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.