Less than a year ago, it was little more than a tantalizing possibility.
With Internet technology, the thinking went, HMOs burdened by phone barrages and backlogs of paperwork could forge a direct, two-way link with each of their enrollees.
From their personal computers, enrollees could update dependents, check terms of their coverage and locate doctors included in the plan without sitting on hold or running a clerical gantlet.
It doesn't take long these days for information technology to flesh out a vision. During the past few months, electronic enrollment and benefits management has bounded to the pilot or production stage for a handful of managed-care plans and technology companies:
United HealthCare Corp., a Minneapolis-based managed-care company, launched a personalized on-line health information service for enrollees in its Arizona HMO in late February. The mix of administrative detail handling and targeted information delivery also became available to Colorado enrollees in mid-March. The parent company plans to roll out the service to other United HealthCare plans around the country during the course of the year. A health-and risk-management division of United HealthCare, called Optum, launched the Internet development project two years ago with a search for a development partner.
Orbis Broadcast Group, a Chicago-based provider of medical education services mainly to physicians and consumers, became Optum's development partner and now is parlaying that effort into a product for general release to managed-care companies, integrated health systems and hospitals as well as to employers with private Internet-style networks called intranets.
Blue Cross and Blue Shield of Massachusetts, in partnership with Healtheon Corp., a year-old Internet technology company, has implemented three pilot projects at employer sites and plans to roll out the finished product in time for the fall open-enrollment period. The collaboration between Palo Alto, Calif.-based Healtheon and New Health Ventures, a technology-incubation arm of the Blues plan, was announced last summer (July 15, 1996, p. 24).
Blue Shield of California and Healtheon last month unveiled a pilot program involving about two dozen employers in that state. The on-line information and benefits management service is expected to be rolled out to all the Blue Shield plan's enrollees later in the year.
In direct competition with Healtheon's Blues partners, a San Diego-based electronic enrollment systems developer called XyberNet last month announced a national pricing arrangement with the Blue Cross and Blue Shield Association. The company has offered a discounting program to the nation's 59 Blues plans that bases rates in part on the number of plans that sign up for XyberNet's HealthFare information service. Each additional contract for participation will lower the rates for all participating Blues plans, says the company's chairman, Joseph Bigley.
American Management Systems, a Fairfax, Va.-based business and information technology consulting firm with a healthcare division, announced last month it's jumping into the Internet-based administrative and customer service market with a "concept system" called HealthWeb. The work in progress, aimed at facilitating enrollee interaction with healthcare providers as well as pharmacies, will be unveiled at the National Managed Health Care Congress that runs April 14-17 in Washington.
Because of the potential to eliminate banks of telephone workers and shorten turnaround time on routine queries of all kinds, the early entrants don't seem worried about being crowded by competitors.
"This is going to be a very big marketplace with room for lots of players," says Jeff Schwartz, managing director of New Health Ventures.
XyberNet quotes recent industry estimates that peg the cost of one health plan enrollment at $4.75 under a paper-based, phone-administered operation but less than $1 with an electronic enrollment system.
Optum Health Forums. Enrollees of United HealthCare of Arizona now have personal identification numbers that patch them through to a personal home page on the HMO's World Wide Web site.
From that page, an enrollee can find a healthcare provider, have benefits explained, order or replace an identification card, contact a member service representative on line, search a library of health resources or update personal or family information.
In addition, a service called HealthFinder Profile allows the HMO to select and deliver health information to an individual's home page based on a menu of topics selected by the enrollee-from exercise and nutrition to stress and weight control, from asthma and respiratory problems to anxiety, high blood pressure and depression.
Every family member gets a different PIN and can order different personal information, says Paul Torrey, chief operating officer for digital publishing at Orbis.
Much of the content is provided through an Internet information service developed by Orbis called HealthAnswers. In addition, the HMO continually scans health-related Web sites for relevant data to include in the Health Forums, after the information is first reviewed by United HealthCare professionals.
The news and educational information is sorted and tagged by topic and fed to personal home pages according to what's ordered in the HealthFinder Profile.
The HMO also can circulate its own health tips, notices of community-based health events and other dispatches according to the individualized lists of home-page topics, says Timothy Bahr, president of Orbis' healthcare division.
The design and technology grew out of focus group discussions conducted by Optum, says Stacy Van Meter, director of Optum New Media Services. Enrollees said they had access to plenty of information, but they needed help filtering and sorting it according to their health interests.
They also wanted help locating providers and getting a list that was current. That information is now on line and can be ordered by physician affiliation, proximity to the enrollee, specialty, professional credentials and other attributes.
From that base of search information, an enrollee gets a customized list of physicians, addresses and telephone numbers, and the doctors' office locations are plotted on a map that fans out from the enrollee's home (See graphic, this page).
If there's a question about covered health benefits, the service uses the enrollee's eligibility number to display the benefits summary applicable only to that person, instead of making an enrollee or HMO phone counselor dig through scores of contracts looking for the right one.
All the services are conducted without having to pick up a phone, Bahr says. In its partnership with Optum, "the first return on investment they're looking at is reduction of call-center volume," he says.
The employer customer. A similar potential to save on human resources and management costs is piquing interest among employers, says Richard Koch, a spokesman for Healtheon. The company is targeting employers as its principal customers and working to provide links to the managed-care plans under contract to the employer client.
In Massachusetts, Healtheon is marketing its Internet implementation services to corporations while the Blues plan works to capture and facilitate the delivery of data to employer-sponsored Internet pages, says Schwartz of New Health Ventures.
For XyberNet, the emphasis is on the insurance company as customer, through which the technology firm delivers its HealthFare service to employers and employees, Bigley says.
Unlike its competitors, XyberNet doesn't have an Internet-based service yet. HealthFare allows employees to call up information on personal computers through a traditional telecommunications network, but only at workplaces.
Bigley says the emphasis on the Internet is overplayed for now because only about 10% of employees have access to the Internet anyway. But the company is planning to roll out an Internet-based version by the end of May, he adds.