HIP Health Plan of New York
Company: HIP Health Plan of New York
Company Description: HIP Health Plan of New York is the largest HMO in NYC based on membership. HIP provides access to physician services and hospital care & contracts with more than 160 hospitals, including major acute care institutions. HIP’s total provider network,including the networks of our subsidiaries, comprises over 41,000 physicians & other providers in over 61,602 locations in NY,CT& MA.
Nomination Category: Team Awards Categories
Nomination Sub Category: Best Support Team
Nomination Title: HIP Health Plan of New York (HIP) Launches HIP Connected, Dramatically Increases Communication Capabilities with Medical Provider Community
1. Tell the story about what this nominated team achieved in the past year (up to 500 words). Focus on specific accomplishments, and relate these accomplishments to past performance or industry norms. Be sure to mention obstacles overcome, innovations or discoveries made, and outcomes:
On January 4, 2005 HIP launched HIP Connected, a comprehensive Web- and telephone (IVR)-based medical management platform enabling providers to interact with the company. HIP faces challenges similar to those of many health plans nationwide--how to service its medical provider community and members efficiently while containing costs. Prior to this launch, HIP’s administrative interactions with the medical community were primarily via paper, fax or phone.
HIP’s goal was to transition communications and transactions with the company to a streamlined electronic venue. Electronic communication minimizes call hold times, reduces paper flow and the burden of processing paper, lessens administrative costs for both provider offices and the company, and permits timely, 24-hour access to information.
Systems development was accomplished through the integration of a large, interdepartmental Provider Electronic Products Team (PEP), represented by care management, claims, communications, customer service, facilities, grievance and appeals, provider relations and IT departments. The PEP project was divided into a series of manageable tasks, each assigned to interdisciplinary subcommittees with a “bubble-up” process implemented to report progress and issues to the larger group. To understand the provider community’s needs to transition from paper-based to electronic systems, HIP solicited over 18,000 doctor offices and conducted 8 focus groups.
Based on provider feedback and corporate objectives, the system was designed with logic to support ease of navigation and a hierarchical menu structure. Additionally, applications were developed on a secure HIPPA-compliant platform, positioning HIP to accept HIPPA transaction sets for electronic medical records (EMR). Modules created included:• Referral and prior approval submission and inquiry.• Member eligibility and benefit limits inquiries.• Real-time ER admission notifications.• Claims inquiry and report pull-downs (paid, pended and denied) and remittance images.• Customized security access based on provider type and staffs’ roles within offices.• Personalized provider message center enabling targeted messages to specific provider groups.
Prior to rollout, HIP educated its 2000+ employees on HIP Connected through Web-based learning and group training. HIP launched a promotional and educational campaign to assist providers in adopting this new technology that included face-to-face training in over 4,000 provider offices and continues with every site visit today.
Results of this initiative were evident immediately with transactions coming in from day one. Electronic transaction volume continues to increase and HIP currently receives over 95% of referral transactions electronically. This resulted in a 70% reduction in data entry staff and $2.4 million dollars savings in administrative and medical costs since rollout. Electronic referral entry favorably impacts claims and grievance and appeals departments and provider satisfaction, expediting claims payment and decreasing the amount of claims that need to be reworked due to no referral being on file.
HIP’s PEP team continues to respond to provider concerns and recommendations to enhance HIP Connected. New functionality slated for 2006 includes a Reports section to provide custom HEDIS and pharmacy reports and Clinical Logic templates to expedite requests for prior approvals. The interdepartmental team approach motivates diverse areas to focus on achieving a common goal and “have a stake” in this corporate objective: innovative use of information technology to promote administrative and clinical efficiencies between the delivery system and the health plan.
2. List hyperlinks to any online news stories, press releases, or other documents that support the claims made in the section above. IMPORTANT: Begin each link with http://, and enclose each link in square brackets; for example, [http://www.youraddress.com]:
http://www.hipusa.com/xq193rev/
3. Provide a brief (up to 100 words) biography about the leader(s) of the nominated team:
John H. Steber, Executive Vice President and Chief Information Officer, joined HIP Health Plans in 1997 as Senior Vice President for Information Systems and CIO. He has played a key role in the development of HIP's current high state of technology and associated systems, including corporate operations. Prior to joining HIP, Mr. Steber was Senior Vice President and Chief Information Officer of Health Partners of Philadelphia, from 1995 to 1997. From 1993 to 1995, Mr. Steber was Vice President of Office Systems for US Healthcare in Blue Bell, Pennsylvania.
Lynn Balducci, MBA, CPA, is Managing Director of Provider Contracting, Analysis and Implementation and Provider EDI. She is HIP’s team leader on the Provider Electronic Products (PEP) team. In her twelve years at HIP, Ms. Balducci has held management positions in budgeting, finance, capitation and delivery systems and has championed several large inter-departmental team projects for HIP including the recontracting of 25% of HIP’s delivery system business in 2000, which resulted in a surplus of over $100 million over the past 5 years.