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Vol.2 . No. 4
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September/October 2000 |
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Using the Internet to Transform How Physicians and Managed Care Organizations Work
by Mary Ellen Luff
A friend of mine was at a conference two years ago when the presenter began the session declaring, "Healthcare is changing at lightning speed." Then he asked, "Who are we kidding?" No industry has been slower to change than healthcare. Physician offices function essentially the same way they did 30 years ago, and nothing really earth shattering has happened with health plans since the advent of Medicare. For all the hype and promises of revolution, my friend was right. The industry has seen a lot of activity, but no real meaningful change in years.
That was two years ago -- before, according to Forrester Research, a Cambridge, MA. market research firm, 52% of US households owned computers and 72% of them had Internet access; before the development of e-business where corporate America was using the Internet to transform core business functions, re-defining who they were and what they did; and before everyone from physicians to consumers to congress promised to put managed care organizations (MCOs) under the regulatory and legal knife if they didn't change how they conducted business. The U.S. is expecting and waiting for the healthcare industry to re-define itself. And for an industry known for its slow embrace of new technology, ironically, managed care has begun to turn its eye and its pocketbook to the Internet as the vehicle to spur fundamental changes in the way providers and insurers work with each other. However, the crucial first steps to getting physicians on board lies not in the technology, but in understanding their culture and processes, and creating mutual value and benefit.
Lessons Learned - Different Cultures and Processes
Remember, about ten years ago, when commercial labs decided to ease the administrative burden for physicians when they ordered and received test results? The labs installed state-of-the-art hardware and software, connected the practices via dial-up modem, and claimed success at automating the lab function. But the systems were self-contained and singly focused, and required the staff to enter patient demographic information twice - once into the practice management system and once into the lab system.
Furthermore, many physicians dealt with seven or eight labs while the system was connected to just one vendor. The upshot was that only the physicians' children and a few errant staff members, who wanted to play Solitaire, used the computers. Not understanding the processes and culture of the physician practice turned out to be an expensive learning curve for the labs. |
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Corporations involved in e-business have similar stories to tell, and they have some advice for new entrants. Technology issues can be overcome. The more difficult task, and the one crucial to success, is the willingness of the partners to delve deep into the processes and cultures of the enterprises. Once they understand them, they must be willing to turn the businesses upside down and inside out. That requires a lot of trust and a significant cultural change. Early on, these companies admit to pursuing e-business strategies more out of competition fears than believing they were critical to the future of their business. After all, they had a recipe for success under the
old economy rules. But, according to a recent survey conducted by Booz Allen and Hamilton, business managers don't need to be convinced any longer that the Internet will be an important part of their future. Now their e-business strategies focus on mutual benefit.
Finding Common Ground
It's no secret that managed care has not been very successful at gaining the trust of providers or at thinking outwardly toward defining mutual benefit that spurs real change. And maybe, like corporate business managers a few years ago, managed care companies are not yet convinced that fundamental change is necessary or that e-health will play an important role in the future. But there is movement that suggests otherwise. According to Managed Healthcare Market Report, a recent review of 15 of the nation's largest HMOs found that most currently offer some level of online information to consumers and providers, such as lists of physicians, formulary and benefit product descriptions. Some have interactive capabilities, such as the ability to check claim status, locate physicians and check member eligibility. Online transactions such as enrollment, claims submissions and real time data for providers are less available, but are either in development or being considered by the plans.
At least one very tangible mutual benefit has been identified that may encourage both physicians and HMOs to partner on some e-health ventures. An e-health industry that delivers administrative savings of just 5%, compounded, would save insurers and their customers a cumulative $14.7 billion over five years. Physician practices would reap cost savings, too. But equally important is the quality of professional life issue of eliminating the thorny and irritating practice management hassles that have relentlessly plagued their practices.
Online applications that account for the swift pace of a physician's workday, eliminate irritating and costly administrative redundancies, and provide real time information will win the favor of physicians. But if MCOs are going to successfully lead the way, at a very minimum, the industry will need to implement the following crucial first steps:
- Include practicing physicians in the strategic development process focusing on business strategy and mutual benefit, not just technology. If technology discussions dominate early, rest assured physicians will not get past the security and medical record confidentiality issues.
- Develop a true understanding of each others processes and cultures.
- Identify a few processes that can be re-defined quickly and successfully. Not only will it help to build trust, but it will satisfy one cultural issue unique to physicians - the expectation of immediate results.
- Provide support to help physicians sort through the barrage of technology "solutions" being thrown at them. There is no reason for physicians to spend the time or investment unless the e-solutions have a direct impact on the financial health of their practices, eliminate administrative hassles or support their ability to provide quality patient care.
Doctors Online
The data in Table 1 below, although specific to one HMO, is representative of the types of infor-mation HMOs are offering to providers.
Table 1
Source: Cigna Healthcare of Arizona
Where do you stand?
We would like to hear from physicians. How are you using technology in your practice? SMG invites you to complete our brief survey on "Where Physicians Stand on Technology." To take the survey, go to Where Physicians
Stand on Technology Survey: http://www.scheur.com/1technology/webpage/mcochallenge.nsf/ts62000
or use the Quick Links box on our home page: http://www.scheur.com
About the author: Mary Ellen Luff handles special projects for SMG. She has experienced the healthcare industry from a unique combination of insider perspectives -- corporate human resources, physician practice management, integrated health systems, and most recently as the Regional Executive Director of a provider-owned HMO. Applying her 15 years of industry insight and broad-based management skills, she has put her expertise to work for providers who are striving to raise the bar for healthcare delivery. |
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