Health plans offer IT grants to encourage more provider adoption

February 1, 2006

There is little disagreement about the role that technology can play in the effort to improve healthcare and reduce costs, but attempts to implement technology solutions along the healthcare continuum have been uneven.

There is little disagreement about the role that technology can play in the effort to improve healthcare and reduce costs, but attempts to implement technology solutions along the healthcare continuum have been uneven.

Providers have been slow to adopt technology solutions, especially electronic medical record (EMR) systems. There are numerous reasons why, including cost, resistance to change, and a lack of computer skills and organizational infrastructure to support EMR systems.

There are some estimates that the cost to implement an EMR system is $40,000 per physician, says Dave Dillehunt, vice president and chief information officer for FirstHealth of the Carolinas. Many providers are operating on margins so tight they can't afford that type of investment.

Each fund is set up differently, and the parameters that healthcare organizations use to distribute the money are also different, but the goals are the same: to help providers begin the process of adopting EMR technology; to help absorb some of the initial implementation costs; and to create an environment where efficiency, productivity and quality of care are improved.

"It is the way of the future, and we want to help pull our providers into that future," says Bruce Madderom, director of e-commerce for Affinity Health Plan.

SUPPORT SERVICES

At the end of 2004, Affinity, looking to give something back to its providers, created a multimillion-dollar reinvestment fund. The intent, however, wasn't simply to start writing checks.

Instead, Affinity created eAlliance, a technology community consisting of itself, its providers and members. Through eAlliance, the company has established support services to help its providers become accustomed to, and comfortable with, a broad array of technology solutions, beginning with EMRs.

The first three projects rolled out under eAlliance were electronic data interchange (EDI), which is used primarily to exchange claim information; interactive voice response, where providers and members can use a telephone keypad to access a computer system to check on member eligibility and track claim information; and a Web-enabled provider/ member portal product, where members can view policies and clinical initiatives.

Working with a consulting company, Affinity organized an outreach program because it saw that many billing services and provider offices didn't have the expertise to make the switch to electronic billing, even if they have computerized practice management systems.

"We're trying to provide information, guidance and direction to our providers," Madderom says. "Then they make the decision whether to run it. Our goal is to partner with them on how they can apply best practices to their organizations."

eAlliance has already made a difference, Madderom says. For example, when he began at Affinity in December 2004, the electronic claim receipt rate was at about 11% (the industry standard is between 50% and 60%). Affinity ended 2005 with an EDI receipt rate of about 50%.

Madderom says the increased use of EDI has reduced costs and the turnaround time on claims.

IT FUND HELPS WITH E-PRESCRIBING

One of the areas where technology can improve healthcare is in e-prescribing. But many providers, especially one-and two-physician offices, don't have the capital to implement an e-prescribing system, says Donald R. Fischer, MD, senior vice president for Integrated Clinical Services and chief medical officer for Highmark Inc. "E-prescribing is a good entry point for providers to get used to using electronic tools," he says. "It would also have a significant ROI [return on investment] in regard to prescribing more generic medications and getting us away from as many drug interactions as possible."

To help providers begin implementing e-prescribing systems, Highmark contributed $26.5 million to the Pittsburgh Foundation to establish the Highmark eHealth Collaborative.

The collaborative will pay up to 75% of the cost for a provider to acquire, install and implement an electronic system, up to a maximum of $7,000 per physician, with the provider paying the balance.