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.

What's Holding Up Those Darned EMRs?

Posted by ED

<ed.note><This is an "ed-itorial" so don't yell at the MBP folks.</ed.note>

<ed.note><Update>: Alton Brantley, MD, PhD, at CCIGroup.org, sent me this very helpful clarification: Ed, The "Health Information Technician" job that you are picking up on is the job description for a person working in Health Information Management which is, today, responsible for handling and codifying paper information. See this. These persons are not informaticists. Informaticists are generally physicians, nurses, and other medical professionals who specialize in understanding medical care processes. They are generally funded at their primary capability level (doctor, nurse, etc).

In a follow up email he adds:

The field of medicine, just like any other discipline, has its own terms. The "Health Information Management" activity used to be known simply as "Medical Records" which was not easily confused with Information Technology or Systems.

There are, in fact, numerous programs to develop health informaticists, funded through the National Library of Medicine. That would be where you should start looking. Generally, one can also get masters degrees in (e.g.) nursing with a focus in information technology and management. The important point is that medical IT is not something one comes at functionally from the technology side. Systems analysts who work in health care settings, over time, learn the applied skills.

Health Care IT is by and large driven by the vendors in the field, as hospitals do not consider developing IT to be part of their core mission. (I've always thought this strange, because many companies such as FedEx are not not IT companies either, but they develop IT systems to drive their business).</Update></ed.note>

Where are the health informaticists necessary to build out the distributed, digital healthcare enterprise? The following is just another factor under the rubric of you get what you incent:

The National Science Foundation’s Federal Cyber Service
The National Science Foundation’s (NSF) Federal Cyber Service Scholarship For Service (SFS) is a unique program designed to increase and strengthen the cadre of federal information assurance professionals that protect the government's critical information infrastructure (NSF, DHS, OPMn NSA, Office of Management and Budget (OMB), Department of Treasury). This program provides scholarships that fully fund the typical costs that students pay for books, tuition, and room and board while attending an approved institution of higher learning. Additionally, participants receive stipends of up to $8,000 for undergraduate and $12,000 for graduate students. The scholarships are funded through grants awarded by the National Science Foundation NSF.

The National Institutes of Health Loan Repayment Programs
NIH Loan Repayment Programs are a vital component of our nation's efforts to attract health professionals to careers in clinical, pediatric, health disparities, or contraception and infertility research. In exchange for a two or three-year (for Intramural General Research) commitment to your research career, NIH will repay up to $35,000 per year of your qualified educational debt. In addition, the NIH will make corresponding Federal tax payments for credit to your Internal Revenue Service tax account at the rate of 39% of each loan repayment to cover your increased Federal taxes. The NIH may also reimburse any increased state or local taxes and/or additional increased Federal taxes (where the Federal tax payments were not sufficient to fully cover your increased Federal taxes) that you incur as a result of your LRP benefits.

Nationwide Health Information Network
So far as I know, Squat.

There is no fedgov educational funding or loan repayment or deferment to "convert" the general post dot com bust out of work IT worker into a health informaticist; and even if there were, they couldn't afford to work in the profession. Please see the following:

From http://www.tnhealthcareers.com/html/him.htm
Health Information Technician – $23,530*
*average median annual earnings

From http://www.usnews.com/usnews/biztech/best_careers_2007/careertable.htm
Clergy - $78,690
Higher Ed. Administr. - $109,557
Management Cnsltnt. - $96,245
Systems Analyst - $70,438

Add to this the pressures to outsource, offshore and down-salary. If you've heard differently, please let me know and I'll post the info here.

Value in Health - Day One Post 3

Posted by ED Wednesday a.m.

Tuesday's first panel was led by Joe Fortuna. The panel focused on the economic imparatives of the "value-driven healthcare movement": reducing costs and improving quality. June St. John, Eric Racine, David Hom, and Edward Rutkowski were the scheduled participants.

Background
The Joint Taskgroup for Value In Health was organized by the Medical Banking Project and the Automotive Industry Action Group (AIAG) to organize pilot programs that demonstrate how banks can improve the quality of healthcare as opposed to focusing strictly on how banks can reduce transaction costs.

AIAG is a globally recognized organization founded in 1982 by a group of visionary managers from DaimlerChrysler, Ford Motor Company, and General Motors; to provide an open forum where members cooperate in developing and promoting solutions that enhance the prosperity of the automotive industry. AIAG's focus is to continuously improve business processes and practices involving trading partners throughout the supply chain.

At MBProject’s 2006 DC Leadership Forum, a spokesperson for the 1600-employer strong AIAG suggested that banks could impact healthcare in ways that go beyond reduction in costs. Entitled “I Have A Dream”, Joe Fortuna, MD, CMO for Delphi Corporation and leader of AIAG’s Health Focus area, outlined new directions for banking. Dr. Fortuna also serves as the AIAG representative on the Advisory Board of MBProject’s C.O.M.B.A.T. Initiative.

After several meetings and a feasibility session that met in Detroit with the major automakers, large banks, a state medical society, a hospital forum and others, MBProject and AIAG decided to launch a new joint effort that will promote the bank’s role in fostering “value in health”. This effort looks beyond reducing transaction costs to utilizing the entire enterprise to support better choices for health and healthcare.

Working Efforts
MBProject and AIAG will foster an open dialogue through multiple sessions at MBProject forums and the AIAG AutoMed show. In addition, the Joint Taskgroup is scheduling meetings in Detroit throughout 2007.

While the mission, strategy and objectives of the Joint Taskgroup are in draft mode, the group is expected to formally support one or more E/PHR Use Cases that will be implemented under the C.O.M.B.A.T. Initiative. As pilot programs are executed, results will be made available to Members at our forums and summaries will be communicated through the Institute series and other appropriate channels.

Participants : (as of 9/2006)
Automotive Industry Action Group
Arvin Meritor
BearingPoint, Inc.
DaimlerChrysler
Ford Motor Company
Medical Banking Project
Michigan State Medical Society
Novartis
PNC Bank
PPG Industries
President’s Council, Medical Banking Institute
PricewaterhouseCoopers LLC
Sanofi-Aventis
Wachovia N.A.

For more information call the Medical Banking Project at 615.794.2009 or visit www.mbproject.org. You can also leave a comment at the blog post and MBP will follow up.

John Casillas Keynote - Day One Post 2

Posted by ED Wednesday a.m.

This is a placeholder post. When I get a copy of John's well received keynote I'll link it here. [ Update: Please check the "Continue Reading" link below for John's transcript. ]

Tangentially, I had lunch with John and John H. English. John E. studies the effectiveness of conferences as tools of persuasion.

I want to invite you on a journey – a digital pathway to better health. You know, one of my favorite movies growing up was The Wizard of Oz. I loved the journey following “the yellow brick road” into a land of imagination and fascination. We watched the Tin Man, who needed a heart, the Lion who wanted Courage, and the Scare Crow who wanted a brain. If ever there was need for these three things – a heart, courage and a brain full of wisdom – now is the time as we face a broad and deepening healthcare crisis in America. Now, I’m no wizard, but I’ve been on a journey for the past 11 years that I believe, in fact I’m positive, will solve one of the most vexing problems our country has ever faced – universal access to quality healthcare at a reasonable cost.

If you’re a first timer I’d like to welcome you to a group that thinks outside the “lockbox”. Our conference is composed of visionaries with great imagination who have entered their own “medical banking” journeys and have fascinating stories. They join our journey – a journey of imagination, a journey of discovery, a journey of seeking answers to a quagmire that has stumped an entire industry, in fact, it has stumped an entire nation.

Soon you’ll hear exciting new terms that form the basis for a holistic approach to the solution we’ve been searching for. Terms like Bank-Driven Revenue Cycle Management, Bank-driven Electronic and Personal Healthcare Records, Value-In-Health, Health Record Banks and the Mega-community. That last one was coined by Booz Allen in a global study examining how diverse stakeholders successfully converged to solve complex social issues. Most well-informed, reasonable folks agree that our healthcare crisis demands a community approach. This is a key element of what the Institute offers you – a cross-industry gathering place.

So if you’re a first timer, like the National Governors Association, Office of the National Coordinator, American Dental Association, Centers for Disease Control or the Pentagon, we’re going to take you on a journey in search of Oz. I’d ask you to keep an open mind to free up your imagination because many people here today – powerful, articulate, intelligent, imaginative people – have reached the same conclusion about unlocking the magical key of banking to finally attain the goal of which I speak.

I must confess, the journey at times has been terribly lonely…but not anymore! Take a look at our Membership – over 50 leading firms that have embraced our journey, fueling the medical banking movement. I’m happy to say that one by one the groups assembled here have engaged. My heartfelt thanks goes out to the President’s Council, Track Chairs and our Speakers. I want to especially acknowledge the Members of the Medical Banking Project for without your support, our journey to build a better future would come to an end. You are contributing valuable insight to where we should be going; like the CIO of Walt Disney. This week Tony Scott is promoting MBProject in New York to the C-Level brass of the Top 50 companies in America. Like Tony, I invite you to contribute the medical banking ideas you’ve learned here and to fully engage in the dynamic collaborative process here at the 5^th National Medical Banking Institute.

During the next 2 days we’re going to tell you about exciting developments to streamline runaway healthcare costs. You’ll see vivid, concrete examples of how banks have demonstrated beyond a shadow of doubt that this plan of which I speak of has amazing potential. Indeed PNC’s case study will show how one healthcare group saved $4 million last year alone. These early successes solidify our position that banks can save our healthcare system over $35 billion annually just in remittance management, which we consider phase one of the medical banking build-out. That means there’s a whole lot more in savings to go!

I invite you to focus on Three Big Ideas this morning that have the power to transform healthcare. First, I’m going to tell you about MBProject’s Pilot Programs, what they are and why you should support them. Second, I want to introduce you to the idea of Banks serving as Infomediaries, which is crucial for grasping the holistic role of banks driving better value in healthcare, and finally, I want to share our deep conviction that a Common Medical Banking Platform will galvanize our industry and pave our digital pathway to better health.

So let’s start with our Pilot Programs. MBProject has worked hard to establish 2 new Pilot Programs, both managed under our C.O.M.B.A.T. Initiative we started in June 2005 at the Vanderbilt Center for Better Health. It stands for “Cooperative Open-source Medical Banking Architecture & Technology”, and our mission with this is to combat the rising cost of healthcare using medical banking principles and technology. The first one, our HSA Accumulator Use Case, supports pricing transparency in healthcare and lays the groundwork for real time payments. I want to thank PricewaterhouseCoopers for managing this program, and Exante Bank, who some people may not know ponied up $110,000 for this Use Case. I applaud their vision and leadership to help us to continue our journey; in fact, we dedicated our Educational Grantorship to them to recognize what they’ve done. I believe they deserve a lot of credit. By the way, a volunteer for a follow-up Use Case has already surfaced – ACS – that will prove out a model that prices the claim at point of service. Together, the Use Cases get us nearer to our goal of ubiquitous real time payment solutions for healthcare.

Our second Pilot Program represents an historic opportunity for a sponsor who understands the potential returns just like Exante did. This pilot program will enable banks and healthcare groups to establish a Medical Internet that will make Personal Healthcare Records accessible to every family in America, and at the same time provides access to Electronic Medical Records to every physician. This is a key element in any national healthcare information build-out because less than 15% of our doctors use EHRs today, and before we can have real time access to our data it must be lifted off the paper! This Use Case offers a formula that achieves this goal in a profitable way.

Now, a word about these Pilot Programs: Global events herald the inevitability of an emerging eHealth ecosystem linked to banks – a medical banking ecosystem. Ask the UK, Australia, Germany, the European Union, Canada and you’ll find that Banks acting as Infomediaries is where this is all heading. They see the writing on the wall. So I ask the question: Is your bank an eHealth infomediary? You ask what’s that? Fair question: let’s break the term down into three components so that you can answer this question for your organization.

First, an Infomediary delivers administrative efficiency – using your IT capabilities to transform the extreme paper chase in healthcare to a digital stream that automates timely and accurate information to your business and retail costumers; second, it involves creating a new mechanism within your existing IT infrastructure to support clinical data exchanges; and, finally, an infomediary delivers quality information that improves the health of your account holders in your new role as health information brokers. I bet most banks didn’t think in 2000 that they’d be health information brokers in 2007. The change is happening fairly quickly. And you know, it doesn’t take a rocket scientist to see the health-wealth equation: healthy HSA holders means more assets for your bank. Now that describes a holistic attitude for banks in the new area of consumer-driven healthcare. The numbers are just too compelling and the incentive for banks is as clear as the noon day.

I know someone out there is asking the question, why banks? In 1995 I interviewed 125 bank CEOs and since then hundreds more to develop the thesis of medical banking. This question drove me on a fascinating journey and fuels my desire to make events like this happen.

In short, banks offer existing processes, systems and infrastructure, coupled with billions of dollars in ongoing investments that assure identity, high value data movement with amazing levels of integrity, and consumer and community-focused public relations. It’s a powerful package that the healthcare system can use today, but without another critical element we haven’t discussed yet, its not complete: and that is Public Trust. Banks have it and you know that without you’re nothing. All successful banks thrive on Public Trust; thus reputational risk must be carefully evaluated to ensure that this towering standard is met for all medical banking services. By the way, the OCC and Federal Reserve are on record as agreeing with our position that banks can offer health data exchanges. And we will continue to engage Privacy Groups to help steer our important journey.

Ladies and gentlemen, we are accelerating towards a digital world and the possibility of being left behind is very real. Who wants to be left behind? Getting involved is imperative, especially if we want to help our healthcare system, and I know that the members of MBProject do. We’ve mapped out a digital pathway for you today but its up to you to take the journey; its up to you to participate. Its not dependent upon you, because the environment will drive us there, but as a mega-community effort we’ll get there faster, and if you look at the rate of inflation in healthcare you know we have a very limited amount of time.

Because timing is of the essence, the 3^rd Big Idea I speak of today is our commitment to launch a Common Medical Banking Platform and an associated Accreditation Council or Board of Governors. This effort will achieve a powerful breakthrough for solving the vexing riddle of healthcare. The platform will energize the medical banking community to better serve the needs of healthcare, government, employers and the public.

Just like the ACH for executing electronic funds transfers, banks understand that if they follow common rules codified in bilateral trade and operating agreements, there will be continuity, consistency and accountability in transactional exchanges. This supports the bank’s reputation as a Trusted Entity for business – how important this is in a conservative industry like healthcare! Yet the current medical banking environment, like any new industry taking flight, has undergone the type of bumpy ride that the Wilbur Brothers experienced – but this didn’t stop them from pressing forward with their dream that man can fly.

Likewise, a Common Medical Banking Platform will help the medical banking community to take flight. It will serve all of our constituencies – banks, vendors, associations, like the Medical Group Management Association, that contacted MBProject to help solve an EFT riddle related to the National Provider Identifier. The platform would help these groups manage the complexity of ramping onto a digital environment. It will iron out the bumpy rides we might otherwise experience with ERAs, HSAs and PHRs, so that everyone benefits.

To meet this goal, MBProject is appointing a committee to draft plans for this platform and establishing a Board. We will focus on core “hybrid” transactions that will rapidly commoditize. The platform will create unity in standards and processes, but the sky will be the limit for competition. Supplemented with continuing education, so critical for navigating the complexities of this newly emerging segment, we will optimize our members’ chances for success. Finally, as investments in this space gather momentum it is critical to facilitate efficiency. It’s really MBProject’s obligation to the industry to lay the groundwork for that efficiency, and it will propel us towards reaching our destination of better health for everyone.

I was fascinated by Nebraska Senator Chuck Hagel’s recent Report recommending that a Federal Reserve Board-like commission could manage a healthcare transformation in America. It’s the second time in recent months that the Federal Reserve Board was referred to as an important model for healthcare – the other being the House version of the Independent Health Record Bank Act. Using this approach, a market-proven model for managing multiple layers of environmental complexity, is good and sound thinking.

Now, some folks take the idea of convergence between banks and healthcare too far. You never want a banker with a scalpel leaning over you on the operating table. But do you want to get online to get your financial and healthcare data using an ultra-secure site? According to a 2006 Global Security Survey by Unisys, the answer is emphatically yes; in fact, consumers will change banks for that kind of security. That same survey asked who should be trusted for your identity management? Guess what the answer was? Banks are who people trust the most.

Today, I challenge you to think more holistically when you use the term “medical banking”. The eHealth Lockbox is a really gateway that heralds a paradigm shift in multiple relationships – bank and providers, banks and health plans, banks and employers, the government, and the consumer. As an Infomediary the bank progressively moves the solution set from monetary exchanges to “health data liquidity” – both involve highly confidential data exchange systems. And don’t buy the argument that these systems can only move “thin” information – you absolutely can move much more complex information like healthcare records. As you do, and you most likely will, banks will support much greater efficiency in administrative transactions, clinical data exchanges, and consumer-friendly healthcare research that will help individuals live healthier lives.

You know I’m tired of the naysayers that say it can’t be done. They must not have read the headlines of the December 2006 issue of HealthLeaders screaming: THE BANKS ARE COMING! THE BANKS ARE COMING! Well I have some news for HealthLeaders, THE BANKS ARE HERE!

Friends, its time to follow the yellow brick road. Financial institutions are prepared to revolutionize healthcare to take us on a journey to where we’ve never been before. And the good news is that in the process this industry is going to make a lot of money, and while that sounds so self-serving its so very important, because we all know what happens to models that aren’t profitable and self-sustaining. A new medical banking ecosystem will bring down the costs of quality healthcare for everyone. Saving money in healthcare as a bank really makes money for everyone – a great win-win-win.

Did you know that there are more banks in attendance at this Institute than ever before? I think they must have realized just like many of us here that there’s a pot of gold at the end of this rainbow. And you know what? Sitting in the audience today are some investment bankers who 48 hours from now will be knocking down the door to be first in line to help launch this new mega-community.

I challenge you to get involved in the medical banking movement. Its shaping new ideas that will improve global healthcare. Our HSA Use Case, E/PHR Use Case, and Common Medical Banking Platform will challenge the status quo and its failing approach to healthcare.

In the process of creating this new Land of Oz all of us must have a holistic consciousness of serving the community at large, because in approaching this task with that in mind in the long run, that approach will benefit everyone. It will help manage the cost, underwrite a robust bottom line, modify consumer behavior, and be socially responsible – in essence everyone will benefit from the pot of gold at the end of the rainbow.

So many people talk to me with dollar signs in their eyes, anxious to take that pot of gold and place it in their profit column. But the critical interdependencies in healthcare are so broad that everyone must benefit, or we all will fail. This isn’t an individual endeavor, its a mega-community effort and its fruits are programs that are self-sustaining. We’ve already proved that so far with the eHealth Lockbox model and its really these types of programs that have a far better chance of guaranteeing we can provide universal access to healthcare at a reasonable cost.

A February 2007 article in the Harvard Business Review sketches an interview with the chairman of one of the largest banks in the world, who claimed that civil society groups like the Medical Banking Project, have realized that carefully calibrated business models can unleash powerful forces for good, and at the same time open the door to new profitable markets. That’s what MBProject is all about. Our mission is to convert digital savings into charitable resources.

Sometimes it seems that we want to kill the goose that lays the golden egg. We must be realistic about what employers can do to help families realize the American dream of a quality livelihood. That’s why we are joining with large employers to forge a new alliance between banks and healthcare groups. Our healthcare is our collective responsibility.

In the final analysis this isn’t a question of technology, is it? It’s a question of passion and will. It’s a question of where the public really puts its trust. It’s a question of what consumers, of what you will do to keep your family safe and secure, both today and during the difficult times of natural and man-made disaster. That’s why MBProject supports our Unified Platform Initiative that links financial, healthcare and homeland security functions. Look at the aftermath of Katrina and you’ll find an acute need for a platform that does just this – emergency access, with positive ID, to financial and healthcare records, and to eliminate fraud and abuse during this time of severe stress.

To save our healthcare system takes strategic players who understand consumerism – another plus for banks – and it is especially important to address the immense stresses of our community safety net. Banks and employers cannot offer HSAs while winking at the problem of the underserved. Our journey to solve the healthcare crisis will stop dead in its tracks if we don’t solve the underserved and unbanked problem. Both of these camps come together in a medical banking paradigm. Do you see that? In the solution of which I speak, a person without a bank account – which could be a Universal Health Account – couldn’t access their healthcare record because these two are systemically linked in the banking and healthcare systems. This is why MBProject will continue to support what we call a “community care platform” and our version of it, Charitable Communities Network.

I like the old sports adage that you’ve got to keep your eye on the ball. We must stay focused. To build a bank infomediary requires focusing on the communities where we live and work – something banks excel at – especially as federal, state and local governments develop healthcare policy, standards and regulations. Well informed in medical banking means forewarned. Do you know who your state CIO is for healthcare?

In closing, I was on a panel at a national event in Chicago with naysayers when the moderator leaned over to me and said, “Medical banking is all about solutions, isn’t it?” I couldn’t have said it better. Our digital path to better health is a fascinating journey that is ripe with opportunity. My question today is will you help? You might ask how. I think I’ve provided that answer this morning.

Stay active in the Medical Banking Project by supporting our Use Cases that target strategic areas that move this industry forward. Learn about our Common Medical Banking Platform as we lay plans to make this available. And above all, think holistically about the bank’s role in healthcare. Let us help you to connect the dots during the next two days and bring you to the conclusion that the bank acting as an Infomediary, holistically deploying its assets with a profit motive, is a powerful idea that will support better healthcare for a long, long time.

Keeping these important ideas in mind you’ll join a growing mega-community of supporters who are on a medical banking journey, building uniquely powerful solutions that support universal access to quality healthcare at reasonable costs. Yes, we’re off to see the Wizard, the wonderful Wizard of Oz!

5th Medical Banking Institute - Day One Post 1

Posted by ED Wednesday a.m.

Yesterday BP Fulmer, President, Medical Banking Institute and the Executive Director of Commercial EDI Services, ACS, greeted the over 150 participants here in his stomping grounds of Atlanta at the Marietta Conference Center & Resort in Marietta, GA. The registration activity leading up to the event  was especially heavy the last few weeks. Later in the day BP was honored as one of two Medical Banking Persons of the Year by John Casillas, the Founder and Executive Director of the Medical Banking Project and the Chair of the Institute. ( Joe Fortuna was the other ).

BP's comments went something like this:

Welcome to the Fifth National Medical Banking Institute.  We hope this will be a unique learning and networking experience for you.

Many hours of work have been put into the planning and development of this program.  The leadership and staff of the Medical Banking Project and the members of the President’s Council, particularly the Education and Programming Subcommittee chaired by Maureen Turo, have provided guidance and direction in defining the focus and scope of the topics that will be explored and the speakers you will be hearing.

We have drawn on the knowledge of many industry experts from all sectors of the market including banking, healthcare providers, payer organizations, large employers and vendors. I am certain there is no other conference or seminar available that will provide you with this broad range of learning opportunities.

Medical Banking is in its formative stage of development today. Your presence signifies that you and the organizations represented here are progressive thought leaders that can truly have an influence on streamlining the healthcare revenue cycle as well as the delivery of healthcare data that will improve our system.

We believe that, together with you, we can shape the development of this exciting new frontier.

WELCOME to the first edition of MBlog!

You've found the spot where we will follow annoucements at the 5th National Medical Banking Institute and publish interviews with industry leaders. Through high value working sessions, the Institute sets the national agenda for what is coming down the pike in the new field of Medical Banking. We are directing all of our press contacts to MBlog for the latest information.

Some of the innovations we'll be exploring via interviews with conference attendees include real time payment in healthcare, bank-driven electronic healthcare (which can save lives), best practices in bank-driven revenue cycle management (shaving $35 billion annually off the paper chase), new work between pharmaceuticals and banks that will improve healthcare and much more. Hear about Dr. HSA's plan for better pricing transparency and learn about critical privacy and confidentiality issues that we must embrace if we are to seriously contemplate a digital ecosystem in healthcare.

It'll all be posted here so stay tuned!

I want to thank our "resident blogger" - Ed Dodds - for making this site possible and providing content management assistance. Ed, founder of the Congmergence blog, has instigated multiple relationships for MBProject because of his sheer passion for this topic. We appreciate his help to make the "Medical Banking Blog" a reality.

Coming soon: Interviews with Dean Mason, President of Exante Bank, the 5th National Medical Banking Institute's Educational Grantor; Roy Ramthun, former economic advisor to the Bush Administration; BP Fulmer, president of the Institute and facilitator of MBProject's new President's Council; and more...

John Casillas
Founder of MBProject and the National Medical Banking Institute series