Q: What should managed-care organi- zations consider before implementing an Internet-based patient-management system?
A: 'You want to make it as easy as possible to use for both the patient and the doctor. When you go into the doctor's office, all of your personal information should be captured there and then stored electronically for easy access,' says Chuck Freidhof, executive vice president of The FocIS Group. 'The biggest concern is about security. This information needs to be password protected and a firewall needs to be secured. Always consult with an expert to assess your needs.'
Q: What are the concerns over patient confidentiality and the Internet?
A: 'I think that, for the most part, whenever you use a vendor that provides access to the Internet to allow patients or physicians access to information, you have to ensure no one can have access without ensuring privacy. It's an extremely important issue,' says Todd Locke, chief medical officer for Qualchoice Healthplan. 'The whole idea of disease management is more difficult when you have to be sure about identifiable data. There are lots of issues that it raises and makes us very cautious about mailing anything or doing anything over the Internet.'
Q: How can employers benefit from receiving drug-test results via the Internet?
A: 'An online system eliminates employers having to wait on drug screens, because they can retrieve test results 24 hours a day, seven days a week. It really speeds up turnaround time, because drug screens are automatically downloaded to the employer,' explains Tracy Skorman, sales manager for Zenza National. 'Employers can get a test result early in the morning, in the evening or on the weekend. It eliminates the paperwork and provides an itemized, consolidated billing system. It can also enable a clinical network management system nationwide.'
Q: How can employers keep their health-care costs down?
A: 'Employees today want more choice, and they want more comprehensive coverage. So one thing many employers are offering is a three-tiered pharmacy plan, which can save them 2 to 3 percent on their overall costs,' says Marty Hauser, president of SummaCare Health Plans. 'What employers see as a value in this triple-tier option is that it's not just an either-or; their employees have a choice in what they can get. Given the complexity of this, a lot of employers are educating themselves a lot more, either by talking to their health-care providers and insurers, or by turning to their brokers and agents.'
Q: What basic information should an employer give to the physician when an employee is injured on the job?
A: 'The main stuff that's useful to an occupational medicine physician is an ADA job description that actually qualifies what the employee does in terms of bending and lifting. The more specific information they are able to relay to the physician in regard to the job itself, the easier it is for the physician to give a list back to the employer detailing what the employee can do,' says Dr. Paul Miotto, medical director, occupational health for Lake Hospital System. 'It gives the employer the ability to place the worker back in the job without having that worker lose time at home.'
Q: What are the benefits of technolognical advances in medical equipment?
A: 'New medical devices and new diagnostic tools coming out help physicians diagnose and treat patients more efficiently with less chance of error,' says John F. Jesser, vice president of health care management for Anthem Blue Cross and Blue Shield. 'There is exciting technology, and with that comes cost pressures on the consumer and the payer. There's a wonderfully optimistic potential, but you really have to sort through some of the things that come to the market. But some of the positives are management of disease and potentially avoiding evasive procedures.'
Q: What can employers and employees do to prevent health-care fraud?
A: 'Health care fraud has a direct input on health-care costs. One thing employees can do is self-audits of their explanations of benefits. Make sure that what you were billed for is what you got. If you see anything questionable, inquire about it, contact the provider's customer service department,' advises Joe San Filippo, COO of Nationwide Health Plans. 'Employers should make sure their health-insurance carrier has an anti-fraud action plan in place. Make sure it's not just a plan on paper, but that the plan is in action. Then follow up with the payer.'
Q: What are the advantages to invest- ing in an online data-management system?
A: 'One of the advantages is efficiency. The timeliness of processing health-care claims increases people's efficiency in the timeliness of care. It obviously saves money, because it eliminates the mail route,' explains Joan Mason, executive vice president and chief operating officer of Ohio Health Choice. 'If you can handle that kind of data electronically, it can shave days or even weeks off of the process. And, of course, the providers are happy because they get paid much more quickly.'
Q: What are some of the challenges facing smaller managed-care organizations when implementing new technologies?
A: 'I think the imple- mentation of new technologies in managed-care organizations is really dependent on their size and workload: The smaller they are, the harder it is to do that,' says Ken Sidon, president of Antares Management Solutions. 'It's really tough now on a smaller organization to attract and keep people and implement new technologies. One solution, and this may be an old term, is partnering. They are probably going to have to pool some resources together — not merge, but share in resources and new technologies.'
Q: How has technology changed the health-care industry?
A: 'Communication innovations such as email and the Internet have increased speed and efficiency so that, for instance, benefits managers can make enrollment changes and providers check eligibility right online,' says Scott Lyon, executive director of group services of COSE. 'Medically speaking, technology has improved quality of life — though at the cost of higher health-care rates that get passed along to employers and employees.'