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, [email protected]

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.