Wouldn't it be fantastic if workers' comp payers moved to "Multi-Payor Portals to Maximize Provider Satisfaction & Streamline Payments"? See flyer below about the Healthcare Payments Solutions Expo of 2009. I know nothing about it, but VERY big players will be presenting.
Unfortunately, since commercial payers (insurers, TPAs, health plans, HMO's) are mostly financial transaction companies, they tend to think of their payment processes as a key part of their competitive advantage --- as in, " we're easier to work with than they are " , " our processes catch more problems than theirs do," etc. So they are unlikely to actually join together to do this unless forced to by external forces. ....such as maybe huge infusions of government cash. What do you bet?
My original vision for Webility (our for profit training and consulting company) was that we would build a multi-payer "communications utility" and handle the 100-200 million communications about SAW/RTW that occur yearly between multiple parties: employers, insurers, providers. Similar to the challenge of getting payers together for consolidated PAYMENT utilities, the claims handlers, managed care/disability companies, etc. were actively uninterested in funding development of (or even using) a COMMUNICATIONS utility, precisely because they viewed their ability to communicate more effectively than "the other guy" as another competitive advantage.
So, in other words, although competition SUPPOSEDLY serves the marketplace well because it allows payers with better payment processes and more effective communications methods to stand out and win market share, that is (pardon my French ) b.s. The actual result is fragmentation, cacaphony, and astounding inefficiency -- and patients falling between the cracks, productivity and jobs being lost, and dollars being wasted.
When I read the Institute of Medicine's book on the state of healthcare in the US, I became so depressed I stopped reading after two chapters. What they failed to say -- but what shone out of every single page -- was the FAILURE OF ENTREPRENEURIAL CAPITALISM to meet the AGGREGATE needs of the society --- and the ABDICATION OF GOVERNMENT from its rightful responsibility for assuring the public's health. Personally, I am NOT in favor of the government taking over the actual doing of the healthcare work, and delivering of services individuals. I DO SEE its rightful role in setting priorities, establishing expectations and ground rules, and designing specifications for a system that then the private sector competes within and delivers services. In my view, the government should take charge of designing and assuring the adequate performance of the DELIVERY system, not just the payment system.
So, I guess in some ways, I'd like to see us (the whole US) engage in a nationwide initiative similar to The 60 Summits Project (the non-profit organization we run), but for healthcare in general. First, assemble a group of wise experts of good will from many sectors / stakeholder groups and invite them to dialogue and develop a vision -- a set of principles and features and general design specifications that a good healthcare system must meet -- and have that serve as the blueprint for system improvement. Sort of like a Healthcare Declaration of Independence and Constitution. Take it around the country, and build buy-in and refine it through many public meetings. And in those meetings, push people (including legislators, regulators, politicians, healthcare industry businesses, NON-healthcare businesses, etc. etc. ) to start thinking about how to embody those values/principles/specifications in actual laws / regulations / insurance policies, business policies and contracts, etc. etc.
Without that guiding document to serve as the intellectual framework, and without an orderly process of building agreement around a solid foundation of core commitments, we're left with political sausage making, and the tussle of powerful vested interests and balancing of power, which is frighteningly likely to result in random surgery and mutations of the astounding hodgepodge of a healthcare non-system that we have today.
Jennifer Christian, MD, MPH
President, Webility Corporation www.webility.md
Founder & Chair, The 60 Summits Project www.60summits.org
Selected news releases for today's health care executives
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Register by May 8th and Save $300, Mention Promo Code HFD938
 July 28-30, 2009 The only event that brings together payers and providers to capture the $64 billion opportunity of automating healthcare payments, addressing CDH billing issues and eliminating bad debt. The ONLY conference of it’s kind with 10 Payer Case Studies and 9 Provider Case Studies! Top Reasons to Attend:
Hear what Top-Performing Plans and Hospitals are doing in a 100% Case-Study Based Setting:
Register by May 8th and Save $300, Mention Promo Code HFD938 | ||||||
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