Internet technology has advanced at a
rapid pace, and more people have
access to it than ever before. It makes sense, then, that progressive health
insurance companies would use it to
provide better information to their members and their members’ doctors.
“Providing better health care to members
has been one big advantage of this technology. The other has been reducing administrative expenses,” says James S. Slubowski,
chief information officer and vice president
of enterprise operations for Priority Health
in Grand Rapids. “This helps health insurance companies run leaner and keep
expenses down for all parties involved in
the health care process to ensure health
care remains affordable for everyone.”
Smart Business spoke with Slubowski
about how this burgeoning Internet technology has allowed health insurance companies to provide better service to their
members and streamline operations.
What kinds of investments are being made
by health insurance companies today to
reduce administrative costs?
First of all, information management
and analysis must be a core competency
of any leading health insurance company
today. It should be able to provide extensive data about its members so multiple
health care providers can securely
access this aggregated data, wherever
the care was delivered. Whether this
information has to do with hospitalization, drugs, emergency room visits or
anything else, the health insurance company should assemble it and make sure
it’s accessible by the member’s doctor.
Any health insurance company worth
its salt should be investing in technology
that can adequately house this type of
information and allow it to perform core
business functions, including enrolling
members, sending out information such
as ID cards, paying hospital and doctor
bills on time, and providing clinical
reporting to physicians regarding members. It’s also vital to provide Web site
tools that members can use to maintain
healthy lifestyles, understand health
care costs and manage diseases.
How does this technology improve health
care and lower medical costs?
The technology reduces administrative
expenses and expedites core business
functions. Here’s one example: Priority
Health paid 5.1 million claims last year, 86
percent of which were received electronically — compared to only about 30 percent
10 years ago. Being able to process claims
from hospitals and physicians electronically now is paramount because it eliminates
errors and rework caused by rekeying. It
simply ensures they’re received accurately
the first time. Specific health plan software
processes those claims automatically so
hospitals and physicians receive their payments faster.
From a medical standpoint, by using Web
tools for members and physicians, quality
indicators or programs can be provided to
make sure that the best care is delivered,
targeted to the patient’s needs. For
instance, a health insurance company can
make sure that diabetic patients have their
eyes checked every year. It can push information to doctors, telling them if their
patients need certain care. These reminders are also sent to members to
make sure they’re maintaining a healthy
lifestyle and managing chronic diseases.
Technology also allows us to share the
quality scores of physicians and hospitals so
members can make selections based on
those scores. Cost information can also be
shared to make price transparency a reality.
More members today have out-of-pocket
costs, co-pays or deductibles, so sharing this
‘price tag’ information allows them to know
in advance what certain procedures will
likely cost. Also, members can check their
health with an appraisal tool that gives them
a health profile and prompts them to ask
questions when they see their doctor. It’s all
about controlling risks for diseases.
Should employers be concerned about their
employees’ personal health information
being kept electronically?
They need to be aware but not worried.
Health information is processed under federal laws and the Health Information
Portability and Accountability Act (HIPAA).
Both providers and doctors consider members’ health information as protected.
Health insurance companies have to make
sure it’s protected and only the right people
have access to it, so it’s well guarded.
What other value does this new technology
allow health insurance companies to offer to
its members?
It allows us to summarize holistic health
information about a member, incorporating
elements such as health risk appraisals,
pharmacy data, physicians’ data and lab
data. This information is secure and available for members to review online so they
can be engaged in their health status and
costs. Leading health insurance companies
consolidate this information and work with
members’ doctors to ensure that the best
care is delivered at the best time. They also
promote wellness by making it easier for
their members to lead healthy lives.
JAMES S. SLUBOWSKI is chief information officer and vice president of Enterprise Operations for Priority Health in Grand Rapids,
Mich. Reach him at [email protected].
