White Paper Shines Light on Administrative Waste: Offers Practical Steps for Cutting Healthcare Costs through Existing Infrastructure, Collaboration

Cutting Healthcare Costs by cutting administrative waste
CHICAGO, April 6 /PRNewswire/- The U.S. economy transmits over 18 billion electronic payments each year, yet approximately half of all healthcare financial transactions are still paper-based. Costs of paper, printing, postage and labor for manual processes in healthcare are estimated to add up to nearly $30 billion a year in waste(1). As healthcare reforms are considered in Washington and in all 50 states, administrative savings represent a bright spot- low-hanging fruit- that could help pay for longer-term reforms.
To help inform this dialogue, Emdeon, in cooperation with the Center for Health Transformation, today unveiled an important white paper at the HIMSS 2009 Annual Conference. The white paper, "Taking the Paper Out of Paperwork: How Electronic Administration Can Save The U.S. Health System Billions," looks at the gaps in the industry that keep it dependent on manual processing- and offers practical steps for breaking this costly and inefficient cycle.
"In these trying economic times, combined with the specter of unsustainable spending, Medicare insolvency and runaway growth in Medicaid, we must find those IT solutions that can not only save lives but can also lower costs," said Former House Speaker Newt Gingrich, founder of the Center for Health Transformation.
The white paper provides a step-by-step roadmap for both payers and providers and highlights best practices that are delivering tangible results today. This pragmatic approach leverages technology and infrastructure that already exist- and provides a vision for a new kind of industry collaboration.
"It's not about infrastructure," says George Lazenby, chief executive officer of Emdeon. "The infrastructure is there, and the technology exists. All the constituents are looking for ways to optimize their business processes."
Among the barriers cited are lack of integration, lack of complete standards, competing priorities between stakeholders and a perceived lack of value to healthcare providers.
"We see higher adoption of electronic healthcare transactions when they meet the needs of both providers and payers," said Lazenby. "It's about making the information available at the point where decisions need to be made."
Recommendations outlined in the white paper include:
For Payers
• Develop and pilot reimbursement programs that reward quality healthcare practice and results, including electronic information exchange
• Ensure all future information technology development is done according to industry standards
• Collaborate around multi-payer functionality understanding that providers want a single resource for interacting with health plans

For Providers
• Keep abreast of federal funding opportunities for health information technology
• Include process re-engineering for an electronic end-to-end eligibility, claims and payment process in electronic medical record (EMR)implementation strategies
• Work with medical societies and specialty groups to advance national standardization goals

About Emdeon
Emdeon is a leading provider of revenue and payment cycle solutions that connect payers, providers and patients to integrate and automate key business and administrative functions throughout the patient encounter. Through the use of Emdeon's comprehensive suite of products and services, its customers are able to improve efficiency, reduce costs, increase cash flow and more efficiently manage the complex revenue and payment cycle process. Emdeon is owned by General Atlantic LLC and Hellman & Friedman LLC. For more information, visit www.emdeon.com.

Link to the white paper:

(1) National Automated Clearinghouse Association, ACH 2007 Volumes, May 19, 2008; U.S. Healthcare Efficiency Indes™, www.ushealthcareindex.com February 2, 2009.

SOURCE: Emdeon


"See"EO: Chief Executive Officer, George Lazenby, Sees All in Emdeon's Infrastructure

A look inside the organization Take a peek behind the technology that makes innovative system monitoring possible

From his office in Nashville, Tennessee, Emdeon CEO, George Lazenby, always has a clear view. This fact has nothing to do with what he can see outside his window. Instead it refers to what he can see inside his organization. With an innovative in-office infrastructure monitoring system, Lazenby can watch all aspects of Emdeon business and service performance—in real-time, at any time. He has unobstructed visibility of every level of the company’s infrastructure, and he watches intently with the goal to better serve customers.

Even the smallest details are within view with this real-time infrastructure monitoring system. Lazenby can see how long it takes for every customer service call to be answered. He’s able to keep a watchful eye on Emdeon’s two data centers and all activities, from billing and reporting to product functions and service. If it takes more than 30 seconds for a customer service call to be answered or there’s even a slight glitch at any point in the process, he’s able to know it—and address it—immediately. And, if he’s not in front of his in-office infrastructure monitoring system, email alerts are sent directly to him should anything merit immediate attention. The monitoring is so thorough that Lazenby can drill down to any point in the vast corporate infrastructure to identify who on his team is responsible for anything he observes. And because monitoring is only valuable if the company is able to respond to issues as they are revealed, Emdeon’s infrastructure is built to provide inherent tactical responsiveness. The company can not only identify problems, but track patterns and take fast action to implement solutions.

According to Lazenby, this level of monitoring and response is the fruit of a continued concentrated focus on improving service levels across the board. The company’s IT division has successfully consolidated operations so that communications are tight, technological functions run efficiently and reliability is consistent. Of course, with the CEO constantly a click away from “seeing all,” accountability comes from the C-suite out—positively affecting performance company-wide. “Urgency is increased when the good people who work here realize addressing service and performance issues are so important that I have a monitor in my office that tracks everything up to the second,” Lazenby explains. “A proactive process emerges from this level of visibility.”

Additionally, this comprehensive monitoring has enabled Emdeon to identify and improve many things that were previously under the radar. Correlations are identified between various aspects of operations and service and can be addressed effectively. By drilling down to find issues that affect interdependent functions, Emdeon is able to eliminate causes of down time and improve reliability. “What we do is critical to what our customers do,” states Lazenby. “That’s why we invest in things like this.”

Lazenby’s in-office infrastructure monitoring system is a quick, comprehensive reference tool created expressly for the CEO. However, the goal is to one day provide customers access to similar information. That’s how confident and committed Lazenby and the team at Emdeon are regarding the integrity and transparency of service. Though sharing the infrastructure monitoring system with customers is likely a few years out, the high quality, real-time data, stats and reporting are already in place and in use—to the customers’ benefit.

As a matter of fact, Emdeon’s extensive monitoring system is the manifestation of the company’s ongoing efforts to improve its core infrastructure. Highly complex and multi-layered, Emdeon’s technology is constantly being honed to ensure near-flawless performance between divisions and disciplines. Ironically, this complexity ultimately provides transparency and simplicity for customers who enjoy such reliable service that they rarely need to think about what’s going on behind the curtain.

A peek behind the curtain reveals the vast complexities of all that goes into Lazenby’s seemingly simple, clear view. Emdeon is ceaselessly engaged in improving its technologies and service. In an infrastructure that runs deep and wide, every aspect of operations is interdependent on the other and it takes a skilled and committed team to navigate the challenges and opportunities that technology brings. “Of course, customers have no need to worry about all that,” Lazenby summarizes, “with this, they know we’re on the case...providing integrity of service.”

With that kind of viewpoint, it’s quite clear. Emdeon is committed to simplifying the business of healthcare no matter how complicated that process may be.

A look inside the organization
Overall Technology Strategy: Emdeon has long been committed to quality management in IT with the goal of 100% reliable performance and efficiency of operations. Already, the company has achieved near Six Sigma levels of sustained performance/service while containing costs. This strategy is a core differentiator for Emdeon with its customers.

Data Center Consolidation: Emdeon now operates two world-class data centers (rather than several locations), geographically distant from one another and equipped with the highest levels of security and functionality possible with today’s technology. These facilities are fortified to sustain operations even in the most extreme scenarios (i.e. - natural disasters).

Solutions Availability Reporting: With an unwavering goal of 100% uptime, Emdeon tracks and reports uptime for the company’s core infrastructure. This valuable information is used company-wide to influence strategies and tactics focused on reliability.

Business Activity Monitoring through Technology: As previously described, Emdeon has advanced its monitoring capabilities to not only watch and respond to issues by division; the company now monitors company-wide interdependencies, in total view and in real-time. In addition to constant assessment of IT infrastructure, Emdeon has added Call Center monitoring to ensure impeccable frontline service.

Use of Ticketing: To achieve uninterrupted uptime, it is essential to do more than trouble shoot. Emdeon utilizes a ticketing system to denote and resolve issues while creating a reference for historical resolution. This approach helps to identify patterns and root causes and institute long term solutions.

IT Service Management (ITSM): Emdeon has implemented ITSM to proactively lead the company to new heights in technological service. With a goal to earn ISO certification and implementation of a comprehensive information security framework by end of year 2010, Emdeon’s ISTM team is focused on integrating procedures that intrinsically improve IT operations, maximizes internal resources and ultimately provides the best service for customers.


Dealing with Accelerating Patient Responsibility

Dealing with Accelerating Patient Responsibility

The market is shifting, and with it the portion of a physician's bill for which the patient is responsible is increasing. Over 40 million Americans are uninsured and it’s getting worse in our challenging economy. However, there are solutions to help physicians protect their bottom line. Physician’s Practice and Emdeon have partnered to provide some insight into these challenges. Click the PODCAST below to listen to a short, informative roundtable discussion on “Dealing with Accelerating Patient Financial Responsibility.”

Paper Cut

Solutions for making the Switch from Paper to Electronic Payments
Solutions for making the Switch from Paper to Electronic Payments

At first glance it’s hard to imagine a provider wouldn’t clamor to receive payments through Electronic Funds Transfer (EFT.) The phrase itself connotes a seamless transfer of monies owed for services rendered. Providers receiving prompt, direct payment—that’s a great thing.

Adoption of EFT benefits not just providers; it benefits payers, patients and the public at large. Cutting the paper and going electronic is a win-win, win-win.

First and foremost, EFT provides significant cost savings. Across the board, all participants in the revenue cycle see notable savings/increased profitability long term with EFT. Savings are achieved through the elimination of costs for supplies and labor for printing, mailing, sorting and hand processing (keying, sending, filing, etc). EFT saves money lost through errors common to traditional funds transfer. When money is transferred electronically, checks don’t get lost in the mail, manual entry mistakes are avoided, and cash flows more smoothly. These savings are seen during payables and receivables—and at every point in the revenue cycle in between.

Billions of Dollars Could be Saved

The healthcare industry would realize nearly $30,000,000,000 in savings if total electronic conversion were to fully occur. Approximately $11,000,000,000 would be saved if just EFT were adopted industry wide. This data comes from the US Healthcare Efficiency Index™, a forum for monitoring the industry’s progress from a paper-based system to an electronic one. Who would benefit from the healthcare system saving billions of dollars by running more efficiently? Everyone.

Naturally, EFT is also a major time saver, and we all know time is a valuable currency in our fast-paced industry. When staff members don’t have to deal with the aforementioned printing, mailing, sorting, hand processing or manual keying, they work more efficiently and productively on tasks that are of greater, more lasting value. There’s no lag time waiting on mail delivery, check clearances, funds to be released or payments to post. Work flow and cash flow are improved.

It’s also worth noting that EFT is not only a leaner process, it’s a greener one as well. Cutting paper out of the process will measurably reduce the environmental impact of paying and receiving funds. Trimming waste ultimately results in less rubbish in landfills, as well as less precious square footage swallowed in storing documentation and copies.

A Leaner System. A Greener World.

Going electronic saves trees by reducing the amount of paper needed. to run the system. The US Healthcare Efficiency Index™ estimates that we would eliminate the need for 4,969,875,000 sheets of paper annually by adopting an electronic system.

With all these long term benefits in addition to the immediate potential for seamless payment, it’s a wonder total adoption of EFT has yet to occur. However for many providers, “seamless” isn’t always what it, well, seems. There are some key issues that must be addressed in order to make EFT the optimal choice for all providers.

The most common barrier is the expense involved in acquiring the needed technology just to get started. Even if a provider desires the long term savings of electronic payment, they may find the initial investment cost prohibitive. From large groups to small clinics, all providers have to invest in technology, even though their resources may be disparate. Though more and more affordable solutions for payment review, reconciliation and posting are appearing in the marketplace, the perception that technology is expensive is deeply rooted and challenging to overcome.

Another issue is lack of consistent, standardized data between payers and providers or allowed variances even when standardized code sets exist. With so many players in the game, it’s challenging to get everyone speaking the same coding language or requiring the same data during remittance. In addition, payments are often not processed electronically because providers did not initiate the claim electronically; every step of the process must tactically lead to the next.

Thankfully, the healthcare industry as a whole, motivated by the potential savings benefits reaching well into the billions, is addressing these issues with responsive solutions.

Most notably, standardization is proving to be immensely helpful. There’s a growing trend in payers standardizing electronic payments to their providers. As payers standardize the process, more providers will be able to make the transition, and everyone will benefit from economies of scale that come into play to help defray costs.

Additionally, HIPAA has mandated code sets to help standardize the process, though variances still exist in an industry as vast and complex as this. Certainly vendors—clearinghouses in the business of electronic data transmission—have been at the forefront of this transition and have developed technology to aid in the translation of data. Innovations and standardization will ultimately work together to navigate the process.

All said and done, it’s time to get on board and join the forward motion. While some industry professionals are somewhat set in their ways, preferring to keep the paper they’ve known and trusted rather than convert, the fact is the industry’s arrived at a ‘lead, follow or get out of the way’ juncture. As a matter of fact, the state of Minnesota is now the first to require all healthcare payers and providers to submit claims, eligibility and payments electronically. Other states may likely follow suit.

In the interim, we can all be assured by the ongoing transitions of colleagues in the industry. Some providers have already made great headway, and thankfully we can learn from each other.

Want more details about the efficiency of the healthcare system? Visit www.ushealthcareindex.com. Ready to cut the paper in your practice? Contact us today to talk about solutions.


eHealth Educational Seminar

eHealth Educational Seminars
Emdeon is offering a free seminar covering payer requirments for filing claims electronically, benefits of real-time transactions, and understanding electronic claims submission reports. Staff from provider offices, hospitals, facilities, billing services, etc. are invited to learn more about how to save money and improve efficiency by effectively utilizing electronic transactions. Participating payer representatives will be present at each seminar to answer any questions you may have about filing claims!

• Week of August 17: Des Moines, IA
• Week of August 17: Omaha, NE
• Week of August 31: St. Louis, MO

Please visit our EDI Transaction Center online to register online and obtain other information that will help you send more transactions electronically.

Do you know?
• Top reasons claims are rejected
• How to resolve claim rejections
• What information is required by each payer to file claims electronically
• How to submit secondary claims electronically
• The benefits of ERA/EFT
• What electronic reports you should be receiving and how to read them
• How to maximize your potential with electronic transactions
• Various EDI transactions available today
• What EDI transactions save you the most money
• What EDI transactions payers are recommending


New Payers on Board

New Payers On-Board The Emdeon network of payers continues to grow
We have recently added the following payers:

• ACS Inc. - Claims
• Benefit Management Inc. of KS - Claims
• Better Health Plans Inc. - Claims
• Blue Choice Medicaid Managed Care - Claims
• Cahaba GBA Division of BCBS of Alabama - Claims
• CIGNA Voluntary - Claims
• Community Medical Group of the West Valley Inc. - Claims
• Connential Key Family - Claims
• Custody Medical Services - Claims
• District of Columbia Medicaid - Claims
• District of Columbia Medicaid - ERA
• Eastland Medical Group - Claims
• EDS - Claims
• First Coast Service Options - Claims
• Group Health Cooperative - WA State - Claims
• Group Health Options - WA State - Claims
• Korean American Medical Group - Claims
• Lakeside Comprehensive Healthcare - Claims
• Lakeside Medical Group - Claims
• MCNA DENTAL - Claims
• Meridian Health Plan - Claims
• Molina Healthcare of Ohio - Claim Status Inquiry and Response
• Molina Healthcare of Ohio - Eligibility Inquiry and Response
• Northstar Advantage - Claims
• PacificSource Health Plans - ERA
• Renaissance Physicians Organization - Claims
• Rocky Mountain Health Care Corp. - ERA
• Rocky Mountain Health Plan - Grand Junction - Claims
• Select Benefit Administrators Inc. - Claims
• Texas First Health Plans (TIOPA) - Claims
• Texas HealthSpring - Claims
• Tricare North Region - Claims
• Unison Health Plan/Better Health Plans - Claims
• United Agriculture Benefit Trust - Claims
• Verdugo Hills Medical Group - Claims
• Viva Health Plan - Claims
• West Covina Medical Group - Claims
• Wisconsin Medicaid - Claims

For a complete list of the payers in our network, visit our website at www.emdeon.com/PayerLists/payerlists.php

See the full list >>