With apologies to Nobel Prize winning economist Milton Friedman, there is a free lunch after all. Blue Cross of California has expanded a unique technology initiative to give 1,200 physicians either a complete desktop computer system or a personal digital assistant (PDAs)-free of charge.This is the second wave of the 21st century technology give-away program in the state, and targets physicians taking part in two safety-net health care plans-called the Medi-Cal and Healthy Family Insurance programs-for poor, uninsured or low-income patients.
The technology offer is aimed at doctors who for a variety of reasons are reluctant to enter the electronic world in their practice offices-even though they face an endless pile of paperwork.
The first wave of the unique initiative began in January 2004 when WellPoint Health Networks Inc., the Thousand Oaks, Calif.-based parent of Blue Cross of California, announced plans to distribute computers and PDAs to more than 19,000 contracting network physicians in California, Georgia, Missouri and Wisconsin. They are part of Blue Cross and/or Blue Shield plans that are operating units of WellPoint, one of the nation's largest health care insurers with $20.4 billion in revenues in 2003.
Some 22,178 physicians nationwide, including about 14,000 commercial and safety-net doctors in California, have or will soon benefit from the unique technology program, estimated to cost WellPoint $42 million.
The technology initiative offers physicians the choice of either a prescription improvement package that uses a PDA or a complete desktop computer system.
The prescription package includes a wireless Dell Axim X3i hand-held PDA, a wireless access point, and a one-year subscription to an electronic prescription service.
Physicians can use this system to write prescriptions and have them automatically faxed or e-mailed to the pharmacy of their choice.
It also provides critical information. For example, a part of the prescription package-called computerized physician order entry (CPOE)-has a built-in feature that warns against the possibility of drug interaction, allergy or overdose. Physicians also receive up-to-date information about new drugs when they are introduced into the market.
CPOE provides drug-specific information that can eliminate confusion among drug names that sound alike, improve communication between physicians and pharmacists and reduce health care costs due to improved efficiencies and fewer errors.
The other technology choice is called the paperwork reduction package. It consists of a Dell Optiplex GX270 computer, monitor, keyboard and printer intended to facilitate online communication, including paperless submission of claims between a physician and the insurer.
Targeted at physicians who are not making full daily use of computer technology or the Internet in their office practices, the system provides the basic infrastructure they need for online communication.
Blue Cross estimates thousands of physicians still are manually processing paper claims, which adds administrative cost and time to an already burdened health care delivery system.
By choosing the computer system that works directly with existing Blue Cross/WellPoint IT platforms, physicians can use an Internet connection to submit claims, receive reimbursements, and track and provide patient information in a more timely fashion.
WellPoint also is offering a substantial discount on the same equipment choices to all network doctors throughout the country who are in good standing.
Time is right
The motivation behind the technology give-away initiative is the relatively slow response of physicians to acquire information technologies for their offices.
"Physicians, whose overhead is already high enough, traditionally haven't invested much in their practices beyond space and personnel," says Dr. Jeff Kamil, vice president and corporate medical director for Blue Cross of California.
"They are comfortable with the way they perform their work and are concerned about introducing technologies into their offices that might change workflow or be misused by staff," he adds.
Kamil believes the time is right for health insurers to champion the use of technologies that can provide greater access to information and data exchange with providers via the Internet or wireless hand-held devices. "Today, physicians can do more with computers to lower administrative costs, and most health plans have information available online that can be of great value to physicians," Kamil says.
So far the majority of physicians see greater value in the computer package. In California, 80% of the physicians in the program have selected the Dell package; the remaining 20% have chosen the personal digital assistant. Perhaps that's because the PDA requires the office to already have electronic medical records (EMR) technology in place.
"We didn't initiate the program just to make Blue Cross of California (or WellPoint) look good, but that certainly has been an added benefit," says Kamil.
"We created the program because this is a great opportunity to get 21st century information technology out to the physician in their offices without them having to make the dollar investment themselves," he says.
The more physicians who can communicate electronically with the insurer, the more improvement the company will see in the delivery of medical care and the reduction in costs of delivering services, he adds.
Kamil also hopes the Blue Cross/WellPoint initiative will motivate more physicians to use the Web to get information they need, rather than making a telephone call to the service center.
"It costs next to nothing if they use the (IT) system to contact us," notes Kamil. "But it costs tens of dollars for us to answer a phone call to give them the same information that they can get electronically."
On the pharmacy side of the business, Blue Cross of California hopes the PDAs will drive network doctors to use the most appropriate drug at the lowest possible cost.
"The PDA makes it easier to look up drugs and see the options a little more easily," Kamil says.
"Right now, physicians receive most of their pharmacy information from drug company representatives who rarely talk about generic drugs. Those representatives typically describe the drugs with the most pharmaceutical 'bang for the buck,' rather than explaining about lower cost alternatives," he says.
One doctor in the program was surprised by the technology give-away. "At first I said, 'Blue Cross is giving away stuff. Companies don't give away stuff,'" says Dr. Vicky Valverde-Salas, a family health physician in Oakland, Calif., who accepted the Dell computer with all the trimmings.
Yet, he doesn't view it as a public relations stunt. "I don't think that's what motivated Blue Cross," Valverde-Salas says. "Rather, the company is trying to bring people along who aren't using (modern) technology tools and who aren't tech savvy.
"Blue Cross is trying to get people who are like anchors weighing down the ship to use technology-because if everybody took part in electronic billing, it would be less costly and much easier for Blue Cross to do business," he adds. "If they can get even 10% of the stragglers to join the electronic age, the company will be that much ahead."
Valverde-Salas, who sees 30 to 40 patients per day, reasons if he spends less time worrying about his billings, that's more time he can spend with his patients and his business.
Selecting the Dell computer-which he upgraded by adding more memory, a DVD player and CD writer-Valverde-Salas is using it for paperless submission of claims.
"With paper, it takes about a month to get reimbursed. And, if there is a mistake, you have to resubmit the claim, and the processing takes two months. If I submit claims electronically, the turnaround time is 10 days to two weeks."
Because technology is so critical to the industry, Blue Cross of California plans to extend its offerings to more doctors to achieve greater efficiencies, improve patient care, and improve administrative functions for the insurer and the physician.
The next likely goal will be to motivate more physicians to start using electronic medical records (EMR)-a prerequisite for using the PDA and its e-pharmacy features.
"EMR has a number of components, some of which are software-based. We could add some features of EMR into our technology program if physicians were interested. It would be great if doctors could get lab values or radiological tests integrated into the patient's electronic medical record," adds Kamil.
Brian S. Moskal is a Chicago-based business and financial writer.
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