The key to curbing future healthcare costs lies in closer collaboration between medical aid companies and healthcare service providers, says Lorna Powe, head of healthcare for Computer Sciences Corporation`s operations in South Africa.
Powe cited NEHEN, a U.S.-consortium of regional payors and providers that designed and implemented a secure and innovative electronic-commerce solution that has reduced their reliance on the services of switching companies.
"The solution has reduced administrative costs and facilitated the timely exchange of electronic data."
Seven years ago, while performing a feasibility study for a client interested in implementing EDI, CSC recognized that a broader solution involving multiple regional partners would benefit not only its client, but also all parties involved. The company proposed a collaborative EDI adoption and implementation effort, which led to the formation of NEHEN.
"NEHEN has benefited patients and medical aid members by reducing or eliminating delays often experienced in scheduling an appointment, obtaining a referral or dealing with a claim that has been wrongly denied. Providers, medical aids and other payors benefit from real cost savings over paper-based processes and less claims rework. Process efficiencies have ultimately allowed doctors more time to provide quality care."
The system has also reduced bad debts and other financial exposures related to inefficient and incomplete performance of certain processes (for example, eligibility inquiry).
"A large amount of risk for doctors is being able to identify patient`s eligibility for a service. Real-time authorisations have helped to reduce this risk," explains Powe. Powe says the enactment of the U.S. Health Insurance Portability and Accountability Act (HIPAA) in 1996, requires medical aid companies to accept standard-format electronic transactions, and healthcare providers to send electronic transactions in a standard format.
"The threat of harsh penalties for non-compliance compelled the industry to be more aggressive about implementing EDI as a solution."
The number one success factor for NEHEN was getting medical aid and providers to work together, says Powe.
"Collaboration enabled the various members to leverage experience gained by other participants; the members of NEHEN believed that providing EDI capabilities to their trading partners did not give them a competitive advantage but rather saw it as an opportunity to improve administrative processes for the healthcare community. As a result, all intellectual property created for NEHEN was shared among the members and, if a member individually developed a solution that might benefit the group, then that solution was donated to NEHEN."
Powe says coordinated development and implementation cycles dramatically shortened the time members would have otherwise needed to reach significant transaction volumes.
CSC is currently working on a number of collaborative projects in the healthcare field. For example, the company is working closely with the U.S. healthcare industry to establish an interconnected medical system and, in the UK, a CSC-led alliance has won a USD 1.7 billion contract with the National Health Service (NHS) as part of the NHS` National Programme for IT (NpfIT) to improve healthcare service for patients in the North West and West Midlands of England.
Under the agreement the alliance will design, deliver and operate an integrated patient care record system, improving the way patient information is accessed and shared by 275,000 health professionals. The service will provide all NHS patients with an individual lifelong electronic care record, promoting seamless care for patients through physicians, hospitals and community services while allowing healthcare professionals to focus on more effectively delivering quality patient care.
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