SM: Suppose the government mandated that all insurance providers in America standardize on a payment system similar to yours. What would the total cost savings be?
BW: Our marketing department estimates that based on our 812,000 providers, if you take a combination of what we are saving today on both the provider and the payment sides, it is just over $800 million.
TM: That is just on the administrative side. If we can implement payment reform as well, close gaps in care, and engage physicians in provider behavior changes, that $800 million in savings would be dwarfed by savings in clinical costs as well as [improvement in] quality.
SM: Who else out there has technology solutions to address other pieces of the puzzle?
TM: I was at the Health 2.0 conference in San Francisco not long ago. There were a whole series of players that have focused on the consumer. They have figured out ways to leverage social networking with coaches to support patients in behavior change. The challenge to that is there is nobody for them to sell to.
SM: I completely agree. The healthcare IT problem needs to be solved at both the provider and care levels.
TM: My view is that payment reform is going to be necessary before the industry can get any legs. We have to create an infrastructure that enables payment reform and in which new players can come into the market and figure out the best practices. We need to look at how we create an infrastructure that can facilitate a marketplace for innovative players like the people at Health 2.0 so they can get integrated into a physician’s practice and have somebody to sell to.
We view NaviNet as the enabler to allow that to happen. I am actively engaged with the Clinical Groupware Collaborative and with the Disease Management Association, and I want to see if we can pull those pieces together and start to change the industry.
Payment reform and behavior change are very different animals. In my view, we are not paying enough attention to behavior change.
SM: Whose behavior needs to be changed primarily?
BW: The main behavior that needs to be changed is that of administrators in doctors’ offices who need to ask for payment at the point of service. If a person goes to Best Buy, the clerks at the store expect payment for the item before that person leaves. If a patient goes to the hospital and has a $1,000 deductible with a $50 co-pay, then he needs to pay that at the point of service.
SM: One of the missing links to do that right now is a real-time view for administrators so that they know exactly how much is owed to the doctors.
BW: Some of our partners have installed or are installing estimators. That will allow them to know how much is required at the point of payment. Doctors have to be enabled to take payment at the point of service. Large provider offices have the ability to take a credit or debit card. Others are starting put in capabilities to enable smaller doctors to do the same.
TM: The architectural approach that we have brought to market allows an individual payer to move forward with real-time adjudication at the rate at which they can do it. It provides them with the ability to collect additional information if they need to. It is not harder than the initial claims process. It is the only way they can make a decision right away. We don’t have to wait until everybody has real-time adjudication to have it in the industry.