Health plans were quick to harness the Internet for marketing, but the industry is just starting to build substantive exchanges of important information with providers, employers and consumers, a recent survey suggests.
What's more, a significant percentage of health plans have no interest in taking that next step, contrary to what consumer surveys indicate their constituents want.
The survey of 79 respondents from health plans and other healthcare entities, conducted by Computer Sciences Corp., shows that the managed-care industry is aware of the potential of e-business and is in various stages of implementing or planning for links to healthcare partners and customers.
For example, 27% of respondents to the survey, conducted at the National Managed Health Care Congress last month in Atlanta, say they have implemented a way for provider sites to perform inquiries and transactions online. Another 19% are in the midst of adding that capability, and nearly 40% are considering or planning for it.
However, only 11% of respondent organizations say they have implemented a way for plan members to perform inquiries or conduct transactions on the Internet, and 18% are adding the service to their Web sites. Nearly 20% say they have no interest in establishing such services for their members.
The situation is slightly better for links to employer groups, with 13% of respondents indicating they have an operating connection and 18% currently adding the capability. But 18% profess no interest in it. Half of all respondents place their organizations in the planning or considering stage for links to both plan members and employers.
By contrast, two-thirds of respondents say they have implemented a Web site mainly for marketing, and 13% are adding or expecting to add the capability. Only 4% indicate no interest.
The survey results document a lingering discrepancy between what payers are offering and what consumers want, says Arthur Spiegel III, president of CSC's healthcare group. A recent survey of Internet users by Gomez Advisors, for instance, says consumers identify the ability to verify health insurance eligibility and track reimbursements as one of the most important features of online communication, just behind the abilities to e-mail physicians and access lab results.
"As consumers' use and expectations of the Internet continue to escalate, this fulfillment gap will continue to grow," Spiegel says. "Likewise, as physicians move online as a result of pressure from their patients, they are likely to demand time-saving e-capabilities from payers.
"Health plans need to begin now to actively assess and capitalize on the potential of the Internet or risk being left behind by their members, providers and employer groups," he concludes.
Some of the reluctance to consider supplying transactional services could stem from the complexity and security risks inherent in taking Internet-based access to the next level, says Sandy Pitman, CSC's vice president of sales and marketing for health plans.
Up to now, the general information on plans or provider networks made available on Web sites could be gathered from internal healthcare information systems and replicated online. Up-to-date reporting of patient-specific data, however, is a more complicated matter involving direct links to those internal core systems, Pitman says. Any plan to furnish information on patient eligibility for treatment and the status of claims requires a secure system with password protection to prevent sensitive details from being accessed by unauthorized eyes.
Deployment of such access is easier in conjunction with provider groups, which are more likely to have a security plan in place for electronic data as well as a strong and stable relationship with payers, he says. Although there are hundreds of thousands of providers with which to maintain connections, the volume is limited and controllable compared with the identification and access management involved in extending services to plan members.
Managed-care plans are having enough trouble keeping tabs on the status of millions of enrollees, including when they join or leave a plan. The additional task of managing individual access to transactions and details of coverage would add another layer of administration, Pitman says.