Do-It-Yourself Processing

Native American health-care agency saves money on insurance claim processing with in-house Web systems
A federal agency that provides health-care services to Native Americans is using Web applications to improve health-care delivery across a 5,000-square-mile area spanning three Southwestern states, all the while speeding insurance claim processes and saving more than $100,000 a year on potential processing costs.

The Indian Health Service, a division of the U.S. Department of Health and Human Services, operates a wide area network that connects health-care professionals working in facilities in portions of Arizona, New Mexico, and Utah that serve more than 50,000 Native Americans. The health-care facilities, including a 52-bed hospital and several health centers and health stations, are part of a regional IHS unit in Shiprock, N.M.

The regional health-care system needed to improve the way it verified insurance eligibility for IHS patients, so that insurance companies were appropriately billed for services, and the way it posted collected insurance payments into the IHS receivables system, says Tom Duran, CIO of the Shiprock service unit. Managers considered using a commercial service to provide those capabilities, but the cost to integrate such a service with the IHS IT system was in the tens of thousands of dollars. On top of that, there would be a charge of 25 cents to 35 cents for each insurance eligibility-verification transaction.

Indian Health Services

The Indian Health Service apps verified insurance eligibility for 325,000 patients in the first 12 months.

Photo by Al Hartmann/Salt Lake Tribune
Duran opted instead to develop the applications in-house. His development team built the E-Verify application (the "E" stands for "Excellence") in just 12 hours to verify insurance eligibility of IHS patients. The browser-based apps were developed using the Cache database and WebLink rapid-application development tools from InterSystems Corp. They were installed on a four-CPU Dell PowerEdge server running Cache and Red Hat Inc.'s Linux operating system.

The system verified insurance eligibility for 325,000 patients in the first 12 months of operation, saving more than $113,000 in transaction expenses a commercial service would have cost and improving insurance collections by several million dollars, Duran says.

Shortly after completing E-Verify, Duran's developers built an application called E-Post that has cut the amount of time needed to post insurance payments into the IHS receivables system from 40 days to 40 minutes. That was followed by the E-Trax help-desk system that went live a year ago. The applications are used by approximately 1,300 people, including some who access them using handheld devices, Duran says.

This year, Duran's department is developing a Web-based patient-record system dubbed E-Nvision. In addition to providing doctors with easier access to patient information, the application will tie together the other E-Series applications. For example, E-Verify will tap into E-Nvision for data about the services provided to patients to create bills for insurers. A prototype of E-Nvision is being evaluated, and Duran expects to have the application in production by year's end.

"Because my budget is very limited, I have to look for ways to maximize our resources," says Duran, himself a Native American whose background is in pharmacology rather than IT. "That money can be devoted to providing more clinical services for our patients." Beyond cost savings, Duran says the easily customized applications empower health-care workers more than packaged software ever could.

Duran has offered the E-Series applications to other IHS departments, and some have begun using E-Trax help-desk software. And Duran believes his development approach serves as a model for other health-care organizations.

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