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

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.

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

Medical Banking Networking Group Launched on LinkedIn.com

Posted by ED

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.

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

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

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.

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

Will Healthcare Bank on Banks?

Posted by ED

Aug 14, 2007 By Gary Baldwin, HealthLeadersMedia.com

If John Casillas is correct, one day we'll use financial Web sites for more than paying bills and checking balances, like some 53 million Americans already do. We'll be paying physicians and checking cholesterol scores. Casillas is the founder of the Medical Banking Project, a Franklin, TN-based think tank. Since 2001, he has been working toward an unusual goal. The very term "medical banking" begs for a definition. "It is merging two different worlds," Casillas says. "I want to optimize banking systems to provide better healthcare."