map that develops.
7. Create the "should" map. Validate your original value proposition: Are the purpose and outcome the same? All of the opportunities that you identified in the "is" mapping should be business requirements in the development of the "should" map. The map should also identify functional managers and best practices. In fact, many organizations prefer to start this step with a best-practice map and customize as they go along.
8. Review, finalize, and distribute the "should" process map. This should never be a cut-and-dried process, cautions Trusten. "You need to communicate the new vision and expectations, set new goals, and arrange for training. Have a plan for informing people about progress during implementation."

Revenue models-Making Changes Happen

Health care is shaking up the search engine market.
Long-time laggard Ask.Com is suddenly a contender, at least in consumer satisfaction, and it’s making a new effort in health care with what it calls Health Smart Answers.
Revolution Health and HealthLine are acting as the main information providers to Health Smart Answers.
At the same time Google and Microsoft are both making their own moves to target the sick and hypochondriac.
The Big Two are taking different approaches. Microsoft is trying to capitalize on its existing strength in hospital computing and medical records. Google wants people to enter and track their own medical information.
The last verb, track, makes this one step removed from what Healthline, Revolution Health and WebMD are up to. Rather than seeking your search and communications business, they want to be your health data storage house.
Key to making any of this work is trust. Will consumers trust Google, Microsoft or anyone else with their private medical information?
They won’t, so long as the government insists it has the right to tap into any database, without a warrant, and use that information for whatever it wants.
For the online health care revolution to really get going we don’t need prototypes, and we don’t need search. We need better privacy laws, against Big Brother, Little Brother, and everyone else, a HIPAA for the 21st century.
HIPAA does more than that
HIPAA is the biggest reason why most small medical offices remain a forest of paper. The act allowed them to get out of the law's consequences if they didn't computerize.Sometimes Yagotta get agreement from me.

Monday, 1 September, 2008

A brief on Health Smart cards- as requested.

Smart card network is secure, convenient and reliable smart card technologies specifically designed to store and transport a patient's most clinically relevant medical records.

The Idea is to incorporate smart card technology into the healthcare system as an instrumental component that protects and enables convenient access to patient data and delivers both clinical and administrative benefits.

ALWAYS CHOOSE a high-capacity microprocessor smart card that is PIN protected to comply with HIPAA security requirements and also provides a feature-rich, flexible platform that addresses key healthcare issues. There are compelling benefits to the patient, healthcare provider and payors that partially include:

� Support for privacy and security requirements mandated by HIPAA
� Convenient way to carry secure data between systems
� Streamlines administrative processes
� Reduction in fraud
� Rapid identification of patient
� Information readily accessible in an emergency
� Enables compliance with government initiatives and mandates
� Provides healthcare professionals with reliable data which is used to advise the best treatment and reduces probability of adverse drug events
� Reduces unnecessary and duplicate diagnostic tests or procedures
� Portable, secure PATIENT ownership of key medical information

Smart cards are used worldwide for many applications, including healthcare, financial, transit, telecommunications and secure identification. The information in smart card is stored in the Continuity of Care Record format and takes advantage of the technology's ability to provide secure, portable data storage, enable authentication information access and support secure transactions between the smart card and the system. The patient/administrative and clinical data sections on the smart card include:

�Cardholder demographics
�Immunizations
�Emergency contacts
�Medical history
�Mental Health Power of Attorney; Health Care Power of Attorney;
�Surgeries & hospitalization
�Healthcare providers
�Medical equipment
�Insurance providers
�Lifestyle
�Religious preference
�Medications: Prescription / over-the-counter / supplements
�Living Will Advanced Directives
�Neuro-Psychiatric
�Allergies
�Ophthalmology
�Organ donor status
�MRI pre-screen questionnaire
�Medical Diagnoses


HEALTH PORTALS TODAY are establishing networks of physicians, hospitals, surgery centers, labs, clinics and emergency services that are or will be equipped with the Health application software, smart card readers and secure access to a network backup system. The network will allow physicians, emergency personnel and other healthcare providers secure and privacy compliant access to a patient's most clinically relevant medical data at participating locations.

Smart Card and Health Insurance



Many health insurers now are relying on magstripe card solutions. These cards are helping trim costs and inefficiencies in flexible spending accounts and health reimbursement accounts, said Beverly Kennedy, senior vice president, health care, of First Data, which recently introduced its Multipurpose Healthcare Card, designed to support FSA and HRA record keeping and claims administration. Health reimbursement accounts allow consumers to set aside pretax dollars to use for health expenses.


Flexible spending accounts allow employees to place payroll-deducted pretax dollars in a special account to pay for insurance premiums, child care and unreimbursed medical expenses. Paying an FSA claim without the card costs approximately $5 to $10 per transaction, Kennedy said, and card technology is helping to reduce those costs.


In January, Horizon Blue Cross Blue Shield of New Jersey rolled out debitcard technology to its entire book of business for administration of FSAs for unreimbursed medical expenses and Transportation Management Accounts, which allow consumers to direct employers to deduct a portion of pretax wages for work-related parking and mass-transit commuting expenses. Two of the largest stumbling blocks to FSA participation are that users have to "use it of lose it" and the "double spending" practice--paying a provider and then having to wait for reimbursement, said Susan Duffy, manager, flexible spending, for Horizon of New Jersey.


"Cards take a lot of the paperwork away from members and provide immediate access and payment to providers." Many plans are confident that card technology will boost enrollment in FSA plans. Humana's HumanaAccess card, which is powered by Evolution Benefits' Benny Card--a MasterCard that electronically accesses pretax contributions set aside in accounts such as FSAs and Transportation Management Accounts--is proving that point.


In 2001, only 11% of the Louisville, Ky.-based company's associates participated in FSAs, but after the card was introduced in July 2002, participation rose by 65%. Plan participants are also increasing the amount of money being placed in FSAs. "People are now comfortable putting more away because they can use the card to access their funds and not worry about losing their money," said Beth Bierbower, vice president, product innovation. The recent IRS ruling (Revenue Ruling 2003-43) that clarified electronic payment rules for medical expenses also has spurred more health-plan interest in cards.


The ruling defines whether employers, third-party administrators or participants can be held liable if medical debit cards are misused. According to the ruling, if the participant uses the card for an expense that isn't qualified for FSA reimbursement, the payment will be denied at the time that the card is swiped, or the participant will be required later to reimburse the plan. Thus the participant is liable if he or she misuses the card. The ruling also removes the need to submit receipts so that expenses can later be reimbursed through FSAs or HRAs.


Some insurers believe card technology may have a place in health savings accounts. HSAs are a new tax-free benefit program included as part of the recent Medicare reform act. "According to the current legislation, the unique thing about HSAs is that there is no substantiation requirement for them and that would make use of the card much more convenient," said Brad Utoft, vice president, product manager, group health products, for Mutual of Omaha. The company is currently offering debit cards as an option with its HRA and FSA products, and is now evaluating HSAs and the associated use of debit cards. Card solutions also are anticipated to have a hand in easing the administration of consumer-directed health plans. For instance, cards will simplify the complex account management process and ease online accessibility. "The hallmark of these products [consumer-directed health plans] is more skin in the game for consumers, and consumers must be given more information about choices they have to make," said Dr. K. James Ehlen, chief executive officer of Halleland Health Consulting in Minneapolis.


"Cards will help that." Which Type of Card? As more health plans adopt card technology in 2005, some will enjoy the benefits of magstripe cards, but others are taking a look at the value smart-card technology may bring to the table. "We're on the cusp of smart-card technology today," Ehlen said. Smart cards, plastic cards embedded with a microchip, memory and an operating system, differ from magstripe cards in that they can hold a significant amount of data, allow integration with numerous databases and can be programmed and re-used. The technology isn't new, however. Smart cards began nearly 20 years ago in France when they were used for pay telephone systems. While magstripe cards have been around for several years, they've been a reasonably effective payment mechanism for medical services, Ehlen said. "But what a smart card can do that a magstripe can't is provide real-time information useful to the patient, clinic and health plan all at once."


Smart-card solutions can perform a variety of functions, including real-time patient eligibility checks, pre-authorizations and referrals, and deductible transactions at provider offices and pharmacies at the point of care. Using them is taking a bite out of the estimated $250 million spent annually on health-care administrative costs. Every time a physician's office calls a health plan to inquire if a patient is covered and what the copays are, it costs approximately $3.50 to $4.50, said Mallory Kates, vice president of marketing for Minneapolis-based Cardtronic Technology, a provider of health-care specific smart cards.


"By providing eligibility checks at the point of service with a smart card, much of that administrative overhead can be significantly reduced." Smart-card technology is used in Europe to streamline the process of conducting routine medical transactions. By the end of the decade, six European Union countries that currently use health insurance cards plan to issue 167 million smart cards to help residents claim state health care in other countries, according to a recent article in the Health Service Journal.


For example, France is developing the Netc@rd program, which will require both patients and physicians to have a smart card to access a patient's online records. Germany, Italy's Lombardy region, Finland, Austria and Greece also are participating in the program. In addition, the European Parliament announced late last year that it's set to begin debate on a proposal for a universal health-insurance card that citizens in EU member countries would use to replace a variety of local cards now needed to obtain health care. The goal of the proposed card system is a universal electronic health-insurance card for all EU citizens by 2008, according to the European Parliament.


"I think the low-hanging fruit in card applications today is because we were historically focused incorrectly on clinical applications for smart cards," said Ehlen. These cards can provide much more than that, however: storing a patient's full medical history, lab results, pharmaceutical information, physician and emergency contact information; and making secure payment for health services. "Not to mention they're helping to preclude some of the wasteful activities of the patient experience today, such as filling out forms every time they enter a provider's office," Ehlen said. Everyone Wins Card technology is a win-win for everyone, said Humana's Bierbower.Magstripe cards have been shown to eliminate most of the paperwork normally associated with an FSA because the debit card allows consumers to pay for eligible health-care expenses at the point of service, said Butch Ward, a spokesperson for Horsham, Pa.-based AmeriHealth Administrators. "Use of the card generally results in a quicker payment to providers, especially when used to pay for services that wouldn't normally be covered in the employer's medical plan, such as LASIK surgery," Ward said.


For providers, who in the past have been somewhat leery of adopting new technologies, card technology is also helping cut administrative costs. "The light bulb that goes on for providers isn't a clinical one but an administrative one," said Ehlen. Employers are enjoying card solutions because they are driving increased participation in underused employee benefit accounts, in addition to providing employees with more pretax dollars to handle increases in cost sharing. Employers save on Federal Insurance Contributions Act tax for every dollar an employee contributes to an account, said Donna Porrit, senior vice president of marketing and sales for Evolution Benefits. Additionally, employers can limit the eligible merchants and service providers to specified "merchant codes" relating to health care, Ward said.


Health plans find much value in the cards as they help realize administrative efficiencies, speed reimbursements and increase plan participation. They also serve as a competitive tool. Card use is on the rise. The amount of transactions made with the HumanaAccess card has grown from $1 million during the first year to $3.2 million last year. This year, $700,000 in transactions was made in January alone, and Bierbower anticipates that total could reach $8 million to $9 million by year end. Aetna believes its soon-to-be-introduced multipurpose card will help the company build better relationships with its members because it will be easier to conduct business with Aetna. It will also improve interaction between patients and doctors by allowing immediate payments and paperless claims.


In addition, the new card eliminates the static instrument of the traditional health ID card and instead puts a multipurpose tool into the hands of its members to access information and care, said Mark Bertolini, senior vice president, specialty products. The multipurpose card will initially be used for health and fund accounting and eventually for credit for medical and nonmedical items. Aetna is piloting its card this year to several large clients and hopes to replace its member ID cards with the new card in 2005. Eligibility Requirements One of the uncertainties of card use has been ensuring that only eligible purchases and service transactions are made with the card. Technology is eliminating that concern. Aligned with the recent IRS ruling that defined electronic payment rules for medical expenses, many card vendors have developed proprietary technologies to ensure the cards are used to make only bona fide payments. Evolution Benefits, for example, does the verification prior to placing the amount on the card at the point of service. At the pharmacy, for example, the member presents the prescription and the pharmacist enters it into a prescription system--there is no change required in either pharmacist or member behaviors, said Porrit. The technology captures the adjudicated and substantiated amount. When a card is swiped, the normal MasterCard/Visa process to pay for the patient-due balance takes place. The Evolution technology links the information to the adjudicated amount and then "looks for" an exact match. If the card is swiped for a different amount, the transaction is rejected. This technology satisfies the substantiation requirement of the IRS ruling and is 100% paperless.


In addition, the same information can be used retrospectively to match transactions after authorization, if an employer or health plan so desires, Porrit added. This technology appealed to BlueCross BlueShield of Tennessee when it selected Evolution Benefits as the vendor for the development of its debit card. If there's any question about a transaction or claim, the company reviews the claim through the system and has the right to ask for documentation for the claim if necessary, said Cheryl Willoughby, manager of GISI Administration for the Blues plan. A Sign of the Times As card technology evolves, more insurers are expected to choose smart cards. In the past, two factors kept smart cards from becoming a real option for the health-care community: hardware expense and the limits of early card technology, said Cardtronic Technology's Kates. Today's cards are much less expensive, have far greater storage and can do many more things. The industry also has benefited by the standardization that began just a few years ago which permits cards to be read by readers regardless of the manufacturer--much the way VHS cassettes can be read on any player.


Also, the cost of technology associated with smart cards has plummeted dramatically. Devices that once cost about $300 a piece now can be purchased for under $10 in large batches, said Ehlen. In addition, some experts believe smart cards will be a helpful tool to increase patient safety. For example, information stored on the cards can signal a pharmacist of potential drug interactions or ensure that patients receive necessary immunizations. Smart-card technology "will initially be used as a benefit to the health-care organizations who are trying to streamline their operations, reduce fraud and reduce costs of processing health-care service payments, and it will become expanded to consumers where the health-plan providers can add services that will make them competitively different from their other local health-care providers," said Randy Vanderhoof, executive director of the Smart Card Alliance, a not-for-profit, multi-industry association working to accelerate the widespread acceptance of multiple application smart-card technology.


"We believe that in five years no one will be carrying a paper card; all health-plan cards will be chip-based smart cards," said Cardtronic Technology's Kates. "Many people in this field are beginning to see that health care is exactly the right application for smart cards. There are just so many benefits for all stakeholders that everyone wins in this equation." How the Cards Work Magnetic Cards Magnetic cards are plastic cards with magstripes on the back. The stripe contains iron-based magnetic particles with binary code in 1s and 0s that are magnetized in various directions.


The card's information is released by swiping the card through a reader. A health insurance debit card can deduct payments for a doctor's visit. Smart Cards Smart cards are the size of a credit card and contain an embedded microprocessor chip that stores digital information. The chip is able to store large amounts of data and add, delete and interact with remote databases and desktop computers. It can have anywhere from 16 to 128 kilobytes of memory. The information is obtained by inserting the card into a reader that is connected to a PC. A health insurance smart card can contain information such as copayment amounts, medication history and the results of a recent EKG.


http://goliath.ecnext.com/coms2/gi_0199-209019/Discovering-cards-health-insurers-see.html.

Making sense out of a Health Website contd..




Marketing your medical business on the World Wide Web through utilizing our medical web design services and search engine promotion plans, will get you great exposure and allow you to reach thousands of Internet users. It is an inexpensive sales channel connecting you directly to your potential consumers. Search Engine Optimization & Marketing To effectively represent your company, it's imperative to be well positioned in all major search engines' natural search results. These results are most often displayed separately from paid or sponsored listings, cannot be purchased, and are the single most common source of qualified site visitors.

Natural optimization is a valuable investment in your existing web site. This procedure does not typically require major alterations to the look and feel of your current site however. Search Engines for Promoting your Web space

Google: Shows searches at any Google-owned web site such as Google.com or Google Image Search. May show searches at some Google partners that show Google's domain in the URL's of their search results, as happens with Go.com.
Yahoo: Shows searches at any Yahoo-owned web site, including perhaps those of Yahoo, AltaVista and AllTheWeb. "Domain AutoSearch" searches, where someone did an address bar search or navigational request and got information back from Yahoo, have been excluded from figures.
•MSN: Shows searches at any MSN-owned web site such as MSN Search. "Domain AutoSearch" searches, where someone did an address bar search or navigational request and got information back from Yahoo, have been excluded from figures.
•AOL: Shows searches at AOL Search and perhaps Netscape Search.
•Ask: Shows searches at Ask Jeeves and perhaps Ask Jeeves-owned Teoma. Pay Per Click Programs By now, you may be familiar with the powerhouses in this space: Google AdWords and Yahoo. Both of these engines allow you to actively bid upon your desired position in search results and charge you for each time your ad is clicked on by a user. Sound too good to be true? It can be.

PPC must have a clearly defined strategy with carefully chosen keywords. Properly market your online presence. Go through this Article below: Net Attracts Health-Seeking Surfers Article By Robyn Greenspan April 13, 2004 There have been no new epidemics reported of Internet users rushing online for health information, according to research from Harris Interactive, which found "cyberchondria" nearly flat in the February 2004 report.

Harris Interactive calculated that 111 million adults have looked for health information on the Internet, compared to 109 million in 2003 and 110 million in 2002. The annual survey of more than 1,000 American adults found that 74 percent of all those online have looked on the Internet for health information, with fewer indicating they look "sometimes" than indicated in surveys from the past two years.

Frequency of Accessing Health CareInformation Online 2002 2003 2004 Often 18% 17% 19% Sometimes 35% 37% 31% Hardly ever 27% 23% 24% Never 20% 22% 26% Despite the volume of health information seekers, it is unlikely that physicians will partner with popular health sites to perform paid online consultations.

Jupiter Research found that only 3 percent of adult Internet users held online clinical consultations with their doctors in 2003, even though 65 percent of adult Internet users said they were interested in using this service in 2002. While roughly three-quarters of the Internet population have used the Web for health information in 2003, the number can be misleading. Monique Levy, health analyst, Jupiter Research, says, "Most are using the Web as a tool to gather information, but not necessarily to manage health or benefits. Only 7 percent used an interactive tool to manage a chronic health complaint in 2003.

" Even with high consumer demand, physicians are reluctant to market their services unless they are compensated, and Levy's research revealed that 92 percent of consumers are unwilling to pay more than $10 for an online consultation even after taking into consideration the time and cost involved in seeing a doctor face-to-face. "A lot of things need to be aligned before it [online consultation] becomes a trend. Insurers need to be involved and will take a long time," says Levy.

According to the Harris Interactive poll, 51 percent of the online health information seekers first went to a portal or search engine which allowed them to search for health information across many different sites, while 23 percent went to sites that focus only on health-related topics. Another 14 percent said they went to a site that focuses on many subjects and that may also have a section devoted to health issues.

Measurements from Hitwise indicate that the Health and Medical category has seen more than a 30 percent increase in share of all U.S. visits since January 2003. More specifically, in the Health and Medical - Information category, WebMD captured the largest portion of individuals during March 2004. Interestingly, the top three search terms that led to visits to Health and Medical - Information Web sites were variations of WebMD.

"Pregnancy," "medical dictionary," "herpes", and "depression" were also among the most popular search terms that resulted in visits. Portals Yahoo! and MSN also grabbed some of the visitors seeking general information on health and wellness and healthy lifestyle, including online medical help and advice, self-diagnosis, general layperson medical reference.

Most Visited Health and Medical -Information Sites, March 2004, U.S. Site Market Share My WebMD 10.61% WebMD 9.84% Yahoo! Health 3.68% MSN Health 2.52% Emedicine 2.24% Med Help International 2.00% Medscape 1.76% MayoClinic.com 1.67% Kids Health 1.62% RealAge 1.43% Source: Hitwise March 2004 demographic data from Hitwise revealed that most of the visitors to Health and Medical - Information Web sites were higher earning 35 to 44 year-old females who accessed the Internet from home.

The average session duration for the Health and Medical - Information category was 6 minutes 26 seconds. Will come up with more...

New services launched- Developing innovative Medical and Healthcare content

After completing over a decade in Healthcare consulting, HealthCursor is now providing Medical content services to all its clients across th...