MBlog

CarevilleTV: Community Healthcare Clinics Can Provide Fertile Soil for Healthcare Improvements

I sat in on a gracious invite to moderate IPayX's Healthcare Improvement Webinar (positioned at MBProject as part of our "Banking on Better Healthcare Series" - see here), which collected opinions from participants for the Obama Healthcare Initiative. On the call sat a patient accounting executive from a world renoun academic health center, a large healthcare IT services firm and the IPayX team. It was small but the content was rich (see this SlideShare).

Douglas Braun, who runs IPayX, was able to describe the Obama healthcare plan in three bold strokes; (1) improve infrastructure; (2) expand coverage to all Americans; (3) improve prevention and public health. While we didn't get to the all important cost factor, we were able to hear a series of interesting observations, some from the Vice Chancellor of Health Affairs at Vanderbilt University, Dr. Harry Jacobson. Dr. Jacobson addressed the 2009 Medical Banking Leadership Forum, where some 55 banking and healthcare leaders attended to discuss the future of medical banking in a "credit-broken" economy. Some of his analyses were presented in the slide deck, comparing healthcare costs in the US versus other areas of the world. Looking at our healthcare "problematique" within a global context is very helpful, I believe, in forming constructive frameworks that could point to solutions.

Interestingly during the Forum, MBProject also focused on three key areas: (1) improving healthcare infrastructure and using those savings to expand coverage to more Americans (the mission of MBProject is to 'convert digital savings into charitable resources'); (2) how to extrapolate and capitalize on business intelligence running through medical banking platforms; and (3) implementing a personalized healthcare platform for increasingly sophisticated medical consumers - one that could include comparing healthcare resources in a community, educating consumers on wellness and prevention (a key issue arising in employer circles that talk about optimizing human capital), using a card-based system for managing a personal healthcare record and providing tools to better manage HSAs - a "health-wealth portal" play.

As I sat on the call and heard the opinions, (supplying many of my own), I saw more clearly that our areas of focus in the medical banking community align well with the stated objectives of the Obama Administration. We have much to offer former Senator Tom Daschle's (D-SD) new team as they sift through ideas...and a healthy dose of respect for the challenge that lies ahead that will require all stakeholder hands on deck.

One of my moments of clarity came from Obama's call for investing in communities. This is an agenda item for which we not only made a call for support among our bank members, noting that banks may be defined as good corporate citizens with access to credit (the latter being challenged today but still holding true), but an Action Plan called "Charitable Communities Network" and later rebranded to "CarevilleTV". After making an investment in this concept, that brings together so many of the community anchors and technologies that can support "healthier communities", I challenged banks to follow our lead in 2003. We got some bites but not enough to crank up the model and see if it really works...yet!

An article published by the The New York Times reads, reporting from Nashville,..."Although the number of uninsured and the cost of coverage have ballooned under his watch, President Bush leaves office with a health care legacy in bricks and mortar: he has doubled federal financing for community health centers, enabling the creation or expansion of 1,297 clinics in medically underserved areas." The IPayX webinar, this article, and our focus at MBProject lead me to a startling conclusion - that the community healthcare clinic setting should become an area of focus for the Obama Administration.

In the safety net setting we can test and deploy new technologies without the typical "game politic". We can get much done that is instructive to the greater healthcare establishment. I strongly believe that we must not race towards a digital economy in healthcare while leaving the safety net behind - nor should we! These "beacons of light" - community clinics dotting the American landscape - can serve a dual purpose to both help the underserved/unbanked as well as offering a critical testing and staging ground for the next generation of technology tools. Of course not all tools can evolve from this setting but my instincts tell me that many, many innovations can benefit from deployment in a real world, community clinic healthcare setting. My thoughts to Obama? Target this area with investment and a way to measure progress along the three critical fronts - cost, access and quality of care.

I have to admit, as I reasoned through these ideas during the IPayX call, and after having talked about CarevilleTV to my entrepenuerially-minded brother-in-law (and former pastor) over the holidays, the notion of moving forward on the Action Plan/Business Plan (yes, it is a self-sustaining business model) ignited once again. Along with other personal reasons involving the passing of my dear sister (see My Tribute here), I'd like to re-energize our "New Media Initiative" at MBProject. The idea was ahead of its time but that is no longer an excuse. We must push medical banking into the mainstream of our everyday community-oriented lives. CarevilleTV offers a plan to do just that. For more information on CarevilleTV (rebranded from CCN), see this.

John Casillas
johnc at mbproject.org
Chair, Medical Banking Institute
Executive Director, Medical Banking Project
401 Pond View Court | Franklin, TN | 37064
Phone: 615.794.2009 Ext. 114 | Fax: 615-468-7606
http://www.mbproject.org

Medical Banking Networking Group Launched on LinkedIn.com

Posted by ED

Medical Banking LinkedIn Group image

For those interested in using social networks to promote the latent integration of banking technology, infrastructure and credit with healthcare administrative and clinical operations, I have created a Medical Banking Networking Group on LinkedIn.com. The invite link is available here.

AHIP Board Backs Hill Reforms Plus 7

HealthWire reported today that AHIP is supporting the concept of a Federal Health Board among other policy goals.

The board of America’s Health Insurance Plans (AHIP) at a press conference in Washington today proposed 7 significant new health reform innovations as part of a package of ideas presented as a first-cut ‘comprehensive’ reform plan. While details were sketchy, a close reading of the new AHIP language shows it also endorses 13 out of 16 features of pending major Capitol Hill proposals.

The seven new health reform proposals from AHIP added to the mix include:

· Congress will set a specific target for reducing national health spending over a 5-year period (from a 6.6% to 4.7% increase)

· A new independent federal board (akin to the Federal Reserve) will develop a specific action plan for reducing health costs in the U.S.

· A national multi-payer online portal will give all providers a uniform method to communicate with all health plans on eligibility and benefits

· All payers will voluntarily adopt uniform national standards for quality, reporting and information technology versus today’s ‘piecemeal’ basis

· Small employers will under federal law be offered an “essential benefits plan” available nationwide and exempt from state mandates

· Emergency rooms will be replaced as a poor source of routine primary care for the uninsured by a planned and organized national system

· Low-income patients will get bankruptcy protection from medical claims under a system of tax credits tied to percentage of income spent

Medical Banking Offers Vision In Uncertain Financial Markets

By John Casillas, Founding Director, Medical Banking Project

In early October, sixty market leaders that are invested in the medical banking space met at a Leadership Forum in Nashville organized by the Medical Banking Project. Talk of the financial crisis quickly made its way into the dialogue with perhaps a unique wrinkle; namely, how will it impact Medical Banking?

Its important that leaders dialogue this issue to arrive at an understanding of market direction. The Leadership Forum provides the opportunity for members of MBProject to come together and discuss the current build-out of medical banking programs, isolating best practices and areas that require cooperation to move things along, like standards. Prior to beginning the session, a survey was handed out to capture opinions on the impact of the financial crisis on plans to implement medical banking programs.

Almost 80% of the delegates said that the financial crisis will not affect investment in medical banking programs over the next 12-18 months. The dollars earmarked for this activity have been budgeted and will more likely than not be placed into the segment. At that point, attendees breathed a collectively sigh of relief. We were all on the same page. Its still “game on” for medical banking.

I prepared a talk the night prior to challenge the leadership to stay focused. Taking a queue from Jack Welsh, former CEO of General Electric, I challenged leaders to not only create and articulate a vision, but to passionately own it, and to relentlessly drive it to completion. After the dust settles in the markets we still need to fix our healthcare system and in the basket of tools within our grasp to do that, medical banking offers a viable strategy to improve healthcare.

The remarks were received well. After an insightful review of the criticality of moving towards a real time system, comparing costs to other nations, by Dr. Harry Jacobsen, Co-Chancellor of Vanderbilt University and overseer of Vanderbilt Medical Center’s $2.5 billion budget, two panels followed discuss the current state of real time platforms and business intelligence in healthcare. This was followed by a talk by McCain advisor Dr. Steve Parente regarding his soon to be published paper entitled: The Next Step For Convergence of Healthcare and Financial Systems: The Potential of Medical Banking.

On day 2 of the Forum, the leadership broke up into work teams and methodically plodded out, through discrete action items, what the agenda will be for the medical banking industry in 2009.

Amidst a very serious crisis affecting financial markets, it should be clear that investment banking, and the bank on main street, are two very different structures. The paranoia has seeped through investment banking to affect main street banks, which are perfectly functional, as well as other industry segments. But the financial stability plan is largely a plan for investment banks, not commercial bankers. A new public relations program organized by the American Bankers Association is trying to get that point across to the American public.

Along these lines, I was asked to draft a column for the September issue of HFM to clearly outline the meltdown in financial markets and its impact on medical banking. In it I argue that although there a systems within healthcare and banking that are broken, there is still regularity and trust in both. We don’t tear down a house after a tornado has passed through if only the roof needs fixing. We still trust the foundation; we live in the house after its fixed. The two industries aren’t 100% broken and some leaders argue they need each other now more than ever before to pull through the crisis (see Martys blog).

In healthcare most of us trust that if something goes wrong we can get to the emergency room and receive care when we need it (although paying for it is another story). In banking, we routinely trust our funds transfer systems, ATM and branch networks, online banking and other areas. They operate 24 by 7 and will do so for a long, long time.

Let’s not throw the baby out with the bath water. Banking is a core requirement in our economy and the areas that are under attack today, although affecting the broader economy, didn’t start and won’t end by casting blame on commercial banks.

Leaders must drive medical banking to completion. In this we will realize the promise of EDI in healthcare. Another way of saying the same thing is we need medical banking to “convert digital savings into charitable resources”, our mission at MBProject, and those savings are needed in communities across America and around the globe. The potential for creative innovation using medical banking is very real. It can improve the quality of lives everywhere.

This has been a premise in medical banking since its inception and its more true today than when it was first conceived by the Medical Banking Project in 2001. Today, more voices are pointing towards the potential of medical banking to hasten needed and long lasting innovations in healthcare.

When the dust settles in banking, the worrisome troubles in healthcare will once again take center stage and as leaders, we must drive the medical banking programs we have articulated to completion. By doing so, we will show true leadership, be responsive to product innovations that can be profitable and productive for all the stakeholders and address critical issues that must be fixed in our healthcare system.

Can Bankers Save Doctors? (Can Doctors Save Bankers?) Part I and Part II

Martin Jensen, of the Healthcare IT Transition Group, www.HITtransition.com, delves into medical banking here and here.

Ignacio Valdes Editorializes on HIMSS response to HR 6898

Ignacio Valdes is the editor of Linux Med News and has been a proponent of open source in health care. He recently posted this notice of his editorial to the Open Source Working Group of the American Medical Informatics Association. It (and associate posts at LMN) may or may not be of interest:

"Health Information and Management Systems Society HIMSS has presented their response http://linuxmednews.com/PDFs/Final_HIMSS_Response_to_HR_6898.pdf to H.R. 6898 which favors open source software and Veterans Affairs VistA: '...The private sector makes significant investments in research and development for healthcare IT products. Healthcare IT is available via a competitive market in which vendors compete on the basis of price, quality, and functionality of a product. The development, routine updating, and provision of an open source "healthcare information system" is not the role of the federal government and such product development should remain in the private sector...'

I have penned a saucy little editorial response here: http://linuxmednews.com/1222727586/index_html

-- IV

A Medical Banking Addendum to the Financial Stability Plan Pending Before Congress

Creating lasting value for taxpayers by linking the 700 billion bail out plan to healthcare benefits

A pivotal feature of the current "bail out" plan is the perception of limited value for the American taxpayer. Clearly in the plan, taxpayer funds are at risk, however, the President, US Treasury and Federal Reserve all believe that a partial to full return of the 700 billion is possible.

Presumably the payback funds (original principal and profits) will go into a general account. We believe this creates the feeling of paying for the broken heater at home - it needs fixing but it sure doesnt feel good when the money leaves our hands.

For this reason, I suggest linking the bail out plan to a healthcare benefit for the uninsured. This could help to solve the perception issue of value.

In this model, a means test could be efficiently applied to qualifying individuals. This "community care platform" could be supervised by a commission appointed by Congress to oversee the appropriate transfer of "bail out" principal and profits to community healthcare benefits.

I further recommend that a percentage of the profits be used to fund President Bush's previous call that every American have a personal healthcare record in 10 years. This could have a lasting impact on the quality of care for every taxpayer after the profits have dried up.

Linking the financial stability plan with a healthcare benefit is a message that could resonate well with the American taxpayer. Changing the perception of value by showing a concrete return may turn this intensely negative issue into a positive.

John Casillas
johnc at mbproject.org
Founding Director
Medical Banking Project
www.mbproject.org
(615) 794-2009

The Rise of the Bank Infomediary in Health Care

John Casillas, www.hfma.org

Privacy and security regulations and the rise of consumer-driven health care are changing the role of banks in health care.

At a Glance

Banks are evolving in four key areas that collectively comprise the rise of a “bank infomediary”:

Efficient administrative processing
Medical Internet
Health information broker
Community care platform

Medical Banking Goes Green

Institute shows how banks and healthcare are teaming to move paper out of the system and create compelling opportunities for "on-demand" health data services

Contact: Evelyn Marquez Sanchez
615-794-2009
info@mbproject.org

Franklin, TN (August 13, 2008) The Medical Banking Project's Seventh National Medical Banking Institute highlights the benefits of "Building An Electronic Medical Banking Community," the theme of the event. The 3-day Institute will be held in Nashville, TN, March 11-13, 2009 and will feature Keynote speeches from the Chair of the Healthcare Financial Management Association, the Executive Director of the Automotive Industry Action Group and other VIPs.

“We’re energized about our mission to convert digital savings into charitable resources by linking banking and healthcare systems,” said John Casillas, MBProject founder and chair of the Institute. “It rids the system of a lot of paper and that’s a ‘green message’ that we haven’t stressed enough. Translated into everyday language, medical banking systems can save 2 million trees and avoid using 103 million gallons of gas every year. It's good for the environment.”

“Banks want to move paper out of the financial system and so the medical banking movement really fits this initiative,” said Maureen Turo, president of the Medical Banking Institute and Vice President of Healthcare Strategy at The Bank of New York Mellon. “As we look at industries where we can re-engineer our systems to make an impact, healthcare is a primary target.”

“Finding smart ways to effectively link and digitize cross-industry workflow is essential,” said June St. John, Chair of Education and Programming for the Medical Banking Institute and SVP, Healthcare Product Manager at Wachovia Treasury Services. “We organized this institute to highlight opportunities for banks to help electronify the paper chase in healthcare. The Institute's educational programming is timely and addresses a critical need in healthcare today - creating the potential for quantum leaps in efficiency for all the stakeholders – payors, providers, employers, banks and consumers.”

Some of the key features of the Institute include:

BancTec Networking Reception & Gala provides a venue for high value interactions and networking for our guests.

Payor, provider, bank and large employer panels will connect the dots and explain how new medical banking systems can benefit their operations.
The Joint Taskgroup for Value In Health, a collaborative of MBProject and the Automotive Industry Action Group (AIAG), convened executives from the financial services, healthcare, automotive industry and State Government to create a "Medical Banking Tool Kit for Employers" that will be highlighted at the session.
The 2009 International Journal of Medical Banking will feature prominent thought leadership and will be distributed at the event.
More to be announced soon…

Educational Grantor: BancTec

BancTec helps clients around the world simplify the process of managing their information. Specifically related to healthcare, BancTec’s RemitCycle 360 information platform exchange provides a HIPAA-compliant payment system that processes Electronic Remittances (835 transactions) and facilitates processing explanation of benefits (EOBs) and money transactions from health insurers to healthcare providers electronically. Implementing the RemitCycle 360 system improves collections, materially reduces administrative expense and dramatically improves bill to post. To learn more, please visit www.BancTec.com

Make plans to attend ASAP! Registration is available at: www.mbproject.org/7mbi2009_registration.php

Sponsorship opportunities are available at: www.mbproject.org/7mbi2009_sponsorship.php

White Papers are still being accepted for publication in the 2009 International Journal of Medical Banking. Please see the manuscript guidelines at: www.mbproject.org/7mbi2009_whitepapers.php.

About the Medical Banking Project...

MBProject is a pioneering authority that coined the term “medical banking” to denote the emerging global convergence of banking and healthcare systems to improve health costs, quality and access. Our educational forums, workgroups and pilot programs showcase visionary ideas and initiatives that inform policy, commerce and academia. Supported by a diverse constituency, MBProject conducts research and outreach that defines and facilitates medical banking, and this supports our mission to convert digital savings into charitable resources. Our work demonstrates how banks can improve healthcare programs for consumers, care givers, health plans and employers. For more information please go to: www.mbproject.org.

Open standard gains new ground in financial reporting

May 14, 2008, By Grant Gross, IDG News Service\Washington Bureau, IDG, NYTimes.com

The U.S. Securities and Exchange Commission has taken a major step toward requiring publicly traded companies to submit their reports to the agency in an interactive data format, with backers saying the change will make financial reports easier to analyze.

All three SEC members voted to publish a proposal that would require public companies to file reports in eXtensible Business Reporting Language, or XBRL, a programming language related to XML that's being developed by a nonprofit consortium of about 450 companies. Under the proposal, which still needs final approval from the SEC after a public comment period, the transition from text and HTML reports to XBRL would take three years, with about 500 of the largest U.S. and foreign companies required to start filing XBRL reports after Dec. 15.

The International Journal of Medical Banking White Paper Submission Requirements

Requirements:

1. The paper must be related to issues that directly affect the medical banking industry

2. The paper must not be a self-promoting or advertising piece

3. Preference is given to original pieces of research

4. The text should be double-spaced and include an abstract, list of milestones and/or deliverables if applicable and the significance of the work.

5. Submissions must be in electronic format (MS Word) and submitted to info@mbproject.org.

6. When submitting a white paper please include: company name, author(s) and contact information including email addresses. We are seeking white papers in the following areas:

Information privacy, confidentiality and security that focuses on cross-industry issues in banking and healthcare
Identity management technology that applies to medical banking programs
Community coalition building, community programs & awareness that can be applied to medical banking constituencies
Treasury and cash management programs targeting healthcare
Card-based platforms and technologies that link healthcare and banking systems
New credit programs for healthcare, both consumer and commercial
Consumer-driven healthcare technology tools and platforms
Open source healthcare programs linking banking and healthcare systems
Electronic and Personal Healthcare Records programs linked to banking systems
Bank-assisted RHIO programs
Independent Health Record Banks/Trusts
Banking opportunities in medical tourism
Man-made and/or disaster preparedness involving medical banking systems
Community care platforms linking consumers with healthcare programs in the local area using automated eligibility and funds transfer platforms

The 2nd edition of the Journal will be distributed to attendees of the 7th National Medical Banking Institute tentatively scheduled to occur in New Orleans, LA in April 2009. If you have any questions please feel free to contact MBProject offices by email using: journal@mbproject.org.

FRONTLINE Travels To Five Countries In Search Of a Universal Health Care System That Could Work In The U.S.

Posted by John Casillas (from the PR)

FRONTLINE teams up with T.R. Reid, a veteran foreign correspondent for The Washington Post, to find out how five other capitalist democracies--United Kingdom, Japan, Germany, Taiwan and Switzerland--deliver health care and what the United States might learn from their successes and their failures. In Sick Around the World, airing Tuesday, April 15, 2008, at 9 P.M. ET on PBS (check local listings), Reid turns up remarkable differences in how these countries handle health care--from Japan, where a night in a hospital can cost as little as $10, to Switzerland, where the president of the country tells Reid it would be a "huge scandal" if someone were to go bankrupt from medical bills.

Reid's first stop is the U.K.--a system very different from ours, where the government-run National Health Service is funded through taxes. According to Whittington Hospital CEO David Sloman, "Every single person who's born in the U.K. will use the NHS ... and none of them will be presented a bill at any point during that time." Reid is surprised to find the system often dismissed as "socialized medicine." The U.K. is now trying free-market tactics like "pay-for-performance," where some doctors are paid more if they get good results controlling chronic diseases like diabetes, and patient choice, in which hospitals compete head to head. While such initiatives have helped reduce waiting times for elective surgeries, the London Times' medical correspondent Nigel Hawkes tells Reid the NHS hasn't made enough progress. "We're now in a world in which people are much more demanding, and I think that the NHS is not very effective at delivering in that modern, market-orientated world."

Reid reports next from Japan, the world's second largest economy and the country boasting the best health statistics. The Japanese go to the doctor three times as often as Americans, have more than twice as many MRIs, use more drugs, and spend more days in the hospital, yet Japan spends about half as much per capita as the United States. Reid finds out the secrets of the nation's success: By law, everyone must buy health insurance--either through an employer or a community plan--and unlike in the U.S., insurers cannot turn down a patient for a pre-existing illness, nor are they allowed to make a profit.

Reid's journey then takes him to Germany, the country that invented the concept of a national health care system. For it's 80 million people, Germany offers universal health care, including medical, dental, mental health, homeopathy and spa treatment. Professor Karl Lauterbach, M.D., a member of the German parliament, describes it as "a system where the rich pay for the poor and where the ill are covered by the healthy. It is ... highly accepted by the population." As they do in Japan, medical providers must charge standard prices which are negotiated with the government every year. As a consequence, physicians in Germany earn between half and two-thirds as much as their U.S. counterparts.

Taiwan researched many health care systems before settling on one where the government runs the financing, but Reid finds the delivery of health care is left to the market. Taiwanese health care offers medical, dental, mental and Chinese medicine, with no waiting time and for less that half of what we pay in the United States. Every person in Taiwan has a "smart card" containing all of his or her relevant health information, and bills are paid automatically. But what Reid finds is that the Taiwanese spend too little to sustain their health care system. According to Princeton's Tsung-Mei Cheng, who advised the Taiwanese government, "As we speak, the government is borrowing from banks to pay what there isn't enough to pay the providers."

Reid's final destination is Switzerland, a country whose health care system suffered from some America's problems until, in 1994, the country attempted a major reform. Despite a huge private insurance business, a law called LAMal was passed, which set up a universal health care system that, among other things, restricted insurance companies from making a profit on basic medical care. Today, Swiss politicians from the political right and left enthusiastically support universal health care. Pascal Couchepin, the president of the Swiss Federation, argues: "Everybody has a right to health care. ... It is a profound need for people to be sure that if they are struck by destiny ... they can have a good health system."

Sick Around the World is a FRONTLINE co-production with Palfreman Film Group. The film's correspondent is T.R. Reid. The writers are Jon Palfreman and T.R. Reid. The producer and director is Jon Palfreman. FRONTLINE is produced by WGBH Boston and is broadcast nationwide on PBS. Funding for FRONTLINE is provided through the support of PBS viewers. Major funding for FRONTLINE is provided by The John D. and Catherine T. MacArthur Foundation. Additional series funding is provided by the Park Foundation. Additional funding for Sick Around the World is provided by The Colorado Health Foundation, The Commonwealth Fund and The Colorado Trust. FRONTLINE is closed-captioned for deaf and hard-of-hearing viewers and described for people who are blind or visually impaired by the Media Access Group at WGBH. FRONTLINE is a registered trademark of WGBH Educational Foundation. The senior producer is Raney Aronson. The executive producer of FRONTLINE is David Fanning.

A New Medical Banking Ecosystem

Franklin, TN (April 3, 2008) Delegates conclude a 3 day meeting today with senior officials in banking and healthcare at the 6th National Medical Banking Institute. Calling attention to natural and man-made disasters, like the subprime mortgage crisis, MBProject’s founder John Casillas asked attendees “yet today, aren’t we faced with an even more compelling man-made disaster as we experience a ground swell in the rising costs of healthcare?” He challenged attendees to rally behind medical banking as a national strategy to mitigate a “financial tsunami” that is leaving more families destitute and undercutting national productivity. He asked leaders to build a “new medical banking ecosystem” to address an impending crisis in healthcare.

Other keynotes included an industry summary by Booz Allen Hamilton, a review of data privacy issues by the Joint Commission, (which issued a new report on quality measurement and data reporting), a review of ONC efforts to build a national healthcare information network by Jodi Daniel, senior advisor at ONC, and an industry panel entitled: Are Medical Banking Systems Ready for Prime Time?”. Today’s talks will feature an industry panel (Converting “Cybercondriacs” to HIT Wizards”) moderated by David Harris, a partner at PricewaterhouseCoopers who chairs the HSA Workgroup at MBProject. The panel features Microsoft HealthVault program, a personal healthcare record service, Best Doctors and OptumHealthBank. Dr. Paul Grundy from IBM, who chairs the Patient Centered Primary Care Collaborative, will introduce bank delegates to the new Medical Home concept and seek their participation to change the healthcare payment systems.

A series of new industry announcements by MBProject Members were announced during the day, including:

Fifth Third Bank announced a new partnership with GHN-Online and Revenue Management Solutions (RMS) to launch a new business intelligence platform for the healthcare industry.
GHN-Online released a new healthcare reimbursement scorecard that measures “the average number of payment days for a clean claim from payors, extracted from the payors remittance advice reports.” The firm further announced a new relationship with Revenue Managements Solutions (RMS) to provide a “comprehensive claims processing and remittance solution for healthcare banking.”
E-Duction announced that it has now processed over 1,000,000 “variable payroll deductions” using a “guaranteed issue credit, zero percent interest and automatic payment via payroll deductions that traditional credit cards don’t offer”. In a separate announcement, the firm announced that an independent market research firm rated users of the program and found that 81% are “highly satisfied”.
The Bank of New York Mellon and The SSI Group, Inc., announced a new healthcare services alliance that will “enhance a range of end-to-end claims processing solutions” for healthcare clients. This includes “new lockbox services for patient and commercial insurance payments, conversion of paper transactions to electronic remittance advices (ERAs), establishment of ERAs and reassociation of ERAs with electronic payments, providing the industry an all-payer solution.”
The Bancorp Bank announced that it is “aggressively pursuing a variety of strategies” in healthcare through 120 established relationships with a variety of clients nationwide; and listed its bank as one of the “Top 50” Origination Depository Financial Institutions (ODFIs) and one of the “Top 5” HSA Administrators in the nation.
PNC announced that it is the first bank in the nation to receive EHNAC accreditation for its health care clearinghouse, lockbox and e-commerce operations. PNC was noted for its “extremely robust systems, policies and procedures” and a data center and disaster recovery documentation that was cited as “the best ever seen” by the independent site consultant.
TransUnion announced a new patent for its Healthcare Revenue Cycle Platform (HRCP), “an ASP-based technology platform that determines, in real time, patient eligibility for financial assistance at point of registration.” Among other functions, the platform “pursues multiple financial assistance opportunities concurrently, providing significant labor savings to hospitals; reducing staff time spent gathering data and filing forms.”

A main focus of the Institute was on emerging privacy and security frameworks. MBProject announced a new medical banking “Gold Seal” standard “that instills public trust” among medical banking constituencies, “a key cornerstone for a new medical banking ecosystem”. A pilot program conducted by the Working Capital Solutions division of the Bank of New York Mellon and Milliman was previously announced. An afternoon session reported out industry results to attendees.

The complete press releases will be posted on the Institute Agenda at www.mbproject.org by April 11, 2008.

About the Medical Banking Project...
MBProject is a pioneering authority that coined the term “medical banking™” to denote the emerging global convergence of banking and healthcare systems to improve health costs, quality and access. Our educational forums, workgroups and pilot programs showcase visionary ideas and initiatives that inform policy, commerce and academia. Supported by a diverse constituency, MBProject conducts research and outreach that defines and facilitates medical banking™, and this supports our mission to convert digital savings into charitable resources. Our work demonstrates how banks can improve healthcare programs for consumers, care givers, health plans and employers. For more information please go to http://www.mbproject.org or contact Evelyn Marquez Sanchez, 615-794-2009,
info@mbproject.org

Overview of Players and Their Roles in the Emerging Medical Banking Industry

Note: I'm not able to attend the MBI this year but I'm going to blog from notes on the hope that this will still be of value to the MBlog readership. - ED

Presenter: Doug Bilbrey, EVP, The SSI GROUP, Inc., Mobile, AL, 800-880-3032, doug.bilbrey@ssigroup.com

During the Medical Banking Boot Camp, Doug's presentation discussed the Players in the Medical Banking field: Providers (Institutional, Professional, Ambulatory Care Centers), Payers (Commercial, Governmental, Fiscal Agents), Vendors (HIS, PMS, RIS/PACS; EDI; Analytical / Revenue Recovery; Document Management {OCR/ICR}; Decision Support {Financial, Clinical}; Clinical Systems; Adjudication Systems), Trade Associations (HIMSS, HBMA, RBMA, MGMA, HFMA, RSNA, ECT...; Cooperative Exchange ), Collections Companies (NCO, Chamberlain Edmonds, Regional / Local ), Consultants, Banks (Consumer, Commercial), Employers, Politicians, Government, Consumers

Discussing the The Bad and The Ugly of Healthcare Fiscal Management, Doug noted:

$300 billion of collected funds goes to processing bills, claims and payments; bad debt; and other transactions each year.
60% of claims paid are paper, average cost of $8 each
Approximately 1 in 5 claims submitted is delayed or denied
- 96% must be submitted more than once!
Bad debt expense ranges between $40 to $60 billion
- 80-90% of consumer self-payments goes uncollected
- on average, 50% of commercial payments

Further, he pointed out that 14 percent of all claims submitted to payers are denied and that this is important when one considers that denials represent 11 percent of a provider’s gross charges.

On "Why Do Claims Get Denied?" he reported:

Coordination of benefits	25%
Patient not eligible	15%
No authorization	5%
Medical Record requested	11%
Untimely filing	11%
Additional info pending	9%
Non-covered Service	7%
Benefits expired	6%
Billing Errors	1%
Contract Review	.03%

Regarding the Cost of Collections, he listed these factors: Patient Balances, Statement Generation/Processing, A/R Aging, Small Balance Write-offs, and Unbilled or Missed Charges

Among Industry Pressures on Providers, he cited: Reimbursement from Payers (CMS, Commercial), Higher Deductibles, Philosophical/Cultural (“We’re here to take care of sick people”), Requirements Complexities (Coding, Billing, Collections and follow-up), Human Resources (Finding them, Keeping them, Incentives ), Legal (Liability), Outpatient Centers (Highly compensated services, Hospitals left holding the bag), Infrastructure (Physical Plant, Technology), and Community Perception

Industry Pressures on Payers faced include: Operational Costs (FTE’s, Payments), Inefficient Processing Mechanisms (Telephonic, Paper), Membership Satisfaction, Community Demands (On-line access, PHR, Provider Tools, and Integrated Delivery Systems)

Industry Pressures on Employers relate to: Costs (Company, Employee, Dependants), Employee Retention, Employee Recruitment, and Enrollment

While Industry Pressures on Consumers comes from all of the above as well as Access to Healthcare, Affordability, and Bombardment of R/X Ads (Do I have this? Should I take this? What are the consequences?)

Meanwhile Political Pressures will focus on Election 2008 (The Economy, Cost of Living {Fuel Costs, Inflation}), Access to Healthcare (Real or Perceived); Fallout (What new pressures will be levied on system? {Fixed Prices?, Additional/Stricter Requirements?}, Who Pays for This?)

Solutions need to recognize Patient Access/The Genesis of The Claim and the Potential Impact

Patient Access is Key since 45 – 55 Percent of all billing errors originate in Patient Access, Patient Access has one of the highest levels of turnover within a provider organization due in part to the Tremendous Pressure placed of Patient Access Staff (Consent Forms, Benefit Verification, Copay and Deductible Collection, Advanced Beneficiary Notice, Advanced Directive and "Do all this in 10 minutes or less") Improved Processes can affect outcome for Patients, Providers, Payers and the Entire System

How Might Banks Help?

Trusted Delivery Mechanisms (PHR, Financial Transactions, Infrastructure); Connections between Payers, Providers, and other Banks; LockBox (Remits, Claims ???, Eligibility Rosters ???) Banks Are Uniquely Positioned (Patient Access {Credit Card Processing, Upfront Collections of Co-Pay and Deductibles}, Claim Processing {Value Added Services [Clearinghouses, Claim Warehousing, Data Archival]}; Remittances (ERAs, Lock Box {Paper to ERA}, All Payer Capabilities), and Providers Need and Will Use These Services

Interview with Maureen Turo, VP, Healthcare Market Specialist, Bank of New York Mellon

Posted by John Casillas

The Medical Banking Project convened a multi-stakeholder group among its membership to develop health data privacy and security criteria that is uniquely focused on the regulatory requirements and market expectations in the medical banking segment. After 15 months of regulatory review, industry outreach and feedback, the Accreditation Review Council (ARC) at MBProject formalized a new "Gold Seal Standard" for medical banking constituencies. The program, which will be placed into production in the May-June timeframe, was announced recently.

We caught up with Maureen Turo, VP, Healthcare Market Specialist, Bank of New York Mellon Treasury Services Division in Pittsburgh, PA to discuss the new Gold Seal program. BNY Mellon was involved in the first pilot program, administered by Milliman, to vet out the issues related to application of the Gold Seal.

Tell us about what you do at The Bank of New York Mellon...

The Bank of New York Mellon Corporation is a global financial services company focused on helping clients manage and service their financial assets. We operate in 34 countries and serve more than 100 markets.

Within The Bank of New York Mellon’s Treasury Services group, I am part of a team dedicated to providing solutions to the healthcare sector. We offer a full suite of services that help healthcare providers better manage their working capital – the technical expression we use is, “address inefficiencies in the revenue cycle.” Some specific examples of what we do include: helping healthcare providers electronically post claim payments to reduce accounts receivable days outstanding; collect and reconcile patient payments at the point of service; identify and analyze denial data; simplify the patient refund process; streamline short-term investing of working capital, and much more.

Why did you get involved in the MBProject Gold Seal standard program?

Healthcare is obviously in need of significant attention. Improvements are going to take collaboration among banks, vendors, payers, and providers. The MB Project provides thought leadership on many different fronts for medical banking with privacy and security accreditation being one of them.

Based on our experience in providing healthcare treasury services and our rigorous attention to regulations and rules, we knew we could provide valuable feedback from the perspective of a financial institution. This multi-disciplined/stakeholder involvement allows MB Project ideas to be improved upon and vetted with numerous industry participants. We were also interested in seeing a cost-effective, valuable accreditation program developed that would meet the needs of banks involved in the program while taking into account the regulatory oversight already governing the financial industry.

Tell us a little about the pilot program. We understand that as many as 23 subject matter experts were interviewed?

Overall, the pilot ran very smoothly! Numerous subject matter experts had to be identified and engaged in the pilot because privacy and information security touch such a wide range of areas in the bank. We found by taking the time upfront to identify the right subject matter experts, we were able to quickly go through the online program modules and answer the questions related to our use of the various identified best practices. At the end of the pilot, we were also able to suggest improvements to the methodology and some of the questions used in the Gold Seal accreditation program.

As the first anticipated recipient of the Gold Seal standard, what are your intended benefits from the program? Do you think these will be achieved?

From the project’s perspective, we think the main benefits of a program like this are threefold:

It provides a cost-effective, independent assessment of a recipient’s compliance in processing healthcare data (under HIPAA) and their adherence to related operational privacy and security standards using a common set of best practices criteria.
It can complement or supplement a recipient’s existing internal evaluations, as well as other external evaluations such as a SAS70 Type II audit.
It conveys to healthcare providers that recipients understand the privacy risk associated with handling health information and attests to their use of best practices to protect that data.

At The Bank of New York Mellon, we certainly think we can derive all three benefits from this Gold Seal program. In fact, we see having a third party like the Medical Banking Project offering and promoting this program as being key to our realizing the benefits we expect to derive from accreditation. I don’t think there’s any question about healthcare providers and their patients continuing to demand protection for health-related information. By providing appropriate levels of accreditation, the project is taking an important step forward to provide assurance to healthcare stakeholders that financial institutions take their responsibilities seriously.

Gold Seal Standard Highlights Public Trust In Medical Banking Domain

A 15 month effort and recent pilot program culminate in the industry’s first health data privacy and security accreditation for medical banking constituencies

Franklin, TN (March 13, 2008) Just weeks before the Sixth National Medical Banking Institute to be held April 1-3, 2008 in Marietta, GA, the Medical Banking Project (MBProject), an authoritative pioneer in the formation of the medical banking industry, announced the creation of the first "Gold Seal Standard" for health data privacy and security for medical banking constituencies. The first version was created after a 15-month multi-stakeholder effort by MBProject members, and highlights the research firm's ongoing efforts to assure the highest standards of quality for emerging medical banking programs.

"We urged leaders to adopt a program that instills public trust in medical banking programs in 2001," said MBProject founder John Casillas. The Institute has strong roots in the national movement to implement HIPAA compliance among medical banking constituents. The first two Institutes held in 2002 and 2003 were 100% focused on privacy and security of health data, policy issues and operating areas where the two industries converge. In recent weeks federal and commercial groups have announced the creation of privacy frameworks that will be explored at the Institute. "We have increasing support from employers, banks, financial services firms, healthcare and IT firms and others, marking that it's time to implement this critical program," said Casillas.

Industry surveys suggest that banks are global leaders in the area of public trust. "Banks have considerable and ongoing investments in technology, processes and controls to ensure the bad guys don't get our money," said Casillas. "The Gold Seal program recognizes that medical banking is a new industry, and that the convergence of systems calls for a supplemental review to assure that the uncompromising standards and controls used by banks to secure our money will be used to thwart those who want to inappropriately access our health data." The program adds criteria outlined in HIPAA to existing banking regulations and controls, and is designed to adapt to additional federal, state and commercial privacy frameworks as they evolve.

MBProject called on its members to form a new "Accreditation Review Council" at the 2007 Institute, leading to a 15-month R&D effort isolating banking and healthcare regulations and related accreditation programs. The Council reached out to government and industry groups as it formed its framework. By January 2008, both the criteria and an accreditation methodology were adopted by the Council and readied for a pilot program.

The two-day pilot was conducted by John Phelan, PhD, an expert at Milliman, Inc., a global consulting and actuarial firm that works with a range of organizations on HIPAA compliance, and BNY Mellon Working Capital Solutions, a division of The Bank of New York Mellon. To meet the pilot criteria, BNY Mellon's healthcare team gathered 23 internal subject matter experts who would be impacted by the program. A post-pilot survey of the experts was conducted to assess the effectiveness of the new program. BNY Mellon and Milliman will present the results at the April Institute.

"The pilot was a successful and critical step in an accreditation program that demonstrates the financial service industry's commitment to assuring the highest security and confidentiality of personal health information," Phelan said.

"The work of the Council is a key foundation for building a medical banking ecosystem that will improve healthcare in America and around the world. We're excited about their work and eager to support the Gold Seal among our constituencies," said Casillas.

To learn more about the Institute or to register, please go to:

>> Institute Homepage & Agenda: http://www.mbproject.org/6mbi2008.php

>> Registration: http://www.mbproject.org/6MBI2008_registration.php

Many thanks to our Sponsors:

>> Educational Grantor: BancTec, Inc.

>> Platinum Sponsor: ACS, Inc.

>> Gold Sponsor: OptumHealthBank

>> Silver Sponsors: The Bank of New York Mellon; Fifth Third Bank; PNC Bank; Teleperformance

>> Media Sponsors: Healthcare Finance News, Future Healthcare

About the Medical Banking Project...
MBProject is a pioneering authority that coined the term “medical banking™” to denote the emerging global convergence of banking and healthcare systems to improve health costs, quality and access. Our educational forums, workgroups and pilot programs showcase visionary ideas and initiatives that inform policy, commerce and academia. Supported by a diverse constituency, MBProject conducts research and outreach that defines and facilitates medical banking™, and this supports our mission to convert digital savings into charitable resources. Our work demonstrates how banks can improve healthcare programs for consumers, care givers, health plans and employers. For more information please go to: http://www.mbproject.org. Contact: Evelyn Marquez Sanchez, 615-794-2009, info@mbproject.org

Pilot Updates At The Medical Banking Project

Posted by John Casillas, Executive Director, MBProject (adapted from the latest Medical Banking Report, Vol. 5 No. 1, Jan-Feb, 2008)

I just want to take a moment to thank all of the members of MBProject who are working in our different areas. We know its not easy given today’s busy schedule to convene with fellow stakeholders to tackle industry issues. We greatly appreciate your time and support. I believe that as we continue to work through the various areas, you will have an impact in the industry for the better. If you’re not involved in a workgroup and would like to be, please call me to discuss. Many thanks again.

Dispute Resolution Initiative

Leadership: Sheila Schweitzer, CEO & Chairperson, CareMedic

Launched after a recommendation by David Harris, Partner, PricewaterhouseCoopers, and an affirmative vote was taken at our last Leadership Forum in Franklin (Nov 07), the workgroup is creating an approach for rationalizing the myriad denial codes in claims processing. As many denial codes as possible, derived from data provided by the SSI Group and CareMedic, are being mapped into a standard matrix. A recommendation and work product is scheduled for presentation at the April Institute. We hope to enlist all of our members to adopt the standard and thus influence the industry towards this matrix. The work product is being placed into production by Sun Microsystem and will appear as a free resource on the public MBProject website.

HSA Deductible Engine Use Case

Leadership: Doug Spence, COO, Foresight

After rallying around a model to procure the current deductible at point of service that was presented at the November Franklin Leadership Forum, MBProject was tasked with finding a client of United Healthcare that would support a pilot program and provide a control group of out-of-network physicians and employees. The concept was taken to our Joint Taskgroup for Value In Health (see more on this group below) and ArvinMeritor accepted the call. In fact, the CEO of ArvinMeritor has indicated full support for the project. The workgroup is now awaiting logistics for implementing a deductible data exchange-prototype with United Healthcare to test the concept further. MBProject member Tim Murray, CEO of ICSGlobal has indicated that his group can implement the prototype. Foresight has also offered assistance. Note that United Healthcare’s Exante Bank (rebranded to OptumHealth Bank) funded this use case. The process is proceeding slower than we’d like, probably characteristic of a major systems change in strategy. Started in November of 2006, milestones included funding, visiting Mount Carmel Healthcare System in Columbus, OH, to discuss a pilot program (Spence and Casillas), meeting face-to-face with the technical staff at United Healthcare and of course funding for the organization and implementation of Phase 1 of the project (development of the industry requirements document now posted in the membership research portal).

Accreditation Review Council

Leadership: John Casillas, MBProject

After nearly 15 months of effort, ARC has examined the major rules in banking and healthcare that pertain to health data privacy and security, as well as assessed all relevant accreditation programs. We continue to add information to this process. At the Franklin Leadership Forum, John Phelan, PhD, Milliman presented a summary of the work and the approach ARC is taking to create an accreditation program that will be accessible via an online compliance tool.

Following the presentation, in late January, a pilot program was conducted at the Working Capital Solutions division of The Bank of New York Mellon. Some 23 subject matter experts (SMEs) were asked to participate during the two-day program managed by Dr. Phelan and Ken Kabala, VP, Senior New Business Development Manager, BNY Mellon. A post-pilot survey was conducted, seeking reaction from the SMEs which was positive and informative. ARC is now reviewing recommendations to improve the program. We intend to unveil the “Gold Seal” program at the April Institute.

Joint Taskgroup for Value in Health

We are very pleased to announce that Jim Patterson, Director of Total Health Management at ArvinMeritor, has agreed to direct our Joint Taskgroup. ArvinMeritor is a tier one automobile supplier with some 8,000 employers in over 20 countries. We also asked Brad Kirkpatrick, Vice President of Marketing at Best Doctors, to co-direct this effort. Brad has been involved in working with employer groups and provides an important perspective to the effort. Finally, we plan to make another leadership announcement - an executive from one of our bank members - pertaining to this work effort at the April Institute or before. We believe these three individuals will help to move the work effort along in a positive direction. The Joint Taskgroup is preparing a program for May 6 in Detroit, where we will hear opinions from some of the largest employers on the planet (GM, Ford, Chrysler, others) about how they envision partnering with banks to optimize human capital.

HSA Preventive Drug Listing Workgroup

Leadership: Roy Ramthun, CEO, HSA Consulting, LLC

MBProject is entering a Memorandum of Understanding (MOU) with the National Council for Prescription Drug Programs (NCPDP) to govern our exchanges. A few years back, John Casillas spoke with former CMS Chief Mark McClellan about language in the Medicare Modernization Act (MMA) that created a “fourth type of clearinghouse” - a Part D sponsor - which could be a bank. It was picked up in the media (see CNBC interview with Casillas and Dan Rother, AARP at: http://www.mbproject.org/tour_media_6.php). Originally, we didn’t envision this to be a medical banking area until Forbes published an article by McClellan’s senior advisor (“Banks: The New HMOs”) advocating bank-PBM partnerships to support the new $400 billion Part D program. We decided to organize a focus group in this area. Our first phase will focus on making a formal recommendation to the IRS for “preventive drugs”, as this isn’t clearly specified in the HSA rules and is a source of agitation in the HSA/HDHP arena. Roy Ramthun is helping to steer the group, comprised mostly of health plans and PBMs. The group is currently awaiting feedback from legal to ensure the workgroup can meet without running afoul of the law.

Medsphere and Tolven to 'Surround, Supplement, and Renew' VistA

Posted by ED

Ignacio Valdes [ivaldes@hal-pc.org], editor of Linuxmednews.com, sent a pointer and some comments out to the American Medical Informatics Association Open Source Workgroup which might be of interest to those in the Medical Banking industry. Tolven participated in a recent Medical Banking Project event.

Medsphere and Tolven announced ( article here ) at the annual HIMSS show that they will form a new partnership to "Surround, Supplement, and Renew" VistA as a viable platform for forward thinking health care organizations. The announcement is loaded with buzz-words, but a close read implies that Medsphere is attempting to reach out to other providers to include them in their currently non-existent ecosystem.

This has potentially very interesting ramifications for VistA which has been languishing for nearly a decade. I believe it is a race to save the patient with renewed and collective investment versus being overwhelmed into irrelevance by the blistering pace of other, newer technology. This should be a STAT! page to the entire VistA community that more effective collaboration will be required to save this valiant trialblazer.

Link to article: http://linuxmednews.com/1204042379/index_html

A New Medical Banking Ecosystem [Update]

Franklin, TN (December 6, 2007) Global delegates will convene at the Sixth National Medical Banking Institute on April 1-3, 2008 in Marietta, GA, to discuss best practices and case studies in the convergence of banking and healthcare systems. The theme of the event "A New Medical Banking Ecosystem" offers a view of the future of a healthcare system that is much more tightly linked with everyday banking," said John Casillas, founder of the Medical Banking Project and chair of the Institute. "This is an exceptional journey and we're receiving overwhelming confirmation in the marketplace that medical banking both works and is growing."

A new "International Journal of Medical Banking" will be launched at the event, further documenting industry growth. "Medical banking is a global phenomenon," said BP Fulmer, president of the Institute and Executive Director of Commercial EDI Services for ACS. "Its got a long tail wind and our prognosis for the future is high growth as medical banking systems seek to offer greater value in the marketplace."

Organized by the Medical Banking Project, both the Institute, peer reviewed by the President's Council, a panel of leading banking and healthcare experts, and the Journal, featuring an editorial advisory board of commercial executives, academicians and employer-based medical officers, offers a uniquely engaging and authoritative venue for gaining critical insights into medical banking convergence.

The Institute hosts three educational tracks, a new "Medical Banking Boot Camp", an advanced topics program and a members-only room for pilot updates, voting and more. Tracks include:

The Hybrid Revenue Platform: chaired by the Healthcare Financial Management Association (HFMA). The track will feature the evolution of health data management across banking and healthcare systems a pivotal technical axis in the build out of medical banking services. The sessions will focus on rationalizing the "extreme paper chase" in healthcare for institutions and everyday consumers too. Batch and real time systems will be showcased. In addition, a new "Dispute Resolution Initiative" at MBProject will convene leadership and seek attendee comments on industry recommendations to simplify the use of denial codes in the claims payment process.

Privacy & Adoption of E/PHRs: chaired by the Health Information Management Systems Society (HIMSS). The track will unveil new banking programs that support health information exchanges. Presentations will feature how consumers can start a "care clipping" service through local banks. Other models that will be presented include Health Record Trusts and a framework for bank-supported RHIOs. A critical debate will examine privacy and security of data in banking systems. A global consumer survey will be referenced that found that banks are the most trusted entity for digital identity in today's emerging electronic world.

Value-Centered Medical Consumerism: chaired by PricewaterhouseCoopers. The track will examine the evolution of consumer health IT services through case studies and presentations. We will feature the convergence of B2B and B2C platforms, the evolution of consumer tools that support a value-centered approach for healthcare and systems migration towards the online banking platform/format to speed adoption of consumer engagement in healthcare.

A new "Medical Banking Boot Camp" will help organizations that need staff training in the complex area of medical banking. The course provides a unique primer for executives who are forming strategy in new medical banking services. A certificate of completion will be issued to those completing the course.

Two new programs have also been announced:

Room A: Advanced Topics in Medical Banking; will include "A Medical Banking Gold Seal" for privacy and security accreditation, a Medical Banking Tool Kit for Employers and "Your Medical Banking Avatar: New Dimensions of Consumerism Using Web 2.0."
Room B: Members Only - Reserved for members of MBProject to review pilot programs and to vote on 2007-2008 initiatives.

The event, organized by MBProject, is open to the public. Online registration is now available at http://www.mbproject.org/6MBI2008_registration.php. Early registration is strongly recommended. A full agenda in addition to white paper and keynote selections will be posted online at http://www.mbproject.org.

Top tier sponsorship programs are also available. To receive a Sponsorship Guide call Evelyn Marquez at 615-794-2009 or email the MBProject staff at info@mbproject.org.

About the Medical Banking Project
MBProject is a pioneering authority that coined the term "medical banking" to denote the emerging global convergence of banking and healthcare systems to improve health costs, quality and access. Our educational forums, workgroups and pilot programs showcase visionary ideas and initiatives that inform policy, commerce and academia. Supported by a diverse constituency, MBProject conducts research and outreach that defines and facilitates medical banking, and this supports our mission to convert digital savings into charitable resources. Our work demonstrates how banks can improve healthcare programs for consumers, care givers, health plans and employers.

For more information please go to: http://www.mbproject.org or contact Evelyn Marquez Sanchez at 615-794-2009 or info@mbproject.org

Semantic Interoperability on Steriods

Posted by ED

<note>RE: Our friend John Hardin -

Dear Members and C.O.M.B.A.T. Advisory Board,

We received sad news this morning and I felt it was important that you hear it from me. John Hardin, a good friend and confidant, passed away on Friday night. We have few details right now but I talked to his wife, Meggan, this morning and she wanted to relay how much John enjoyed working with our members at MBProject and how much he believed in our cause.

As you may know, John presented at our 3rd National Medical Banking Institute and was instantly recognized with an unusually gifted talent in the area of open source technology. In fact, John was a open source warrior, holding key positions in a number of open source organizations to advance the cause (OASIS, OMG). His final position was at Sun Microsystems, an open source advocate, where he managed B2B initiatives. Most recently, John wrote an analysis of how an innovation in UDEF, created at Lockheed, could facilitate semantic interoperability of medical records. You can find this analysis in our last issue of The Medical Banking Report, July/August 2007, Vol. 4 No. 3.

John chaired our Planning & Design Subcommittee for the C.O.M.B.A.T. Initiative. He architected the design for a medical banking platform that could be used by banks for provisioning healthcare records, fully incorporated in MBProject's response to ONCHIT's RFP in 2005. His work defined "C .O.M.B.A.T. Version 1", and we formally recognized his efforts by awarding him with MBProject's Person of The Year Award in 2006. John introduced MBProject to General Motors, Walt Disney, and the Automotive Industry Action Group, paving the way for the formation of our Joint Taskgroup for Value In Health. His contributions in the new arena of medical banking will be memorialized in our website.

I will personally miss our stimulating and encouraging talks about how to link open source to medical banking, align the stakeholders and how small unknowns can create a "disruptive" force in healthcare that can have ripple effects all over the world for the better. I would be most appreciative if you joined with me in extending our sincerest condolences to the Hardin family during this time of loss. He is survived by his wife, Meggan, and his two sons who live in Kansas City.

Sincerely,
John Casillas
Chair, Medical Banking Institute
Executive Director, Medical Banking Project

John Hardin's colleague from SUN, David Lee Todd, adds this post.</note>

This article was written by MBProject Member, John Hardin, Product Manager, B2B Platforms, Sun Microsystems, Inc. John was MBProject’s “Person of the Year Award” in 2006 due to his work in the Planning & Design Subcommittee of MBProject’s C.O.M.B.A.T. Initiative. This article appeared originally in The Medical Banking Report, July/August 2007 Vol. 4, No. 3

As the stage is being set for widespread adoption of clinical record document sharing capabilities, sometimes referred to as Regional Healthcare Information Organizations (RHIOs) or Healthcare Information Exchanges (HIEs), there is a growing number of standards that are competing to provide the payload document formats. These standards include the Continuity of Care Record from ASTM, the HL7 CDA and the XDS-Medical Summary from IHE, among others. Additionally, the interview published by Health-IT World. The article provides excellent insight to many of the issues and opportunities associated with EHR.

As adoption grows, the number of disparate formats creates a lack of interoperability across platforms and applications. If your E.H.R. application produces a CCR as output to share information about a patient, but the care provider that you are sharing with uses an E.H.R. that accepts / produces a HL7 CDA format, then the two can’t communicate electronically. This then creates the requirement for a mapping, transformation and integration project to link the two documents, translating from one to the other and back again. Multiply this times the size of the medical industry, even in a single region, and the result is such a lack of interoperability that the applications become ineffective at sharing data, and the entire objective of the build out becomes difficult to meet.

Some collaboration between these groups is happening, however, there may still be a condition where we don’t have a single standard.... Obviously, this is a problem across all of IT, encompassing most software applications and nearly every industry. It has single-handedly spawned the entire Integration software industry, and complex frameworks are being built to facilitate the processes of transformation and delivery of documents that are different in format, and use different terms to name the data elements. A further difficulty arises as each of those standards bodies improve on or change from one version of the document format to the next. These changes can break the mapping and transformation code, which then require more development to stay current. This is an exponentially increasing problem, which won’t be solved until either every software application that needs to exchange data uses the same formats, or a bridging solution can be implemented to cross the gap between formats.

The problem has a simple explanation: different names for the same data concepts, and is closely related to the formation of ontologies or taxonomies. The solution is termed Semantic Interoperability. The Universal Data Element Framework (UDEF) proposes to solve this problem by adding an attribute, in the form of an alphanumeric tag, to every data element in each format. This would provide a common identifier for each data element concept in each document, which can then be programatically analyzed and matched, then transformed, by software. This will be a major change from the mostly human-based analysis, coding, testing and implementation effort that characterizes current integration projects. Also of note is the fact that the UDEFID’s are alphanumeric, allowing them to also provide bridges across language translations (from English to Korean, for example).

Continue reading "Semantic Interoperability on Steriods"

Medical Banking Careers at McKesson

By MBProject Member, BP Fulmer, Executive Director, Commercial EDI, ACS, Inc., The MEDICAL BANKING REPORT, July/August 2007, Vol. 4, No.3

About a month ago one of my colleagues sent me an email entitled, “Looks like Medical Banking is legitimate.” Obviously, the title caught my eye. My immediate thought was, “Of course it is.” So I opened the email and discovered that not only is Medical Banking a legitimate endeavor it is now being recognized by one of the worlds largest and most successful healthcare companies in the world as a corporate function with a career path.

That company is McKesson. The email I read included a link to their human resources list of open positions. It listed medical banking positions and acknowledged that McKesson is creating a “medical banking” unit. The listing heralds that medical banking is becoming a formalized corporate function and an emerging career.

A couple weeks later I had the opportunity of having breakfast with Jim Bodenbender, Vice President and General Manager of McKesson. I asked him about this bold move to create a special operating unit inside Relay Health devoted exclusively to the development and pursuit of medical banking products and market opportunities.

Convergence Highly Likely for Online Banking and eHealth

The MEDICAL BANKING REPORT, July/August 2007, Vol. 4, No.3

When it comes to the growth of online banking there is one factor that stands above all the others: Public Trust. According to a survey by Ponemon Institute, a think tank that advances responsible information management practices in business and government, 57% of consumers said if there was one privacy breach at their bank, they’d stop all online services. That’s a pretty small margin for error.

The survey (sponsored by Watchfire in April 2005) had 2,328 responses (17.2% response rate) and was conducted with a cross segment of customers from Wachovia, PNC, US Bank, Washington Mutual, National City and Citigroup.

The statistic isn’t entirely surprising. What banking service isn’t inextricably bound to Public Trust? It is much like the air that a banker breathes. Without Public Trust all bets are off that a bank will succeed.

This is one reason why banks today are locked into an Identity Theft Arms Race. No one likes to be compromised.

Privacy vs safety a paramount concern

Posted by ED for JC

The referenced TriCities.com article articulates with great clarity where the focus of the privacy debate should be: Privacy vs. Safety. We should expect our health data to be treated with the utmost of privacy and confidentiality...but to the detriment of our own safety? Some privacy wonks say that HIPAA protects no one. Really?

Yes, HIPAA permits covered entities to use our data without authorization for "TPO" - treatment, payment and operations. Thus if one is unconscious and can't sign a consent form, its ok to look at that person's record. If a third party (payor) is responsible for payment, its ok to send a claim without patient consent. This seems safe to me, especially because HIPAA has mechanisms in place (through BAA contract) that requires that any entity receiving the data use it for the specific purpose intended (payment of a claim, for instance). It also requires a minimum necessary standard. Only the minimum amount of data (not the 130 page medical record) can be supplied for payment of a claim, unless required.

Some privacy groups say this standard isn't adequate. They say that anytime anyone accesses our data it must be accompanied with a signed consent form. Even in the area of public health, where breakouts are monitored and patient data must be accessed quickly, some privacy groups contend that if a person doesn't want their data shared, it shouldn't. Should privacy be placed above public safety? Isn't this the key question? Within this context, what does VA Tech teach us?

This is a difficult debate but simple common sense can get us beyond many issues. Its easy to crusade behind an "I'm-for-the-small-guy" mask. I identify with the underdog too. I just want that underdog to be safe. I want to be safe. And by the way, I AM the underdog. Aren't most of us?

I'm ok with hospitals having my data for TPO, but the privacy groups want to force hospitals and others to go through hoops when my life is in danger. They want me to get behind the idea that HIPAA doesn't go far enough. Perhaps there are changes that could be made and as an underdog, I'm open to that possibility. But we must be careful not to create an environment that makes all of us less safe, shouldn't we?

There is a delicate balance between privacy and safety. Perhaps we should err on the side of safety. I'm interested in how some privacy groups justify their position in light of VA Tech. This is an acid test. To use VA Tech for political purposes is immoral, to be sure, but for testing standards it provides a meaningful and absolutely necessary exercise.

---
John Casillas
Chair, Medical Banking Institute
Executive Director, Medical Banking Project
320 Main St., Ste. 230
Franklin, TN 37064
v: 615.794.2009, ext. 3
f: 615.794.1481
http://www.mbproject.org

MBProject Members in Good Standing

Posted by ED

as of August 13, 2007

<ed.note>I post this because I think some folks may still be laboring under a misperception that the MBP isn't serious about changing the paradigm.</ed.note>

ABN Amro

ACS, Inc.

ACS EDI Gateway, Inc.

Azima Healthcare Services, Inc.

Best Doctors, Inc.

Canadian Medical Association - Practice Solutions

CareGain, Inc.

CareMedic Systems, Inc.

Centers for Medicare & Medicaid Services

Claimtrust, Inc.

Conmergence

ConnectYourCare

Edifecs, Inc.

E-Duction

eGistics, Inc.

eTransX, Inc.

Exante Financial/UnitedHealthcare

Fifth Third Bank

First Horizon Merchant Services

Fiserv Health, Inc.

Foresight Corporation

Genpass Card Solutions

HealthFusion, Inc.

ICSGlobal, Ltd.

Information Technology, Inc.

Insight Healthcare Financial, Inc.

InstaMed

MaxSurge Healthcare Solutions, Inc.

McKesson

McKesson Transaction Solutions Hub

Mellon Financial Corporation

Office of Civil Rights

PFPC

PNC Bank

PNC Financial Service Group

PricewaterhouseCoopers, LLP

Private MD Secure Records Online

QHR

Remettra

RemitStream Solutions

Revenue Management Solutions

Sanofi-Aventis U.S., LLC

SearchAmerica, Inc.

Starbourne Communications Design

Sun Microsystems, Inc.

The SSI Group, Inc.

US Bank

US Treasury Department

Veterans Health Administration

Visa U.S.A., Inc.

Wachovia, NA

Walt Disney Company

Walt Disney Corporate IT

Wausau Benefits