7th National Medical Banking Institute, March 11-13, 2009, Nashville, TN

Nashville Airport Marriott Hotel
600 Marriott Drive
Nashville, TN 37214
615-889-9300
Fax: 615-889-9315

Updated: 03-03-2009

Wednesday - March 11, 2009
10:30 -1:00	Pre-Conference Registration
11:00 -12:00	President's Council Luncheon Meeting
Medical Banking Boot Camp
1:00 - 1:15	Introduction
	June St. John, Chair, Education and Programming Subcommittee, Medical Banking Institute; SVP, Healthcare Product Manager, Wachovia Treasury Services, Charlotte, NC Patricia Alafaireet, Director of Applied Health Informatics, School of Medicine, University of Missouri, Columbia, MO. MBProject and the University of Missouri have collaborated to create a Medical Banking Executive Training Program. We will be discussing the educational requirements for this program. ** NOTE: John English, Professor, Vanderbilt University, will provide an update on our training program.
1:15 - 1:45	Session 1: The Healthcare Transaction Marketplace: Primary Players, Market Position, Claims Processing Systems
	The healthcare revenue cycle will be reviewed by a senior executive. From this purview, we will look at the matrix of tools and digital techniques that have been developed to facilitate revenue cycle workflows in healthcare. This will set the stage for a better understanding of how banking systems can impact this area. Foster North, VP, CareMedic Systems, St. Petersburg, FL
1:45 - 2:45	Session 2:  The Emerging Role of Banks In Health Data Processing
	The session will look at how banks have integrated their technologies and systems with the healthcare revenue cycle to reduce "friction" in the system. The basic medical banking platform will be explored, resulting ROI and a view towards how the platform could be adapted for greater efficiency in the future. Both batch/back end and real time systems will be presented. Specialized lockbox programs Richard Mobley, VP, Healthcare Services, BancTec, Irving, TX Real Time processing programs Bill Marvin, CEO, Instamed, Philadelphia, PA
2:45 - 3:15	BREAK
3:15 - 4:00	Session 3: Privacy & Confidentiality: Building a Secure Platform for Growth
	"Medical banking" represents a new industry that results from the adaptation of banking systems for healthcare. As hybrid innovations grow, more sensitive health data will flow through specialized medical banking channels and this creates a need for education, training and external affirmation of data privacy and security protocols. The Accreditation Review Council at MBProject oversaw the development of an online system of compliance assessment - the Gold Seal - that will be presented. The Accreditation Review Council believes that the Gold Seal will need to address a new series of compliancy measures for "credit-grantors" created under the FACTA regulations, commonly referred to as the "Red Flag Rules". Scheduled for enforcement in May 2009, these rules need to be evaluated to determine overall impact in medical banking programs. A White Paper by MBProject member TransUnion, which was accepted in the 2009 International Journal of Medical Banking, will be presented. Overview of MBProject's new Gold Seal Program: John Phelan, PhD, Healthcare Management & HIPAA Consultant, Milliman, Inc., Westlake Village, CA Presentation of White Paper - Red Flag Regulations: Exploring the Impact of New Identity Theft Regulations on Healthcare Providers: Nancy Vickroy, Director, Healthcare Product Marketing, TransUnion, Chicago, IL
4:00 - 4:45	Session 4: How Medical Consumerism and Medical Banking Align to Create Value
	As medical consumerism gathers increasing momentum in healthcare today, the need for point of service technologies is growing. This area significantly impacts management of the healthcare revenue cycle and because of this, medical banking programs are aggressively building tool sets to support the consumer. A study assessing this impact and the appropriate banking response was commissioned by Fifth Third Bank, (also accepted in the 2009 International Journal of Medical Banking), and will be presented. Presentation of White Paper - The Impact of Consumer Directed Healthcare on Providers: Stuart Hanson, VP, Healthcare Solutions & Wholesale Lockbox, Fifth Third Bank, Chicago, IL
5:30 - 8:30	Corporate Networking Suites Open -- BancTec Networking Suite -- WAUSAU Financial Systems Networking Suite
Thursday - March 12, 2009
7:30 - 8:30	Registration
8:30 - 8:45	Call To Order & Honorable Mention of Educational Grantor
	Maureen L. Turo, President, National Medical Banking Institute; VP, Healthcare Strategy, The Bank of New York Mellon Treasury Services Division, Pittsburgh, PA
8:45 - 9:00	A  Vision for eHealth Using Banks - Orientation & Awards
	From MBProject's standpoint, 2008 was relatively quiet year. The credit crisis impacted growth plans yet it is the same crisis which re-focused banks and financial services firms on healthcare because it is an industry that compares favorably with others for future growth (note: Experian's $90 million acquisition of Search America). While using banking platforms to advance eHealth strategy is still an emerging concept, we see firms quietly building alliances and technologies that are convincingly changing the competitive landscape. Some industry veterans feel that medical banking represents the "next generation of health data management services" and given market indicators, it appears we are reaching a tipping point. John Casillas, Chair, Medical Banking Institute; Executive Director, The Medical Banking Project, Franklin, TN
9:00 - 9:30	Pushing the Envelope Out For Good - Moving Healthcare Onto An Electronic Platform Using Banks
	One of the most vibrant healthcare associations in America, the Healthcare Financial Management Association, has launched a new initiative to build a new payment system. This multi-year initiative, which found over 100 healthcare administrators and thought leaders including MBProject at a DC summit and reception at the French Embassy, finalized key building blocks that include creating a more responsive infrastructure for payment processing...thus rolling the red carpet out for banks to help. Robert Broadway, Chair, Healthcare Financial Management Association (HFMA); VP, Bethesda Healthcare System, Boynton Beach, FL
9:30 - 10:00	BREAK
10:00 - 12:00	Mayo Clinic Health Policy Center - Advancing Health Care Reform By Creating A Federal Health Board
	The nation's top healthcare CEO's and policy experts examine the potential role of a "Federal Health Board", similar in nature to the Federal Reserve, that could orchestrate affordable healthcare coverage for all Americans. Originally architected by the late Dr. Jerome Grossman of The Harvard/Kennedy School, the idea has gained increasing traction among industry leaders. Proceedings will be documented and provided to Congress and President-elect Obama's new administration. Moderator: Ceci Connolly, National Staff Writer, Washington Post, Washington, DC Keynote Panel: Robert K. Smoldt, Chief Administrative Officer Emeritus, Mayo Clinic, Rochester, MN David M Mirvis, MD, University of Tennessee Health Science Center, Memphis, TN Murray N. Ross, Ph.D., Vice President, Kaiser Foundation Health Plan, Inc., Oakland, CA Roy Ramthun, HSA Consulting Services, Silver Spring, MD Stephen Parente, Ph.D., Associate Professor Finance, Carlson School of Management, University of Minnesota, MN
12:00 - 1:30	LUNCH
12:20 - 1:20	NATIONAL ROUNDTABLE Medical Banking & The Health Data Ecosystem - Engineering A Revolution in Revenue Cycle Management
	National providers and payors describe the benefits and challenges of medical banking and what the future holds. We will examine critical path industry issues that are impeding movement of healthcare to a digital platform, as well as touch upon the whole idea of "real time adjudication" and how the panelists think this area could build out given the recent consumer push towards point of service processing. Moderator: Sheila Schweitzer, Chairperson & CEO, CareMedic Systems, St Petersburg, FL Panelists: Robert Nay, Director, Blue Cross/Blue Shield of Florida, Health Options, Jacksonville, FL Charlie Myers, Director of Operations, Special Programs and Support, Johns Hopkins Hospital and Health System, Baltimore, MD Russell Taylor, Strategic Systems and Processes, Aetna, Inc., Middletown, CT Laurie Holtsford, Director, Business Office Support, Community Health Systems, Brentwood, TN Scott Hawig, Divisional CFO—PRMO (Patient Revenue Management Organization), Duke University Health System, Durham, NC
1:30 - 2:45	CONCURRENT TRACKS
Track 1	Strategic Revenue Cycle Management
1.1	Linking Banking & Healthcare Systems - Part 1
	How are providers using medical banking platforms? What are the key ROI metrics? As these platforms move into best practices, what does the future hold for moving from a payment/remittance tool set to a business intelligence platform for healthcare? Moderator: Doug Bilbrey, EVP Sales & Marketing, The SSI Group, Inc., Mobile, AL Panelists: Charlie Myers, Director of Operations, Special Programs and Support, Johns Hopkins Hospital and Health System, Baltimore, MD Laurie Holtsford, Director, Business Office Support, Community Health Systems, Brentwood, TN Todd Slocumb, Chief Technology Officer, Revenue Management Solutions, Oklahoma City, OK Christine Smith, Product Manager-Remittance Solutions, WAUSAU Financial Systems, Mosinee, WI *Note: Todd Slocumb and Christine Smith are the new Workgroup Leader and Co-Leader (respectively) of MBProject's Workflow Automation Focus Group. They will be reporting out a listing of key industry issues developed at our 2008 Medical Banking Leadership Forum.
Track 2	Innovations in Medical Consumerism
2.1	UPDATE: HSA Adoption Issues
	How will Health Savings Accounts fare under the new Obama Administration? Will adoption issues increase? What are the regulatory and market factors that could impact HSA adoption? The panelists will review the regulatory environment in 2008 and future policy trends as well as present bi-annual research, hot off the AIS press, that the industry relies on for HSA metrics (number of HSAs, deposits, etc). In addition, a brand new survey of employers is being prepared -- more on that to be announced to the industry prior to the Institute! Moderator: Roy Ramthun, HSA Consulting Services, Silver Spring, MD Panelists: Tom Hricik, National Director of HSA Product Distribution, ACS HSA Solutions, Pittsburgh, PA Greg Scandlen, Fellow, Wheatland Institute; CEO, Consumers for Health Care Choices, Hagerstown, MD Todd Berkley, VP, Market Solutions, OptumHealth Financial Services, Salt Lake City, UT
2:50 - 3:30	The Great Privacy Debate
	A stunning on-the-ground look at how groups in Washington, DC are changing the ground rules for healthcare information technology systems. Devon McGraw, Executive Director, Health Privacy Project / Center for Democracy & Technology, Washington, DC
3:30 - 3:45	BREAK
3:45 - 5:00	CONCURRENT TRACKS
Track 1	Strategic Revenue Cycle Management
1.2	Linking Banking & Healthcare Systems - Part 2
	How are insurance carriers and health plans adjusting their strategy to promote greater adoption of electronic funds transfer and remittance management? Or are they? What are the ROI metrics for this side of the medical banking realm, and what does the future hold for moving more provider-customers to a digital paradigm for end-to-end claims processing? We will also look at the emerging area of real time payment processing during this session. Moderator: Rick Morrison, Vice President, WJM, Inc., Little Rock, AR Panel: Russell Taylor, Strategic Systems and Processes, Aetna, Inc., Middletown, CT Vince Marzula, Vice President & Product Group Manager, PNC Bank, Pittsburgh, PA (I) Greg Morris, President & CEO, TriHealix, Norwalk, CT Steven Lloyd, Vice President of Sales, Homeland Healthcare, Richardson, TX
Track 2	Innovations in Medical Consumerism
2.2	How Banks Can Support Personalized Healthcare Informatics
	MBProject has advanced the idea of using banking systems to speed consumer adoption and demand for personal healthcare records. How could this paradigm unfold? What banking activities are underway to support this dynamic? Is the PHR a stand alone application or does it need to be part of a broader consumer health IT play that meets multiple "health-wealth" needs? This panel will look at specific health IT programs, how they are being positioned and what banks can do to move this ball forward. Moderator: John Casillas, Founding Director, Medical Banking Project, Fanklin, TN Panelists: Paul D. Witman, Ph.D., Assistant Professor, Information Technology Management, School of Business, California Lutheran University, Simi Valley, CA Toby Rogers, EVP, Commercial Markets, DestinationRx, Chicago, IL Kumar Swaminathan, Industry Manager, Consumer Centric Healthcare, Sun Microsystems Inc., Menlo Park, CA Frank Convertino, Vice President, Sales & Channel Development, Centri Health, Los Angeles, CA
5:00	ADJOURN
6:30 - 9:00	BANCTEC NETWORKING & RECEPTION GALA Mingle with your colleagues and new acquaintances at the Medical Banking Project's ultimate gala event! Over the years this networking highlight has produced some of the industry's most talked about strategic alliances and partnerships. Don't miss this important opportunity to advance your business objectives in medical banking!
Friday - March 13, 2009
7:00 - 8:00	Registration
8:15 - 8:30	Orientation
	John Casillas, Chair, Medical Banking Institute; Executive Director, The Medical Banking Project, Franklin, TN
8:30 - 10:00	Keynote Panel - Banking on Better Healthcare
	In 2008, MBProject initiated a national dialogue in the form of a National Town Meeting called "Banking on Better Healthcare". Held in conjunction with The SSI Group User Meeting and attended by over 300 banking, healthcare and government executives, the national webcast examined how banks are engaging healthcare. The Keynote Panel comprised of senior banking executives will take up this issue again: why should banks specialize programs for healthcare? How are banks re-engineering existing systems to meet critical healthcare needs in America today, like reduced costs for transaction processing, point of service cash management/collections, implementation of programs to assist in the national build-out for an eHealth infostructure (electronic and personal healthcare records), and governance structures (like the "Health Fed" and its application for speeding adoption of standards, financing EMR infrastructure and fueling value and pricing transparency in healthcare). Moderator: John Casillas, Chair, Medical Banking Institute; Executive Director, The Medical Banking Project, Franklin, TN Panel: David Trotter, Executive Vice President, Head of Sales for Treasury Management at Wells Fargo, Charlotte, NC Al Briand, Division Head, BNY Mellon Treasury Services Product Management and Strategic Development, New York, NY Paula Fryland, Executive Vice President and Manager of PNC Healthcare, PNC Bank, Louisville, KY Ralph Bernstein, SVP and Senior Lead, U.S. Bank Healthcare Payments Solution, Minneapolis, MN
10:00 - 11:00	Capitalizing A Whole New Industry
	Launching an electronic medical banking community will take focused effort and investments, and today's investment banking and venture capital communities aren't sitting idly on the sidelines. Hear how key funding groups are capitalizing this brand new industry. Moderator: Kevin Lavender, Senior Vice President, Healthcare Finance, Fifth Third Bank, Nashville, TN Panel: Harriett Flowers, Managing Director, Converge Capital, Dallas, TX Raymond Falci, Managing Director, Cain Brothers & Company LLC, New York, NY
11:00 - 11:30	BREAK
11:30 - 12:30	Driving Medical Banking Into Everyday Practice - A New Tool Kit for Employers
	The nation's top automobile companies are reeling under the weight of healthcare costs and other environmental factors. The Medical Banking Project and the 1600 employer Automotive Industry Action Group formed a Joint Taskgroup for Value In Health over two years ago to orchestrate a "disruptive innovation" in healthcare, drafting a new "Medical Banking Tool Kit". The Tool Kit will be officially announced and a panel of team members will discuss why its critical for employers to adopt. Moderator: John Casillas, Chair, Medical Banking Institute; Executive Director, The Medical Banking Project, Franklin, TN Panelists: J. Scot Sharland, Executive Director, Automotive Industry Action Group (AIAG), Southfield, MI June St. John, Chair, Education and Programming, Medical Banking Institute; SVP, Healthcare Product Manager, Wachovia Treasury Services, Charlotte, NC Eric Booth, COO, The Leapfrog Group, Washington, DC
12:30 - 1:00	Next Steps for Moving the Industry Forward
	Maureen Turo, President, National Medical Banking Institute, VP, Healthcare Strategy, The Bank of New York Mellon Treasury Services Division, Pittsburgh, PA
1:00	ADJOURN

XBRL Part II Implementation: Are You Ready? Live Webinar March 18, 2009, 1:00pm to 3:00pm (ET)

Posted By ED

Note: XBRL has been mandated by the SEC for large organizations and will likely become part of the medical bank environment over time so I've provide this event pointer. 

FEATURED SPEAKER LIST:

U.S. Securities and Exchange Commission
David Blaszkowsky
Director, Office of Interactive Disclosure

Bowne & Co., Inc.
Rob Blake
Senior Director of Interactive Services and founding member of XBRL.ORG

International Accounting Standards Committee Foundation
Kurt P. Ramin, CPA, MBA, CEBS
Chairman (Emeritus) of XBRL International
Advisor, IASCF

Ernst & Young LLP
Paul A. Penler
Executive Director, Auditing Tools and Techniques Global Assurance and Audit Practice

Summary: Implementation of The SEC's mandate to adopt XBRL-based financial reporting is now closer than ever. XML data tagging to makes it easier for internal controls, shareholders, investors, analysts, and the regulators to mine financial reports for data. Moreover, it helps provide an interactive data that is helpful in automating regulatory filings and business information processing. As the proposed timetable for the adoption of XBRL-based financial reporting is fast approaching, affected entities should be well-informed and use this format now or run the risk of not being able to fully utilize this feature rich reporting method.

The Knowledge Congress is producing a follow up to its highly successful webinar in September to discuss updates, the recent and the possible impact of XBRL in various financial reporting processes. Key experts and regulators are expected to speak at this event. The event will take place on March 18, 2009, 1:00pm to 3:00pm (ET). Click the button below to register in this event.

Course Level: Intermediate
Prerequisite: None
Method Of Presentation: Group-Based-Internet
Developer: The Knowledge Conference
Recommended CLE/CPE Hours: 1.75 - 2.0 (Please note, your State Bar or Accounting Board will make the final determination with respect to continuing education credit. If you are applying for CLE credit in Texas you must register 20 days before the event date.)
Advance Preparation: Print and review course materials
Course Code: 083817
Course Fee: $199 - $299 (Please click here for details)
NASBA Sponsor Number: 109004

We are an approved multi-event sponsor in the state of California. Our provider ID is: 14451. In Texas, Illinois, & Virginia, we submit programs for individual approval in advance. In New York, our programs are submitted immediately after the event live date and attendees are sent the approval codes once we receive them from the New York State Bar. All Other states: Once attendance is verified, attendees are emailed an official certificate of attendance which they submit to their respective State Bar Associations. Our programs are created with continuing education in mind and therefore are designed to meet the requirements of all State Bar Associations. If you have any questions, please email our CLE coordination: info@knowledgecongress.org

Important Notice:
Discounts apply for early registration. If you have a scheduling conflict and can't attend this live event on its scheduled date, you may want to order the full recording of the event for your review at your convenience.
Please email: info@knowledgecongress.org for any question or if you wish to order the recording.

For Group registrations please call 1.800.578.4370 for more info.

Unlimited Attendance Plans:
The Knowledge Congress has an extremely affordable benefit rich group preferred plan for companies that send multiple people to multiple webcasts. In addition to saving, you'll receive many exclusive benefits.  

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

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.

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

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.

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.

The “Futures” of Medical Banking -- A Systems View

By Ed Dodds, a Systems Architect at <Conmergence />

Occasionally John Casillas and I have chats about possible content for MBlog, the Medical Banking blog, and the various technological factors which are developing in parallel to the field of medical banking. One of my major themes (you'd have to ask him if he's convinced yet) is that once one buys the premise of the distributed, digital enterprise there is really only one business domain – data. Every distinction people perceive is imposed by legal contrivance, legacy tradition and personal interest. If you buy this premise then the “bit” of the argument is that just because healthcare and finance (and indeed any other business) have been done in a particular manner, this is no real predictor of how they will function in the future.

The intersection of two technologies, XML and IP (extensible markup language and internet protocol) mean that just about any information source can be digitized and delivered anywhere. While not perfect technologies, they provide an interconnectivity platform which makes convergence and interoperability more possible now than at any previous time. Some of the developments that these technologies will enable and that will likely intersect medical banking are:

Collaborative intelligence tools:

Semantically informed proprietary and open source blogs, opensearch, portals, wikis ( think “web 2.0” ) will be coupled with “Z” models ( Zecco, Zillow, Zopa – think “finance 2.0” ) and global, mobile “intelligent mobs” (both actual and virtual, like Facebook, IndyMedia, MySpace, SecondLife) empowering consumer driven healthcare, class warfare and class action suits.

Corporate hierarchy consolidation pressure:

The adoption of open standards and balanced scorecards, compensation metrics and disclosure via universal charts of accounts and extensible business reporting language due to the SEC and media attention on C-suite fraud, insider trading, and hedge fund regulation will encourage per-worker productivity gains. Globalization and green politics will drive the adoption of work over IP, results-only work environments and long-lived transaction technologies will foster new financial instruments. Where standards exist, mergers happen. In the domain of data, this type of consolidation often requires the merger of infrastructure alone.

Cybersecurity:

Terrorism fuels the political discourse but methamphetamine addiction-inspired identity theft rings are the actual cause of many current woes. Medical banking is already caught in the cross-winds of a digital ID storm as more consumers seek convenience for things like accessing money, healthcare records and even traveling through airports. The perfect storm is forming as “paper to digital” conversion gathers momentum, (much data leaving our shores using poor data encryption practices), and new technologies make this data ubiquitous. Business is off shoring, down-salarying IT functions, and thumb drives are literally as cheap as sand.

Ubiquitous global broadband connectivity (via 3G/4G, airship/dirigibles, broadband-in-gas, broadband over power lines, cable, DSL, Fiber to the home, fixed wireless, ISDN, Ultra Wide Band, WiFi, WiMax, satellite, etc.) means virtual medical tourism, distance medical education, remote disease sensing from automobile and home healthcare servers, laptops and smart phones will be able to offer voluntarily provided de-identified PHI to the medical banking data grid. Unified communications (email, H.323, IM, IVR, SIP, VOIP, etc.) as well as contactless payments, mobile payments and smart cards will also deluge data centers, which always seem to be located on or near fault lines, fires or floods.

Today, emerging technologies that are transforming political fault lines provide ample content for John and I to discuss. Sifting through it all to discover how transaction costs in healthcare can be rationalized using medical banking principles has become a hot topic. We can envision a sea of opportunity as technological convergence is manifested through new commercial programs that bring ever increasing value to our healthcare system using banks. From a technology head, medical banking has a long life span, many tentacles and a very promising future indeed.

Conmergence is a strategy consultancy facilitating convergence and enabling the distributed, digital enterprise. Dodds edits the Medical Banking Project's MBlog.

John Casillas Panel Presentation for HFMA ANI in San Diego, CA

Good afternoon. Two weeks ago I spoke at an Advisory Board with the incoming chair of HFMA, a previous chair and a past chair of the AHA. Just prior to that, I testified at HHS at America’s Health Information Community, organized during Dr. Brailer’s reign as President Bush’s health IT czar. These groups had something in common: both were intrigued by how medical banking will impact the future of healthcare.

Many groups I address throughout the country are engaged, so I marvel at those who say it will never happen. They say well that’s impossible. It could never be. I can think of lots of examples where those kinds of people have been proven wrong. Man will never fly. We’ve been to the moon and back. A woman will never be president…could happen next year. The Berlin Wall will never come down. Today East and West Germany are united. How wrong they were!

What I’m trying to get at, is that over the past 15 years creating the thesis of medical banking, I’ve heard a lot of nay Sayers. Yet medical banking has arrived! Not just locally either. This is a global movement. Our members are in Canada, Australia and the European Union. And the key player in this global revolution is the banking community. The nay Sayers are wrong again!

Consider the slides as bonus material. Rather than talk at slides I want to engage you directly.

Now, there might be some in the audience who have been in that group of nay Sayers. Let me remind you that there was a time when 98% of the population believed the world was flat. The other 2% were burned at the stake as heretics. I feel that burning sensation sometimes, but I know we’re right. Today a growing team of cross-industry visionaries agree with us – over 50 corporate members at MBProject in banking, healthcare and policy. Many national leaders agree, who attended our Institute – HIMSS, Centers for Disease Control, National Governors Association and others. They see a brighter future by marrying banking and healthcare systems. Now some may still believe the world is flat, but I know there is one thing we can all agree on. The current system is broken, its just not working. Over 45 million good folks are uninsured and we have a rising tide of bad debt.

That’s why I’m here today – to give you 4 good reasons why medical banking offers solid footing for our healthcare system and hopefully get you involved with our movement. My reasons are based on the idea of the bank as a Trusted Infomediary in the healthcare system of the future. Now, the natural question most of you are asking is why banks? So let me respond with a question: where do you put your money? You see, most people really do trust banks, and there’s more.

A “Bank Infomediary” can do four things for healthcare: one, banks can revolutionize the revenue cycle by pushing the boundaries of automation and real time payments; in fact we will soon launch a common medical banking platform called BoardTrust, that will open up brand new possibilities; two, banks will help America to finally build a “medical internet” that uses all the bank touch points – 99% of all providers and plans on one side and 55 million plus online banking customers on the other; three, banks offer a valuable channel for educating consumers about better healthcare choices; and four, banks can assist the community to coordinate healthcare resources which helps to increase access to the underserved.

So let’s peel back the onion. In the revenue cycle, I believe that existing systems in healthcare has exhausted the cost-cutting potential of EDI, not due to lack of great technology but because of challenges in distribution of that technology. I hear this from healthcare groups all over the country. There is frustration as to why we can’t move more quickly to a digital framework, not just for the claim but eligibility, COB, remittance and more. I’ll tell you one reason why: we haven’t embraced the capabilities of the bank. Let me tell you why I think this is true.

First, the bank’s lockbox is morphing in functionality and can integrate workflows not just using the remittance but all the EDI transactions. This creates new value for hospitals and plans, and can synchronize the market.  For example, the new lockbox unifies paper and electronic remittances into one digital stream and automate routine patient accounting tasks. Some national banks are working with clearinghouses like CareMedic, SSI or McKesson to provide this service. In one case, the clearinghouse is the bank – PNC. Banks cannot do this alone, so they will align or acquire. In 1996 we forecasted a wave of convergence like this, integrating banking systems with digital tools that manage medical transactions. And it’s happening today. Yet what makes this powerful is the bank’s reach. We may finally get all providers on the EDI bandwagon, and that will save at least $35 billion in administrative costs each year.

A futuristic CEO panel convened by QHR, an MBProject member, had two recurring themes. First, that medical banking can offer a return that extends well beyond payment and remittance management. This is true, because it encompasses two forms of liquidity: (2.) financial liquidity – through high value transaction processing and more access to corporate and consumer credit, and (1.) health data liquidity, through on-demand movement of electronic health records.

As banks better understand the value of the complex UB04, a new credit market will emerge that uses the eHealth Lockbox as a business intelligence platform for unlocking $200 billion in non-working A/R assets sitting in your ATB. So medical banking offers a pathway for smarter resource utilization, starting with the digital lockbox and moving on to meet longer term organizational needs. By the way, those needs respond to community needs, which typically are the focus of investment by banks. Steering bank investment towards the hospital is good business. And that goes for banks too. A healthy community means growth in deposits, and that’s a good reason why banks are so involved in the community. Medical banking aligns incentives in the community leadership – who routinely get together at the bank or hospital board – and because of this, medical banking is evolving external to the patient accounting domain. Board members are talking about new synergies with banks. For this reason it seems prudent to become better informed about medical banking.

The second theme at QHR’s forum was that medical banking isn’t visible in the suburban or rural hospitals, and we agree. The early focus of banks is on major markets, but this will trickle down. Our mission is to convert digital savings into charitable resources, so we have a plan to get these new efficiency tools down to the level of solo practitioners, not directly, but through market mechanisms.  Now, this vision may not be what you read in HFMA literature, where some hospitals had mixed reactions about medical banking. That doesn’t surprise me. But what does is how long it takes to broaden the vision. When we coined the term “medical banking”, we articulated a vision that the provider groups we talked to embraced. So we hope these roundtables and articles will lay out a broader vision.

Banks, like any business, are in healthcare for compelling economic reasons some not as obvious others. A good example of this is a hospital closure in North Dakota. Local residents were left 61 miles away from the nearest hospitals, and their most common concerns were interestingly enough, medical banking issues. Let me illustrate: poor access to emergency medical care (a quality of life community issue and thus a banking issue), the loss of local jobs, further declines in the local economy, the suffering of elderly and children and out-migration of residents. This is one example of a disturbing national trend of closures, and that’s why this is a community-wide issue. Leaders are looking beyond parochial interests to solve a deep and broadening healthcare crisis. A hospital closure has long term economic consequences for banks.

So how does this translate into the revenue cycle? Well, I’ve explained how there is a greater economic picture here, and community incentive, for a bank. Today’s health IT firms compete for a slice of the IT budget. Banks compete for the hospital’s total economic impact to the community. The bank gains multiple revenue sources from the hospital – credit terminals, ATMs, payroll deposits, loans, and more. Packaging medical transactions into their services, especially as claims processes go digital and can be incorporated into a value chain, is inevitable. It’s a new tool set the banks can deliver to the hospital to reduce their cost for serving the community. PNC: $1-10 million. In 1996, we forecasted the emergence of a unified platform for healthcare and financial transactions. We said that if this happens, banks would start to compete for your medical transactions, just like they do your financial transactions. This would bring millions of dollars of investment into the hospital community and it tends to decrease costs. I’m sure you’ve heard the saying by now: when banks compete, who wins? You do.

Today this competition is in full swing. MBProject advanced the idea of a specialized lockbox program in 2001, and starting in 2003, banks like PNC, Mellon, Wachovia, Lasalle, US Bank, Fifth Third and others issued press releases and proved our point. McKesson is forming bank alliances and others are too. It’s driving the specialized lockbox for healthcare. We are seeing a virtual tidal wave of banking investment coming into health IT, and we think the outlook looks very good, and it comes at critical time when provider margins are suffering. Today, banks are pouring millions of R&D dollars into automating patient accounting tasks, like remittance and denial management, secondary billing, automated consumer credit decisioning that can mitigate self-pay risks in consumer-driven healthcare through companies like E-Duction, that automate payroll deductions for HSA/HRA holders and more. We believe the first digital tools will be well-established, ones that you already use, but placed in new, high value banking platform that offers new cost savings. It’s a classic market development, like SABRE, the airline ticketing system that, when linked to banks, changed the competitive paradigm in the airline industry for both businesses and consumers. Today we go online for ticketing, car rentals and hotels. The banking system made this change possible, and the same kind of paradigm shift in healthcare is inevitable as medical banking models flourish.

Fortunately, we have hard evidence that when a bank gets involved, costs come down. PNC presented a case study at our Institute showing how a provider saved $4 million last year using their specialized lockbox. I know there’s not a person in this room, or CEO in the country, that wouldn’t like to increase their profit margin by $4 million.

Medical banking offers a holistic view of what banks bring to the table. The ROI of a digital lockbox should be comprehensive: decreased investment for IT, (new revenue cycle applications, maintenance), lower costs for imaging and for managing consumers, seamless integration with new programs that speed third party and self-pay collections using card technologies, credit networks, real time credit decisioning and online banking. We see a community-integrated revenue cycle that optimizes all the banking assets – ATMs, credit/debit terminals and branches – to increase collections and offer compelling consumer conveniences. The bank also opens up a new channel of 55 million consumers who already do online banking. This secure gateway, “single sign on for the consumer”, can manage financial and health data needs. Forrester reports a cost of $1.17 for resolving consumer disputes online vs. $33 using manual systems. When managing commercial payments, NACHA, a bank group, reported a manual cost of $11 vs. $5 or less for EDI. New bank platforms will bring these savings within the reach of most providers.

The issue of Public Trust is vital to our vision. Our members routinely assess HIPAA and other privacy rules – and there are quite a few – and we do this to instill Public Trust in medical banking. We started an Accreditation Review Council that will assure providers that the banks they use are HIPAA compliant. MBProject drove HIPAA into the banking world to win Public Trust. We know that privacy issues will evolve so we facilitate cross-industry dialogue with policy makers, industry groups and others who strive to keep our information confidential.

Today banks are locked into an Identity Theft Arms Race. How else can they keep your trust? One privacy institute - Ponemon – did a study showing that 57% of a bank’s online consumers will bolt if there is one breach of privacy. They also asked 30,000 business leaders what institution they trust. Guess who it was? The bank is who they trust the most. So make no mistake about it, security and privacy in banking is a top concern, and this bodes well for medical banking, especially as we roll out pilots that focus on point of service access to the current deductible, funded by UnitedHealthcare, and another pilot using online banking to distribute personal health records.

In a consumer-driven world, banks are becoming an epicenter for consumer research about their health conditions – our third area of focus. 4.5 million consumers use HSAs today; they’re now being offered by 1600 banks, up from less than 100, just 2 years ago. As banks compete for this new market, new consumer tools are being linked to banking systems, from Subimo, ConnectYourCare, or Best Doctors, that help the consumer to manage their HSA, select a provider or use new “health-wealth” calculators that predict health expenses and help families to better plan for retirement.

Economically speaking, banks want HSA holders to become wise healthcare consumers, because choosing better healthcare will keep more money in the bank. We started a joint task group with the Automotive Industry Action Group that address value in health and Sanofi-Aventis is helping us in this effort. Billions of dollars are at stake. This incentive aligns well with employers who need a healthy workforce, public policy, and ultimately the individual and family, where the head of household wants better health information, and I might add, turns to online banking for convenience and simplicity. This is why banks are emerging as a health information broker, and understanding what this means to marketing hospital services is important.

Finally, we envision banks offering a way to coordinate community healthcare programs, helping safety net providers to care for the underserved, and we link this population to the 40 million unbanked households because the demographic overlaps and this is quite a banking challenge – just as much as the uninsured is a health challenge. Targeting this group can solve problems for both camps, and so we believe that banks and employers will easily see that they can’t offer HSAs while winking at the underserved. It’s not in their best interest, and there are already new employer initiatives addressing this. Our initiative in this area is called CarevilleTV, rebranded from Charitable Communities Network. We believe that serving this market requires easy-to-understand communication programs that offer objective news on consumer options in the community.

In conclusion, as they say in sports, it’s important to keep your eye on the ball. Getting involved in medical banking is a good idea as it begins to shape our common destiny. Banks working with health IT firms can increase efficiency in many ways and they offer a stable partner in your revenue cycle that can deliver long term dividends. That’s what hospital CEOs are telling us they want to see, and it’s really where medical banking shows its greatest promise. Thank-you.

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