Cessna photos line the walls of the new ClaimTrust facility in Murfreesboro, TN, where CEO Joe Ferro is pacing the floor. He’s a pilot at heart and he’s very busy. I chat with his long time assistant who kindly presents me with a golf shirt with the ClaimsTrust logo. Joe is a burst of energy as he swings open his office door. I’ve known him for twenty years. He’s a health IT die-hard who is a stickler for details. He is anti-vaporware (software that just doesn’t work). So when we talk about bringing healthcare online, he’s got a few opinions.

Joe moved his company from Florida to Tennessee where he built a new facility. He's glad he made the move! Click on his pic to see his new website.

“John, we need to get the legacy system vendors to the table,” he says when I pry into his thoughts about moving to a digital platform. “Sure we’re all moving data in and out of the mainframe but to really fast track interoperability and health data liquidity the big systems need to be at the table.” He’s talking about the McKessons, Siemens, Meditechs, HMS’ and others who are the core systems in every hospital.

Joe brings hard core experience to the discussion. His new facility has garnered a number of accreditations and local accolades as well. He marches me into the digital brains of his operation after passing through double-enforced concrete walls and two heavy doors. Its impressive - over 50 robust servers are operating concurrently as air conditioners keep the temperature down. Everything is intricately organized down to the wire. I’m getting pretty familiar with the security layouts of data processing centers in my tour. In his facility everything is electronically logged and recorded. This truly represents the backbone of the emerging digital world. Amazing.

Joe’s primary effort is assessing fraudulent or abusive healthcare claims. In the mid-90s, he and his wife Kathy created a mammoth database comprised of the CCI (Medicare correct coding initiative) edits, LMRPs (local medical review policies) and other standards. Each claim that is introduced into his “black box” will undergo some 40 million editing permutations in sub-seconds to determine if its bogus or ok.

This is a good pointer in our “point and click expedition”; namely, that as we move to a digital platform its critical to ensure the appropriate checks and balances are in place for auditing the movement of data, and that the data is not fraudulent! The integrity of data is important, whether its claims coding analysis or determining where, when, why and how our personal information was exposed. Like the firms I spoke to earlier, Joe’s interest perks up when I mention our Gold Seal program. “Mark me down for that” he says.

Core to Joe’s business is claims coding. A medical claim is comprised of codes that are used to describe what happened during a patient visit. The codes are linked to payments and are tallied up to arrive at a final bill, sort of like a grocery list with product codes and pricing (for the consumers following our post). Up to 5% or more of all medical claims are considered “abusive” according to OIG standards (US Office of the Inspector General). That typically means they are overpaid – and the experts say such overpayments exceed $60 billion annually. Joe’s system detects this and alerts the sender of the claim – the healthcare provider – that there is a problem.

An area receiving a lot of focus today is the CMS “RAC” (recovery audit contractor) audits. The government is bulking up the program because it has successfully found billions of dollars in overpayments to Medicare providers. Joe is perfectly positioned to do this kind of work, providing a digital node in the health data highway that does the truck-side checks – making sure everything is legal. In the grand scheme of our emerging “digital highway”, that’s what ClaimTrust brings to the table. The name of the company truly tells the story.

Joe’s company adds a critical building block to the “health data grid” – trust and accountability are key to the point and click generation. His work fits his personality as a pilot who is absorbed in mitigating risk so that take-off and landing are flawless – 100% of the time. That’s something we all understand…and expect! Until next post…

Yesterday I was traveling on Route 840 south of Nashville and stopped at a 500 acre farm right across the street from a bankrupt golfing community. I met a 4th generation farmer who maintains a store on the property that serves up fresh milk from the diary. At first I just wanted to know about the property next door but we end up talking about the Tour. I want to hear from people on the street.

Its not easy, she confides. Premiums for her and her husband continue to rise even though they have a high deductible health plan ($5,000 deductible). She’s frustrated. “We’re trying to keep our farm and this is one of the hardest bills to swallow every month. We never get sick and when we do we’re afraid to go to the doctors because you get penalized. Its just like throwing our hard earned money out the window and its gotta change.” She’s willing to pay for insurance so I ask her what needs to be done? It needs to be cheaper, she quips.

I have a feeling Lucy represents many who are working hard but finding that they can’t go on. They need real solutions so being the medical banking evangelist that I am, I tell her about how banks and healthcare groups are converging to build a platform that reduces cost. She wonders aloud if the savings will ever reach her. Rather than tell her that many of those savings would be used for indigent or charity care, something I get the feeling she simply wouldn’t accept, I tell her about the idea of a “health-wealth portal” where she can manage her healthcare spend, HSA investments, easily compare hospitals and doctors and, one day, pull her health records. Her eyes light up. Can my bank do that, she asks eagerly, because it sure would help. Yea Lucy, I counter, it sure would.

I’m anxious to hear about how firms are going to make this happen, aren’t you? Next week we’ll hear about how three companies in Oklahoma, Georgia and Australia are working to bring healthcare online. This week was much the stuff of phone calls and preparations, although today’s article by Health Data Management lead to an invitation from soul mates in the “twittersphere” - this one from near the Outback. A company called MyHealthLife in New Zealand says that it has built an educational website tied to a transaction platform that processes payments when folks do things that help them to live healthier lives - even small changes that can make big differences in the quality of life. As I mull over this it becomes increasingly clear that selling HSAs will focus far less on plan features and much more on the consumer experience - the enrollment process, website tips, engagement using health-wealth tools, social media and even ARGs (alternative reality games). In fact an interesting research report I read yesterday compares the online healthcare experience of competing firms offering HSAs (funded by Metavante - see “The Consumer Experience of Online Healthcare”).

People like Lucy are busy. They need good information asap and they want to develop a trusted relationship with their doctors that extends into the online domain. Many doctors like the online medium too, but they need to know they are getting paid for their time…enter medical banking. Lucy resents paying ever increasing premiums while paying more out of pocket for “just about everything anyway.  I’d rather take that money and invest it.”

We talk about 47 million underserved Americans and the plight of increasing premiums and deductibles. When will it end, she laments. Its a good question. She’s hopeful the Obama Administration is shaking up the establishment enough to create a breakthrough. I think maybe its people like her, millions of frustrated and irate consumers, who ARE the breakthrough. She will likely continue to manage her family’s healthcare by putting off medical treatments, using HSAs and high deductible health plans and demanding more transparency and online tools that are convenient and deliver great value. Its not ideal, I know. But its reality.

I turn my jeep around and wave bye. She yells out “go make a difference!”… and in the space of one second the Tour starts to take a different turn. Rather than preaching the wonders of medical banking (and I can’t imagine that I will completely stop that) I think the centerpiece of the dialogue must be people like Lucy, and you and I, and how to position tools around our lives that help us, like online banking, ATMs and credit cards. In the final analysis Lucy just needs tools that can help her “do better healthcare”.

I’ll be on the road to Oklahoma City tomorrow. Until next post…

I won’t blog everyday but something neat happened today…a small bank called and inquired about resources and materials to learn about medical banking. I absolutely love it when that happens because it tells me we’re starting to reach the large marketplace of small banks and their healthcare administrator clients - two key anchors in Main Street America.

We have newsletters, white papers, many hours of industry experts talking about key issues, published articles, etc., all archived in an online portal since 2001. My work in this area started in 1992 when my brother and I started a regional firm (RCM) and built a specialized healthcare remittance platform for a hospital in Philadelphia. By 1996, the impact of this work was so undeniable in terms of savings and efficiency that I literally stopped everything to research and write a newsletter on the topic. This was after I spent a year on a plane visiting some 125 bank CEOs with their hospital and/or physician clients. I challenged these guys to think differently about how they do business, cooperating to create a new platform for efficiency. It took until 2003 to see real change, two years after MBProject was launched.

Its wonderfully affirming to hear smaller banks ask about medical banking. It also helps of course that top tier banks like BNY Mellon, Wachovia-Wells Fargo, US Bank, PNC Bank and other banks and financial services groups have invested at least $1 billion in health IT so far according to our estimates. The next tier - regional banks - are starting to react. When banks ask me where to begin I have to first convince them that medical banking isn’t an overnight study - its a journey. The best practices are still emerging. It will take a strong investment in time and resources…and the best time to start is now!

To assist the market we’re organizing 2 programs - “Medical Banking Sales Specialist” educational track (MBSP certification - with the help of a Vanderbilt University professor) and “Medical Banking Healthcare Strategist” track (MBHS - still under development at the University of Missouri’s Healthcare Informatics Department). The former takes two days, the latter will probably take 9 months and includes a project deliverable.

Those just getting started should consider joining MBProject or at a minimum, plan to attend the 2010 Medical Banking Institute (April 7-9) in Nashville, TN. Boot Camp provides a great primer and the follow on sessions delve into the critical path issues, best practices and solution sets that are bringing healthcare online.

Other programs to consider are TAWPI’s HPAS, the HSA Council at the American Banker’s Association, HIMSS Financial Systems Symposium (usually a day or two before the big HIMSS meeting) and HFMA programs focused on medical banking. Each group offers insights into the medical banking area. Until next post…

Executives In Focus

There are so many who deserve credit for helping to facilitate the “medical banking movement” (as David Harris, a partner at PricewaterhouseCoopers in the revenue cycle area, calls it). Among those is one of the architects of the Nashville for-profit healthcare arena - Dr. Harry Jacobson. He is Chancellor of Health Affairs Emeritus at Vanderbilt University and former CEO of Vanderbilt Medical Center, a board-certified nephrologist who co-wrote one of the nation’s top text books on the subject and much more. His disciplined and critical thinking helps me to feel confident that we’re on the right path.

Members on the Move Today

• RMS, a financial/data clearinghouse in Edmond, OK (who we featured yesterday) made it to the top of the list again today… reporting that a new regional bank has signed on - names withheld to protect the innocent (like me)!

Unfortunately I fell ill the very day we set our sails towards the brave new world of medical banking…so couldn’t coordinate our interview with Metavante, a large financial services firm. We’ll be doing that soon because Metavante offers a superb example of an integrated solution of the future - a platform that processes both financial and health data transactions through a single interface. The firm also acquired a personal health record vendor, so look for more exciting developments to put healthcare online from this firm, that provides IT infrastructure to thousands of banks across America. By the way, Metavante was itself recently acquired by Fidelity National Information Services.

Fortunately I did make a team meeting to organize our Leadership Forum in Oct 2009 at the Vanderbilt Center for Better Health. These are great folks to work with! A key agenda item will be hearing from the national leadership on the “ERA of ARRA” as John Halamka remarked in our last email exchange. For those unfamiliar, John heads the HITSP effort, is CIO at Harvard Medical School and is a great talent who is in Japan for a couple of weeks (click on John’s picture to visit his blog!) How he spearheads the harmonization of multiple industry standards is almost mind-numbing…and still finds time to balance his other activities (like work!). I think John and the HITSP team deserve a lot of credit!

A key point not to overlook in the integration of banking and healthcare platforms is reduction of end-to-end costs for transaction processing. PNC Bank, which has developed a leading industry platform in the medical banking segment, provided a case study at our Medical Banking Institute that showed how one provider with national operations saved $4 million during the first year they used its platform. That’s one of the B2B value points and I hasten to add that according to an independent survey funded by the bank, hospitals will use 66%+ of those savings for indigent/charity care. MBProject’s mission is “to convert digital savings into charitable resources”, and this is a great example of our mission in action.

While that’s very exciting there is more to this story. I believe that the data flowing through new HIPAA-compliant medical banking platforms like the one mentioned above could, with consumer/patient authorization, be routed to requesting online banking consumers who want to track their healthcare spend. New point tools will help consumers to manage their health and wealth through a single, secure portal - their online banking account which is used 3-5 times each week by some 55 million households. This new paradigm creates a win-win-win for the care provider, consumer and bank.

Well, I’m off to bed to get rid of this blasted cold and get back on the trail ASAP!!! Until next post…

Today’s MBProject Members on the Move –

• RMS, a financial services/clearinghouse provider, reports that it received an industry accreditation from EHNAC.
• Benchmark Revenue Management, a revenue cycle analytics firm, reports that it signed a multi-hospital group in Ohio.

Since issuing our press statement (MBProject Issues Magna Carta for Medical Banking), we’ve been fielding numerous media inquiries about our unique format. We chose this format to get above the noise in DC, to communicate our vision of how to improve health care leveraging the financial system.

Our tour starts next Monday so we’ve been working with sponsors, adjusting our tour home page, prepping our blog and linking twitter to facebook…and more! Its been fun!

We issued a Tour Framework to our members and received comments back…this will help to guide our discussion during the journey.  More to come soon!!!