A Place at the National Podium

Emdeon’s Senior V.P. Miriam Paramore Addressed Delegates, Officials & Notable Guests, Shared in National Dialogue at a DNC Healthcare Reform Forum

Amidst the feverish excitement of the recent Democratic National Convention in Denver, Emdeon Business Services participated in an event—in a national dialogue, really—that soberly transcended party lines or affiliations to address a topic relevant to all Americans: healthcare reform.

The public Health Policy Forum, of which Emdeon was a corporate sponsor for an opening VIP reception, brought together a host of influential figures to discuss the present and future of our nation’s healthcare system. Emdeon’s Senior Vice President of Corporate Strategy, Miriam Paramore, herself a recognized thought leader in the industry, offered opening remarks for the reception, representing Emdeon in welcoming the likes of Congresswoman Allyson Schwartz, author of the E-MEDS Bill which requires e-prescribing for Medicare, columnist Arianna Huffington, and Kansas Governor Kathleen Sebelius.

“Emdeon is in the conversation,” Paramore says, recapping her experience at the event. “I’m thrilled to represent a company that’s doing the right thing...participating in the dialogue on the healthcare crisis that affects us all...to help in real, material way.”

Paramore came away energized not only by Emdeon’s role in the national discussion, but in how the company plays a substantive role in “moving the needle” by digitizing the industry and using information technology to turn raw data into usable information. Effective information exchange is essential to the functioning of the entire healthcare system, especially as that system is in a constant state of evolution.

“Our mission is to simplify the business of healthcare,” Paramore explains. “That’s why we are part of discussions on public policy and regulation, to stay on the forefront and influence direction changes that impact the electronic exchange of healthcare information. We are often the connecting point that keeps our customers prepared and ready. ”

Now more than ever, Emdeon is the “glue for the industry when changes occur that impact health information exchange.” By staying close to the regulatory machination, Emdeon is consistently ahead of the game, investing to accommodate altering governmental and industry standards/requirements long before business partners will be affected.

From pay-for-performance issues to handling unfunded mandates and quality initiatives, Emdeon aggressively seeks ways to use technology to make data accurate, expedient and readily accessible for payers, providers, and pharmacies. By improving eligibility transactions and applying business intelligence to EDI, Emdeon is helping reduce the $150 billion of inefficiencies* related to insurance and billing activities that burden the healthcare system each year.

“Of course, this is our business, and our customers are our priority. Yet as we better serve our customers, we are improving the system as a whole. We’re motivated to step up our corporate responsibility to make a difference. We are not on the sidelines, in the quest for true reforms” Paramore summarizes. “We encourage our business partners to do the same.”

What does all this mean to you? Here are a few key ‘take aways’ Paramore shares with you from her DNC Health Reform Forum experience.

• Join the conversation.
What individuals in your organization are committed to knowing issues, defining goals and finding solutions? Whether you begin simply by staying more informed or you choose to participate more prominently, you must be in the mix; your voice is vital to reform.

• Start your own conversation. Create ways to communicate with constituencies within your organization about key issues, to gain perspective from all angles. Start dialogue, and ensure communication is two-way so that questions, ideas and information can be shared effectively.

• You can count on Emdeon to help connect the dots. As you join in discussion and generate conversation from within, you can count on Emdeon to help filter and share information throughout the industry. Connect with your Emdeon account manager- we will always do our best to accurately represent your ideas, questions and concerns to the associations and industry and governmental groups in which we participate.

*Source: Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey, 2005; A New Model For Enhancing Care While Reducing Costs, Source: Cap Gemini, E&Y May 2002

Beyond Price Transparency

by E. Todd Bennett

Price Transparency. These two health industry buzzwords convey the need to empower patients with simple and precise information about the cost of healthcare. Boiling down the complex healthcare pricing systems into patient-understandable terms prior to care is a critical step to enabling the patient to understand how much money they will owe after treatment and determining how they will pay their portion of financial responsibility. Furthermore, providing the costs of treatment prior to care gives the consumer an opportunity to shop for alternative care and figure out how their financial responsibility will be paid. While today’s patient financial responsibility estimation technology achieves price transparency by emulating the claim adjudication process, future enhancements will provide even more actionable information. Building on a foundation of treatment cost estimates, transparency also needs to incorporate facets of quality based on physician credentialing, patient safety, and healthcare outcomes. As these two components come together they will represent a fundamental driver to a successful consumer based market for healthcare.

In this evolved market, before seeing a primary care provider or a specialist, patients will be able to compare the credentials and quality metrics of providers in their area and across the country in conjunction with the price of their services. Credentials offer subjective evidence to understand the physician’s specialized training and to impart confidence in their ability to provide high-quality treatment by acknowledging where they were trained. Similarly, credentials will include board certification when a physician attains a higher degree of education and disciplinary actions when the physician is censured by an affiliated hospital, various medical boards, or indicted for criminal convictions. Information such as how many procedures of a given type the physician has performed will build on this theme of experience and add perspective to healthcare decision making. How much do you know about the physicians you see? Exposing physician credentials opens the door to information that will enable patients to compare quality.

Patient safety is another facet of quality transparency. Exposing comparable patient safety measurements will enable patients to understand the relative safety of one healthcare provider versus another. Imagine being able to compare the medication administration safety and infection rates of regional hospitals. Is the provider using Computerized Physician Order Entry to reduce the likelihood of prescribing errors? Does the nursing staff have access to systems that prevent medication administration errors? How many infections were caused in the last year within the hospital? Contrasting patient safety trends with those of similar providers provides information to the patient that has never been available before. Evaluating quality factors such as these increases transparency and helps patients assess where to get treatment.

New transparency tools will also enable patients to understand the outcomes expected with certain types of treatments and procedures. Outcomes will likely be demonstrated through standardized, evidence-based measurements and allow you to recognize the relative effectiveness of the types of treatments used by a particular physician. Instead of blindly accepting that a single clinical course of action exists for a given diagnosis, outcome comparison will demonstrate the comparative benefits of a treatment or procedure provided by one doctor versus the others available. The healthcare industry is dynamic and always striving for better quality, and making outcomes more transparent will spur competition leading the industry to even more breakthrough improvements.

Even after these quality transparency tools are readily available, price will very likely still play one of the largest factors. One hallmark of our society is that quality often costs more. A provider that develops strong credentials, keeps an excellent safety record, and achieves effective outcomes for patients will likely cost more than an average quality provider or one with a few blemishes on record. The ability to accurately estimate healthcare costs will be viewed in light of provider quality, and healthcare decisions will be able to undergo scrutiny with factual, comparative information. Providing transparent price and quality information prior to care will foster competition and lead to higher quality services at ever-competitive prices. As the healthcare industry continues to develop capabilities that enable more pre-care transparency, our aim should be far beyond displaying patient cost estimates and consider the quality aspect of the providers we pay.

Interested in hearing more on this topic? Emdeon sponsored a breakfast symposium at AHIP’s Institute 2008 in June, where our Vice President for Product Management, David Butterworth, presented alongside other industry leaders on Payment Assurance and Point-of-Service Price Transparency– Addressing the evolving market needs and accelerating market adoption. We were there to capture the entire discussion…view the 60-minute symposium!”

Todd is a member of Emdeon's Payer Product team, responsible for Real-Time Eligibility, Real-Time Claim Status, and Emdeon Vision for Claim Management.Do you have questions or feedback on this article? Email Todd at ebennett@emdeon.com.

Industry service alert: Attention Medicare Part D Payers

For all payers who issue Medicare Part D Explanations of Benefits (EOBs): Did you know that Emdeon produces millions of EOBs to eligible Medicare Part D recipients each month?

Here at Emdeon, we have developed CMS form design requirement expertise, and are able to move quickly to change or update forms to meet new CMS form requirements at no additional charge. Because we produce millions of outgoing mail pieces every day, we are able to saturate zip codes and qualify for three- and five-digit pre-sort rates to ensure the lowest postage possible, given your mail mix. By utilizing both #10 and 6x9 envelopes, we obtain USPS pre-sort letter rates on mail up to 3.5 ounces.

Through our Client Access System, our web-based self-service payment management tool, our customers can manage these documents and access archived documents for up to ten years.

If you are still processing Medicare Part D EOBs in-house, Emdeon provides the experience, agility, and scale to the CMS-mandated process. Call us at 877.EMDEON.6 or send an email to us to request a complimentary cost analysis today!

X-Ray Vision for your claim cycle

As you may have noticed in recent communications, Emdeon now offers an application that is more than just a claim tracking tool- Emdeon Vision for Claim Management delivers transparency and intelligence throughout the claim delivery cycle. This tool offers summarized and detailed claim data, claim image viewing, extensive reporting capabilities and more complete tracking of your claims at every step in the claim delivery cycle. In addition, recent product enhancements have integrated Emdeon Vision for Claim Management into multiple solutions across Emdeon’s suite of services. So now you have the ability to track your claims and get status updates on both paper and electronic claims!

Whether the claim was filed on paper or submitted electronically, Emdeon Vision provides complete visibility at each step along the way. Your service representatives will be able to see when the provider sent the claim, when Emdeon received the claim, when the claim was transferred to your adjudication system and, finally, when the provider received the electronic remittance advice acknowledging payment. Emdeon Vision even offers status and tracking information on claims routed for PPO repricing.

Have paper claims? Whether we have scanned your claims or you are scanning your own claims with Emdeon software, Emdeon Vision enables your customer service representatives to view online images of the claims as they were filed by the provider. You’ll even have the same great, end-to-end tracking on those scanned claims as you do on your EDI claims- all in one convenient, easy-to-use application.

Emdeon Vision really is like having X-Ray vision into your claim administration processes. Why wait? Start seeing through your entire claim cycle today.
Take a few minutes to view our quick tour video now and learn how Emdeon Vision can help you “know” your claim cycle.

Maintaining the affordability of the prescription drug benefit

Are you looking for ways to better control your drug expenditures?
Managing all or more of your prescription benefits in-house may be your best solution for lowering drug expenditures and optimizing clinical outcomes. By doing so, your organization can create a customized formulary; negotiate directly with manufacturers eliminating the middleman; develop your own pharmacy network and obtain timely data to identify trends and cost drivers.

Our Solution
Emdeon provides claims processing and other administration services for pharmacy payers and providers that are conducted online, in real-time, according to client benefit plan designs. Our Prescription Benefit Solutions allow our clients to directly manage more of their pharmacy benefits and provide a cost-effective alternative to an in-house pharmacy claims adjudication system. To learn how Emdeon can help you better manage your benefits and reduce drug expenditures, view the SelectRx Quick Tour or call 800.521.4548, ext. 3.

Achieve Savings Through Targeted EDI Growth

Like payers, providers understand that increasing automation and electronic transactions has a direct impact on their bottom line.

For payers, simply “turning on” electronic capability does not guarantee every provider will begin utilizing this capability. To truly create savings, sometimes a helping hand is needed to identify “paper-offenders,” that is, those providers still submitting paper claims. A targeted growth program focused on increasing electronic transaction volumes can help identify those providers and target them with specific messaging to educate and encourage their office staff on how to improve electronic submission rates.
“At Coventry, we saw clear, measurable increases in both EDI rates and our real-time transactions,” said Harry Fox, former Vice President of e-Commerce for Coventry Healthcare and current Vice President, Business Information Officer at Kaiser Permanente, speaking of Coventry’s Accelerated Growth Program with Emdeon. Over the last several years of the program, Coventry’s rate of electronic submission has risen from 39 percent to 71 percent. By increasing the usage of real-time eligibility and claim status inquiries through Emdeon, Coventry’s call center volumes have decreased by approximately 30 percent.

Claim data analysis and opportunity identification based on rejection rates and low provider utilization help establish goals and drive data-driven programs that increase the adoption of electronic transactions and reduce paper handling. Customized programs are tailored to fit individual payer needs. Coventry Health Care’s growth program, administered by Emdeon, included provider education seminars, direct telephone outreaches and targeted direct mail campaigns to providers.

According to Fox, Emdeon has “a group that understands the data, understands how to analyze that data and they are able to execute the growth strategy through sales and marketing.” Learn more on Emdeon’s approach to growing EDI volumes by clicking here.

Interested in learning about our new program to grow provider participation in Electronic Fund Transfer (EFT) reimbursement transactions? We now have a team dedicated to provider EFT enrollment outreach. Contact your account manager or give us a call at 877.EMDEON.6 to receive more information on this exciting new service!

Emdeon Commits to CAQH CORE Phase II Rules

Improving electronic administrative data exchanges

To demonstrate our commitment to improving administrative data exchanges, Emdeon has committed to complete a testing process by no later than the end of 2009 to certify that we can exchange electronic healthcare administrative data according to the CAQH Committee on Operating Rules for Information Exchange (CORE) new Phase II rules.

The voluntary business rules enhance interoperability between providers and payers; streamline eligibility, benefits and claim status transactions; and reduce the amount of time and resources providers dedicate to administrative functions. The Phase II rules cover requirements for electronic connectivity, patient identifiers, claim status and reporting of patient financial responsibility for an increased number of service codes included in the HIPAA standards. Phase II builds on the rules created by the initiative during its Phase I efforts, completed in 2006.

CAQH, a nonprofit alliance of health plans and trade associations working to streamline healthcare administration, launched CORE with the goal of enabling provider access to patient administrative information before or at the time of service using the electronic system of their choice. CORE rules are built upon existing standards, such as HIPAA. They are developed through a collaboration between more than 100 healthcare industry stakeholders as partners in a multi-phase rules development process. Participating health plans cover more than 130 million lives or more than 75 percent of the commercially insured plus Medicare and state-based Medicaid beneficiaries.

Emdeon joins more than 40 organizations that have committed to becoming Phase II rules certified or endorsing the rules.

Business Objects and SAP Recognize Emdeon's Innovations

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Industry leaders admire Emdeon’s compelling business intelligence innovations
Business Objects, an SAP company and the world’s leader in Business Intelligence software, recently honored Emdeon with its competitive Business Intelligence Excellence Award for 2008, recognizing both Emdeon’s IT department and infrastructure as innovative through its use of successful business intelligence strategies in creating Emdeon Vision. This coveted award acknowledges Emdeon’s enhanced database infrastructure as well as its use of BusinessObjects XI, Business Objects’ intelligence platform, to increase productivity by significant proportions.

The Challenge
Emdeon, the leading processor of healthcare transactions in the United States, issues up to 800,000 text-based reports per day to healthcare providers and payers. According to Gene Boerger, Vice President of Advanced Business Reporting, “If a claim is sent electronically, we send text-based reports back to the healthcare providers to track the claims into Emdeon, out to the insurance company, and back to the provider. Our experience is that these reports are very difficult for the providers to handle.”

The Solution
“With Crystal Reports as a key component, we’ve developed an electronic solution that allows us to distribute information much more quickly and efficiently….providers can immediately view the status of any electronic claim in the process,” describes Boerger. According to Business Objects, customer feedback credits Emdeon’s innovative solution for the “successful transition from paper-based reporting to a more efficient and cost-effective Web-based delivery.”

Emdeon Customers Agree
MedePresence CEO Dave Dugan concurs: “Emdeon Vision will definitely drive down errors, while accelerating and automating support for us as your channel partner. Keep up the awesome work!” According to Boerger, “Our business is about making sure that electronic healthcare transactions are delivered quickly and accurately, and that the responses are returned in a timely manner to the customers who need them.”

Simplifying the Business of Healthcare
“Using BusinessObjects, we’re able to deliver the data multiple ways to multiple customers with multiple security models – quickly and effectively. This enables us to focus on the organization of the information itself, which is a much smarter use of our resources,” explains Boerger of this innovative solution. “Whether it’s medical claims, dental claims, electronic remittances, real-time insurance eligibility requests, or Health Insurance Portability and Accountability Act (HIPAA)-based transaction sets, Emdeon Vision makes life easier for payers and providers alike,” writes Business Objects.

To learn more about Emdeon’s Business Intelligence Excellence Award and how Emdeon can simplify your healthcare business, call us today at 877.EMDEON.6 (877.363.3666) or visit us online at www.emdeon.com.

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