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Web streamlines the health care industry

Health insurance has long been one of the last big bastions of paperwork, but insurers are adopting technological advances that make information- gathering and billing electronic.

Consumers are accustomed to filling out forms and perusing documents as part of the health insurance enrollment and claims processes. But with new technology and the push toward a greater role for consumers in health care decisions, those habits are going away.

Some insurers now allow consumers to enroll, change addresses or request new insurance cards online. Doctors and hospitals can check a patient's eligibility and referrals over the Internet and can even initiate the claims electronically. And consumers have easy access to volumes of information about various medical conditions, drugs, the cost of procedures and the quality of care they can receive.

"It's changed totally how health care is delivered," said Dr. Jay I. Pomerantz, chief medical officer for Buffalo's HealthNow New York, parent of BlueCross BlueShield of Western New York.

Finally, the insurers and hospitals are collaborating on electronic efforts like WNY HealtheNet to streamline coverage, claims and payments.

"It's invaluable," said Eileen A. Leary, chief operating officer of Buffalo Medical Group, the biggest local physician practice. "HealtheNet makes sure they [patients] have the insurance that they believe they have and also confirms that referrals are in place so that physicians get paid."

All the technology means a lot of adjustment and investment, but it's necessary in the modern world, insurers say.

"We are coming to terms with the fact that our customers are increasingly Internet-savvy and they want to use the Internet for more things than they did in the past," said Paul von Ebers, senior vice president of marketing at Univera Healthcare.

"Our members are looking for more information about health care in general and about health insurance specifically, and they want to do more online. It's a challenge for all health insurance companies to keep up with what our members and employers want."

That starts with letting consumers choose their insurer and provider online. Some employers send insurers their employees' enrollments in an electronic file, but using paper applications. The carriers also let members change an address or request an ID card online.

But this month, HealthNow began offering its Coverage Advisor tool on its Web site, allowing individuals to look at their options during open enrollment, enter their specific requirements and needs, and select the right plan for them.

They can also estimate how much to put into a flexible spending account or what their out-of-pocket costs will be if they select a high-deductible health plan.

The insurer this month also launched Healthcare Advisor, which helps enrollees select a doctor or hospital for treatment based on the provider's experience, the volume of patients, the quality of care and the cost.

Univera is introducing similar services in the spring to help members make plan and doctor choices based on their responses to a series of questions about family size, health status, and what services they might use. They will also be able to understand and compare drugs, and estimate treatment costs.

Employees are looking for tools to help them decide which plan is the best option for them," von Ebers said.

Independent Health Association also offers online tools for evaluating a provider's quality or estimating costs. But it goes further with Benefit Assistant. Introduced over two years ago, the online enrollment service lets consumers sign up for their medical plan without paperwork.

"It simplifies and makes it easier for them to make their benefit choices and manage it," said Scott W. Averill, executive vice president and chief marketing officer for the Williamsville- based insurer. "We've gotten very, very positive reviews."

So far, about 50 employers have implemented the service, with 25,000 users. It can also be used for other insurance and employee benefits, including life insurance, dental, shortterm disability and flexible spending accounts. And the coverage doesn't have to be from Independent Health, although "we prefer that," Averill joked.

IHA also installed the DestinationRx health plan tool that Medicare uses on its Web site so consumers can compare drug coverage options. That helps local seniors see which insurance product fits their medical and drug needs. And it lets them learn more about drugs they're using and generic alternatives.

IHA executives credit the introduction of DestinationRx, which is a separate company, with helping to add 10,000 Medicare members in 2006. "A lot of seniors really valued that," Averill said. "That's an example of what we're trying to do to make it easier for people."

> Online personalization

The insurers are also using the Web to help consumers understand how to stay healthy. That's especially important, they say, as consumer-driven health care takes hold and members absorb more costs.

HealthNow will introduce its Personal Care Advance tool online at the end of the first quarter. It will provide each of the insurer's 800,000 members with their own personal health care record and home page that they can customize to offer information for healthier lifestyles or reminders to take care of themselves. It also allows patients to create a health record that can be shared with doctors.

"The whole gist behind this is to try to enable our members to have greater access to information about their health and to have access to resources to learn more about improving their health," Pomerantz said.

Univera also posts information on treatment alternatives, how to stay well, and how to achieve treatment goals. Like HealthNow, it includes information about the cost and quality of providers, and von Ebers said the insurer will be improving those tools and expanding the information early this year.

"This is an area that all health plans are experimenting with," he said. "Nobody's hit the magic formula yet, but it's something we're all working on."

Similarly, IHA's Independent Me gives members information about health issues and how to live better, such as a health risk assessment to help members learn how to reduce the risk of chronic conditions. It also has online health coaching.

Like HealthNow's version, it will also personalize a "dashboard" for them when they log in, track their information, and offer articles on issues relevant to them. It can even send them alerts by e-mail to remind or inform them of doctors' appointments, tests they should have, or new information online.

"It keeps the member engaged because it's very personalized," said Pamela Menard, IHA vice president of care management.

And it recently launched a new program that will use claims data or other information the member shares with IHA to either predict more serious conditions that can be averted or assess compliance with doctors' instructions, and warn the member or doctor accordingly.

"With an aging population, those tools become even more valuable," Averill said. "The more we can give them tools to manage their own care, the better off we'll all be."

> Drug assistance

IHA also uses technology to monitor drug use and prevent harmful mistakes. For example, in pharmacy lingo, "QD" on a prescription means "once a day," while "QID" means four times a day - easily confused with messy handwriting.

Most pharmacists already know how many times a day specific drugs should be taken, but IHA's system is programmed with the information just in case. So if a pharmacist misreads handwriting and tries to fill a prescription for too many pills in a given period of time, the system will catch it.

Similarly, with so many new drugs, pharmacists can't always spot every conflict, especially if consumers use multiple pharmacies. IHA is a backup.

Last year, it sent up to 80,000 messages to pharmacists each quarter warning of drug reactions. Only 3 percent of transactions were reversed by the pharmacist, "but they were at least alerted," said John Rodgers, IHA director of pharmacy.

And it can review a consumer's purchases to ensure the member is complying with directions to take or stop a drug.

Insurers also use technology to give self-insured employers - those who pay their own medical claims but contract with an insurer to manage the plan - constant access to claims summaries and other information, but without personal information that could identify employees. Employers can even produce their own reports, and manage other information and plan details.

That's an improvement from the periodic reports employers get now, and can help employers to work with insurers to identify costs, trends and potential problems early. "Employers want to conduct business electronically as much as possible," von Ebers said.

Insurers can also use "predictive modeling" to determine the likelihood of individuals getting sick in the future, based on their past claims, current conditions or family history.

> Better processing

Finally, insurers and providers are pushing to put more of the claims process online, to reduce errors, cut costs and streamline the payments. Both groups collaborated in the local HealtheNet venture, which allows doctors and hospitals to immediately verify a patient's eligibility for coverage and care, or ensure the proper referrals are there. That's now actively used here.

Now, the parties are extending that to the new Healthe Link, which would allow electronic prescribing and would centralize lab and drug information for easy recall. "That clearly helps the provider out in a very substantial part of their activities," said IHA's Rodgers.

The coordinating group is now seeking a technology vendor and hopes to launch a pilot by April 1, Rodgers said.

But while most claims are now submitted electronically, many payments are still paper checks, especially for individual doctors or small practices. State law requires payments within 45 days, but they are often on a set schedule.

There are independent efforts to make health care payments electronic and fast. But most small doctors' offices aren't set up for it, von Ebers said.

However, that's one of the next big areas for change. HealthNow is rolling out a new electronic funds transfer system for doctors called PayFormance that would enable a "clean" electronic claim - with all the information and no complications - to be paid within days. Pomerantz said HealthNow is the first local company to introduce the service, although Excellus this year will introduce a similar feature.

"I call it PayPal for doctors," Pomerantz said. "Now they don't have to wait until the check shows up in the mail and for it to clear."

But there's still an industry resistance to paying too quickly. "We're paying out our customers' money," von Ebers said. "We also have to balance cash flow on the other side. Wal- Mart is probably not paying its suppliers instantaneously."