Hill Physicians Medical Group: Establishing a Profitable Pathway for E-Commerce

Client Situation

One of the largest medical groups in the country, Hill Physicians serves 350,000 HMO enrollees in Northern California. Its delivery system includes nearly 2,500 physicians, 700 primary-care doctors and 1,800 specialists, and 20 hospitals. They have also teamed up with leading academic and tertiary medical centers in the region such as UCSF-Stanford Healthcare, Children's Hospital (Oakland), and UC Davis to provide members access to tertiary medical care when needed.

In one of the most competitive healthcare markets in the country, Hill Physicians has established outstanding leadership in both controlling costs and providing quality. The Pacific Business Group on Health (PBGH), representing California healthcare purchasers, recently awarded HPMG its Physician Blue Ribbon Award for Excellence. It was chosen as one of eight recipients out of more than 150 physician groups that were evaluated on the criteria that represent PBGH's four strategic initiatives: quality, cost, partnering, and data management.

To advance their leadership position, Hill Physicians desired to use information technology to further reduce cost and improve customer service, especially through the use of electronic data interchange (EDI) technology. In doing so, Hill Physicians would establish a pathway toward realizing the benefits of electronic commerce.

Services Provided by IT Optimizers

To address Hill Physicians need to identify and implement electronic solutions that would fit Hill Physicians rigorous financial and quality criteria, Hill Physicians engaged IT Optimizers. The IT Optimizers project team helped define, develop and implement an electronic commerce strategy for Hill Physicians that reflected its focus on controlling costs while providing superior services to physicians and members. This has included:

• Providing strategic guidance for optimizing the use of technology for administrative and clinical purposes, balancing the cost of new technology with financial and other benefits

• Developing, in tandem with Hill Physicians, a comprehensive "Future State" design vision, to harmonize business, physician, membership and technology goals

• Conducting a rigorous EDI/E-Commerce vendor selection and negotiation process, culminating in the selection of Healtheon as the vendor of choice

• Negotiating a contract with Healtheon, structured around mutual success parameters

• Developing a strong implementation team, creating detailed workplans, sharing technical knowledge and providing hands-on assistance in the technical implementation of EDI at Hill Physicians and its physician partner sites

• Re-engineering the existing claims processing function in support of revised, streamlined electronic processes

• Providing lead marketing and roll-out support of the EDI solution to Hill Physicians, through presentations, seminars and hands-on assistance.

"Working with Information Technology Optimizers has helped us achieve goals we would not have accomplished on our own."

—Craig Lanway, Chief Information Officer, Hill Physicians

Benefits

Electronic claims processing is alive, with electronic submission volumes growing daily at Hill Physicians.

• The project achieved its key milestones, including selecting the vendor, bringing up a number of physician practices on-line and, based on that success, conducting ongoing roll-out to physicians

• Physicians benefit from dramatically improved claims service and turnaround

• Hill Physicians benefits from improved service levels, enthusiasm of physician groups and improved data quality and data management capabilities

• Success with implementing electronic claims has brought about new confidence in the benefits of an electronic future, energizing Hill Physicians administrative staff and participating physicians to pursue a "full electronic environment within an IPA setting"

• Consistent with the "Future State" design, today's success has set the stage for other e-commerce services that will further enhance Hill Physicians low cost/ high service level leadership position. This supports Hill Physicians goal to provide members with the best, most advanced level of medical care without allowing expenses to increase dramatically.

"We had the opportunity to participate as a beta site and we found the support from the project team to be extraordinary. Some issues arose along the way regarding how claims might be simplified and processes streamlined. In every case, the issue was responded to quickly and resolved to our satisfaction. Even at this early stage of our use of the electronic claims system we are already seeing that turnaround time from filing to reimbursement has shortened substantially."

—Dr. Tom Long, Pediatrician, San Ramon Valley Primary Care, Chief, Pediatrics, Hill Physicians

Transforming the Business: The Life Cycle of Paper Versus Electronic Claims

After the EDI vendor had been selected, the work focused on setting up EDI, both at Hill Physicians and physician offices. This work has led to dramatic reductions in the time needed to process a claim, and improved data quality from claim submissions. As the chart shows, it takes about 2 weeks to process a paper claim. If there are problems with information on the claim, the cycle expands even more.

Transforming the paper to electronic format dramatically compresses the time and improves data quality, as shown in the accompanying chart. Data capture allows the identification of errors quickly, enabling Hill Physicians to communicate any errors to physicians within 24 hours.

The Future

With the success of its initial efforts in putting an electronic foundation in place, IT Optimizers continues to work with Hill Physicians to roll out the electronic claims solution to physician sites. IT Optimizers is advancing the vision by re-engineering Hill Physicians internal process' for the optimal electronic environment and implementing further "Future State" capabilities in Authorization, Eligibility Payment functions, thereby using the electronic network to improve clinical, quality and financial information flows.

For more information, please refer to www.hillphysicians.com.

 

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