Cutting Edge Issues

eHealth:
Towards A New World of Communications in Medicine

Case Study: Overlake Hospital Medical Center

Information on Demand: Consumer-Controlled Medical Records

Finding Leaders for Internet Health Care

Building the Security-Capable Enterprise

Planning Business Strategies with Internet Support

Internet Use as a Survival Strategy

Case Study Zone

Who is eMed?

Internet Use as a Survival Strategy

Part 3

That is not necessarily the same as making the processes available via World Wide Web; that is the second phase. The objective, then, was to create a pathway, using the claims processing system, that physicians would become very comfortable with and accustomed to using.

Hill Physicians would then be able to add systems for referrals and authorizations. This was the beginning of work on a clinical system. Once clinical data packets for laboratory, radiology, and pharmacy functions have been added, then the IPA will be well on the way to an electronic environment. The next step, which will probably be taken in 2001, will be to revise the fee-for-service compensation plan for primary care physicians by adding a management fee. At that time, 10% to 30% of primary care physician’s compensation will be a sliding-scale management fee that is based on his or her performance in managing the health of the population. We already have a variety of factors that could serve as performance measures because we have been profiling our physicians for many years; for example, the immunization rate among enrollees might be one such factor.

REWARDING PROACTIVE PRACTICES

Part of the management fee, however, is intended to compensate our primary care physicians for interacting with their patients via email, voice mail, or telephone, as well as for proactively reaching out to patients with particular needs (such as patients with diabetes mellitus). Physicians will no longer be waiting in their offices for people to arrive. Instead, based on the database that we are building in our data warehouse and in their offices, they will be able to bring in those patients who should be seen.

We are also following the example of Kaiser Permanente in arranging group visits, which we have been conducting since 1998. These are a departure from fee-for-service relationships between the patient and physician. Groups of patients sharing similar conditions (such as asthma, migraine, or diabetes) meet on a regular basis with specialist physicians, dietitians, and other providers working in relevant fields. Patients fare significantly better when they are part of these groups, according to our data. That should be obvious, but it has not been clear in the past; our results, however, are quite convincing. Several things may be responsible for these good results, including peer support, but we really want to promote the group visit concept because it produces superior outcomes and is a much more efficient way of serving the population.

The major goals of e-commerce, for Hill Physicians, were the uploading of eligibility data and making possible the electronic submission of claims, referrals, and authorizations. In late 2000, we will start to build the foundation for the necessary clinical, quality, and financial information flow. Ultimately, we will use the e-commerce network as the basis of broader applications.