adoption is progressing, but slowly
Over the last few years, health plans have made
progress in reducing their almost intractable reliance on paper-based
transactions. The use of EDI as a platform
for high-volume transactions is firmly in place, and more recently, web-based technologies
have helped health plans drive provider adoption of critical transactions such
as claim submission. Large firms, such
as WebMD, and solution vendors, such as HealthTrio, Navimedix, and athenahealth,
have become key players in this space - while HIPAA regulations have
standardized transactions. Still,
provider adoption is lagging. Heres why:
digital health plan has not yet arrived. Health plans continue to spend less on IT
than do companies in other service-oriented industries, such as financial
services. According to one estimate, the
healthcare industry spends only 2% of its gross revenues on IT, as compared to
the financial services industry, which spends as much as 10% on IT. (1) This
means that many health plans have been late to implement electronic
transactions and supporting technologies.
Just as importantly, many providers particularly those who are
associated with smaller practices do not yet have access to the technologies
(e.g. EDI, broadband internet
access) that would enable them to leverage these capabilities.
providers dont see the value - yet. The benefits
of electronic transactions from cost, efficiency, and accuracy perspectives
are demonstrable. Many providers,
however, still believe that the value proposition is not compelling. In other cases, providers dont have the
technical infrastructure to support electronic transactions, arent aware that
health plans offer these options, or are simply resistant to change. In too many cases, health plans havent developed
effective e-channel strategies to reach this untapped market of skeptical
· Channel infrastructure
and organizational issues within health plans are an obstacle. Support functions associated with e-channels are
often fragmented within health plans, leaving the onus on providers to figure
out how best to access support. For
example, EDI issues are typically directed to a health plans IT department,
paper claims might be mailed to a third-party clearinghouse or billing service,
and questions regarding web-based transactions might be directed to a
e-business group within IT. In many
cases, providers find that transactions (particularly claim and referral
submissions) are processed more reliably when sent on paper.
B. and C. Dold. "Clinical Information Systems: Achieving the Vision.
Sponsored by the Kaiser Permanente Institute for Health Policy, 2001.