Knowledge Center
Learn more about which health plans use NaviNet.
White Papers & Published Articles
Partnering with Providers
2011 | S. Michael Ross, MD & Meghan Oates-Zalesky
Health plans must impact the cost and quality of care their members receive to compete in today’s environment. Members need to remain well, and those with chronic conditions need to be appropriately managed. Providers hold the key to influencing real member health improvements. With emerging shared-risk models such as patient centered medical homes (PCMHs) and accountable care organizations (ACOs), providers need tools, information, and supplemental resources to deliver the necessary care management and care coordination functions to share financial risk. In return, health plans must have demonstrable proof that these care management functions are being performed and that the desired outcomes are being achieved.
Best Practices in EHR Implementation
2011 | Timothy Liddell & Betsy Cross
Electronic health record (EHR) systems are receiving a lot of industry attention. In addition to creating electronic patient records, they fundamentally change the way a practice works by improving operational efficiency and streamlining workflow. A decision to implement an EHR is not just about technology, but about introducing important decision-making and change in a practice to gain maximum benefits.
Steps to Meaningful Use of the Electronic Health Record
2011 | Elizabeth W. Woodcock, MBA, FACMPE, CPC
The Electronic Health Record (EHR) Incentive Program earmarks several billion dollars for eligible professionals, as well as hospitals, that make meaningful use of a certified EHR between 2011 and 2017. This program has its rewards—bonuses paid through either the Medicare or Medicaid program— for successful participants. It also has penalties in the form of percentage reductions in Medicare reimbursement for the eligible professionals who
do not meet the government’s standards for meaningful use of a certified EHR.
Unified Patient Information Management: Improving the Way Patient Data is Accessed, Exchanged and Managed
2011
The U.S. healthcare system has serious problems and inefficiencies. According to the U.S. Department of Health & Human Services, healthcare administration cost the U.S. more than $400 billion out of $2.5 trillion in total spending in 2009. Today, patients are paying more for healthcare out of their own pockets and struggling with understanding benefit plans that require them to play a greater role in their care. Physicians and other healthcare professionals are coping with health reform requirements and quality of care reporting, while also juggling operational and cash flow challenges. Health plans are facing financial pressures, while managing health reform and increased competition. Healthcare IT vendors are also dealing with reform, as well as technology mandates and challenges such as interoperability. The solution to these and many other issues plaguing the U.S. healthcare industry is better patient information management.
A Primer on Meaningful Use - Understanding the Federal Government's EHR Incentive Program
2011 | Elizabeth W. Woodcock, MBA, FACMPE, CPC
The U.S. government is paying eligible health care professionals to automate their medical practices. The Electronic Health Record (EHR) Incentive Program – a product of the American Recovery and Reinvestment Act (ARRA) passed in February 2009 – earmarks several billion dollars for eligible professionals, as well as hospitals. The federal program seeks to promote the “meaningful use” of EHR systems that are certified by the government’s designated accreditation program. Adoption of these certified EHR systems, according to the government, is an important step in enhancing the quality, safety and value of health care in the United States.
Electronic Transactions Between Payors and Providers: Pathways to Administrative Cost Reductions in Health Insurance
2010 | John L. Phelan, Ph.D.
In 2006, Milliman issued report analyzed cost savings that providers would experience if they transitioned from paper to EDI transactions. Now, a new report analyzes the cost savings healthcare plans see when conducting five transactions over the Web: 1) claim submission (including attachments), 2) eligibility verification, 3) prior authorization/referral certification, 4) claim status inquiries and 5) remittance advice.
The result:
“Milliman estimates that, for an average healthcare plan with 500,000 commercial members, using standard electronic transactions to communicate with providers, as defined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA), could result in annual administrative savings of over $23 million.”
Automation in the Business Office
2010 | Elizabeth Woodcock, MBA, FACMPE, CPC
With the increasing use of high deductible health plans and escalating amount of financial responsibility being placed on the patient, medical practices are facing a major challenge: collecting revenue directly from patients at time of care. In this article, Elizabeth Woodcock, practice management consultant, discusses the benefits of automating your business office processes to reduce costs and increase efficiency, which in turn boosts profits. In this white paper you will find many ways to incorporate automation into your office’s workflow.
Collecting from Patients at Time of Care: Understanding the Challenges and Solutions
2010
In an effort to control costs and increase access to health insurance, insurers and employers are offering different types of benefit plans, including high-deductible plans, healthcare savings accounts, flexible spending accounts and other consumer-directed healthcare (CDH) products. While these products give consumers more control over their healthcare spending, they result in an increase in patients’ out-of-pocket expenses which directly impacts provider revenue and forces changes to the practice workflow.
American Recovery and Reinvestment Act Will Save Billions and Reduce Medication Errors by Accelerating E-Prescribing
2009
This study, prepared at the request of the Pharmaceutical Care Management Association, estimates the impact of health care provisions in the American Recovery and Reinvestment Act of 2009 (ARRA) on the adoption of electronic prescribing (e-prescribing) and resulting savings and safety gains.
Patient Payment Collection: Challenges for Payers and Providers
2008
Increasing healthcare costs have forced hard choices on employer groups looking to continue to offer medical coverage to their employees in a cost-effective manner. Employer groups in turn have pushed health plans to offer products to manage premium increases.
Improving the Quality of Care by Electronically Linking Patients and Providers
2008
As patient-provider communication tools from health plans and vendors proliferate, healthcare providers will demand a cost-effective solution that can integrate these new forms of patient communication into their primary office workflow systems.
Managing Radiology Utilization in the Provider Office: Leveraging Web-based Solutions to Maximize Benefits and Control Costs
2007
Implementing a standard online approach to proprietary radiology utilization management programs to ensure adoption, usage and successful achievement of program goals.
Making Pay-for-Performance Work for Program Sponsors and the Provider Practice
2007
Delivering patient-specific clinical content to providers at point of care via an online workflow-based infrastructure.