When he’s not solving another industry problem, BP Fulmer, a former commercial airline pilot with many years of experience in cash management banking and healthcare, is running ACS’ Commercial EDI Gateway. As the Executive Director of this program, BP has seen first hand the need for integrating banking systems and know-how into the healthcare system. He often likens his journey starting with a 15 year stint in banking to "entering a dark cave" when he started his work in healthcare. BP has managed state Medicaid programs and energized a new "EDI Gateway" program at ACS that provides outsourced services to health plans and others.
Besides all this, BP serves as the President of the National Medical Banking Institute series, an educational arm of the Medical Banking Project. Under his guidance, the Institute formed a new President’s Council with leading domain experts. We asked BP what he thinks about medical banking in general, and what he hopes to accomplish at the Institute.
BP, do you think "medical banking" represents a paradigm shift in electronic processing in healthcare?
There is no doubt in my mind that banks are poised to become a major influence in the movement of healthcare records and transactions. The infrastructure is already in place to provide data and transaction switch and routing services over some of the most secure and efficient communications networks in the world. While there will be some needs to modify the transaction sets and the capability of these networks to accommodate them the connectivity to the healthcare provider community already exists. The impediment that exists today are the banks themselves. There exists virtually no healthcare transaction domain experience in banks and banks, by nature, are cautious to move into markets that they do not understand. By the way, this is good. It is one of the reasons why banks enjoy such high levels of consumer confidence.
How do you think the banks view the idea of medical banking?
Some are totally bewildered, others are like deer in the headlights not knowing which way to go, and a few (very few) have figured it out that because of the evidence in the farm there must be a pony somewhere. But, I do believe that banks, in general, recognize healthcare as perhaps the last business sector there is to conquer and there are literally trillions of dollars at stake.
What kinds of improvements in healthcare do you see coming out of the medical banking ‘movement’?
Most of the improvements are tied to making the administrative side of healthcare transaction process and settlement more efficient. The real time nature of the banking and credit card networks will support the move to online adjudication (or near adjudication) of claims, eligibility, deductibles and status a reality. For PHR/EHR to have a chance of achieving their full impact on the delivery of healthcare we must have the real time networking capability that banks already enjoy. It makes sense for us to turn to banks for leadership and networking expertise.
What do you think the Medical Banking Institute should offer to the industry at large?
The Medical Banking Institute is the only place of which I am aware that brings together some of the best minds from healthcare and financial services to create an open forum for the dissemination, discussion, study and debate of the various alternative resources and methods of streamlining the movement and processing of healthcare transactions and data that exist today. But more important, it is the only forum actively involved in fostering and supporting the development of solutions for the future. Solutions that must involve the cooperative interaction of banks, clearinghouses, practice management vendors, providers and payers.
What’s the most exciting thing, in your opinion, that is happening at the Medical Banking Institute in March?
Aside from the fact that this will be the largest and most successful Medical Banking Institute in its five year history I am excited about the diversity of the organizations that well be represented as attendees and sponsors.
Also, there will be several sessions dedicated to the impact of CDHC on the healthcare market. I am fascinated as to how CDHC (otherwise know as "The great risk shift to providers and consumers") has almost dominated the national healthcare debate. (I suppose RHIO’s and PHE/EHR are right up there as well.) Two years ago I was concerned that high deductible plans would create financial burdens on consumers and providers resulting in "push back" from both groups. It didn’t take a genius to figure that one out. But what is interesting is that payers and employers are beginning to feel this "push back" because providers are beginning to question whether it is worth taking patients on these high deductible plans due to the credit risk and their bad debt experience with these patients. The assumption is this could threaten "in plan" provider access and the relevance of payers to provider networks.
About B.P. Fulmer
B.P. Fulmer joined ACS three and one-half years ago and currently serves as Executive Director of ACS Commercial EDI. Mr. Fulmer has served in this position since November 2004. In this position he has been charged with developing a commercial services unit that operates as part of the ACS EDI Gateway. The ACS EDI Gateway processes over 750 million EDI transactions a year and is connected to 61,000 submitters representing over 250,000 providers. Mr. Fulmer has 17 years of banking and financial services management experience plus 15 years healthcare transaction processing management experience. Mr. Fulmer’s banking experience includes serving as a bank examiner, check transit operations, correspondent banking, Comerica banking, electronic funds transfer and running cash and treasury management services at two regional banks. Mr. Fulmer’s healthcare transaction management experience includes responsibility of running the Medicaid Fiscal Agent operations for ACS and First Health Services in Florida, Georgia, Tennessee and New Mexico (twice). He has run a medical billing services company and an internet based practice management software development firm. This experience gives Mr. Fulmer both the payers and providers prospective of the healthcare transaction. Mr. Fulmer brings a unique prospective to the Medical Banking Institute as President (2005- current) in that he has extensive experience in banking and healthcare and has a track record of innovation in both fields.