Smarter Web Sites Help Improve Managed Care Service: Capgemini

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Managed care organizations are using their Web sites to improve self-service options for members while also expanding assistance to providers, employers, group benefit managers, brokers and agents, according to a new study by Capgemini US LLC, Atlanta.

MCO sites are not just improving administrative efficiency, although this is still their top priority, says Capgemini, a consulting and research firm. Health care payers have added product support, such as calculators, to help members and employers manage new consumer-directed health care lines, including health savings accounts and flexible spending accounts, along with disease management programs and e-prescription tools for physicians

Conducted in October 2004, the survey analyzed 97 external, public Web sites offered by MCOs around the country, including Blue Cross Blue Shield and commercial health plans, nonprofit and for-profit plans, small regional plans and national chains. Capgemini also interviewed payer Webmasters to get their views on trends.

Among MCOs adding useful new functions to Web sites, Blue Cross/Blue Shield of Michigan applied its WebDENIS (Dial-in Eligibility Network and Information System) program to handle transactions in high volume, enabling it to cut traditional phone inquiries by 75% from its heaviest employer-users, according to Capgemini.

Blue Cross Blue Shield of South Carolina offered e-prescribing tools for physicians along with a new voice-chatting capability that allows physician staffs to check patient eligibility and other data through their office PCs. Another convenience for providers: a customized directory that stores basic patient information and automatically fills in online claim forms with that information.

Another BCBS organization, Blue Cross Blue Shield of Florida, recently redesigned its site to expand online services for physicians, brokers and employers. Among the innovations: customized reports for brokers such as lead tracking and commission statements.

In general, MCOs broker portals are still limited to providing static information, the study found. However, an increasing number are providing brokers with online access to plan descriptions, marketing materials, provider networks forms and so on. A small number also offer brokers price quotes, enrollment, renewal, billing or the ability to calculate commissions.

For employers, many sites offer health publications and wellness information while allowing them to enroll employees in plans and update member information.

Capgemini predicts that the next big push from employers will be for payer Web sites that help them control costs by providing plan members with online health risk assessments. In fact, 53% of sites now allow members to complete a health risk assessment, up from 30% last year.

Other survey findings:

–Health plans are giving members a wider variety of online administrative functions. In 2004, 66% allowed them to change information (up from 39% last year), change physicians (47% vs. 32%) and complete an enrollment application (42% vs. 28%).

–The vast majority of sites now have separate portals for providers (94%), employers (87%) and brokers (79%), as well as members (100%).

–Almost 70% of Web sites provide some online medical or disease management capabilities. The leading medical conditions targeted were diabetes and asthma.

While most payers are still not able to provide individually customized solutions or measure the exact financial return on their Web sites, most consider their sites very valuable, Capgemini says.

“But in order to take full advantage of the potential benefits, many still face the significant challenges of integrating their online functions with each other and with their legacy systems,” says John Distefano, a Capgemini vice president.


Reproduced from National Underwriter Edition, November 18, 2004. Copyright 2004 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.