Fierce Q&A: WellPoint partners with providers to ensure smooth ICD-10 transition

Image removed.When FierceHealthIT caught up with Ian Bonnet earlier this year, the vice president of business, IT strategy and execution leadership at Indianapolis-based WellPoint wasn't fazed by the Centers for Medicare & Medicaid Services' dawdling over a final deadline to implement the ICD-10 coding system. (CMS ultimately chose an October, 2014 deadline.) A delay would only give the organization more time to implement a preparedness strategy that's already proved successful, he said.

"We've been focused on ICD-10 for a little over three years," Bonnet told FierceHealthIT. "The scale and the pervasiveness are completely unprecedented from anything we've ever had to do before. Fortunately, our CEO recognized that. We've had all the right sponsorship to drive renovation across the entire company."

One of WellPoint's strategies is to partner with provider organizations to make sure that everyone's prepared when they flip the ICD-10 switch. Bonnet described how WellPoint and its partner providers use real data to identify potential coding problems before go-live and shares the steps the organization takes to build trust with providers.  

FierceHealthIT: What role do providers play in your ICD-10 preparedness efforts?

Bonnet: One thing that I push really hard on at WellPoint is collaborating with providers. This year we initiated--really in earnest--collaboration with providers ranging from large academic hospitals to the small rural hospitals to solo intern practices.

Have I gotten 80 percent of the market? No. Am I even touching 0.8 percent yet? No. But that's exactly why we decided to do it. We decided to go directly to them. As a Blue Cross Blue Shield plan in 14 states, we have a very large footprint of providers. So for us, provider collaboration is key and that's not going to change.

FHIT: What steps do you take to collaborate with a provider?

Bonnet: Step one is we have to be well enough down the renovation path that we can actually speak this new language and our systems are starting to function. We're already there.

Step two is that the provider has to at least be down the path of being able to spell ICD-10 and starting their renovation process.

Step three is we look at our claim experience with that provider--whether it's a physician practice or it's an institution--we look at our claim experience with them and say we see a lot of claims in a code set that has complicated changes, oncology or cardiology or what have you.

Based on that, we do a lot of analysis on our side. We go to the provider and say "Here's what our relationship looks like as far as the types of claims that we see and the types of services that you provide. These categories are really complicated relationships between ICD-9 and ICD-10. We want to make sure once we go live with this thing, neither of us have any disruption: You don't have any disruption as the provider and we're reimbursing you accurately and appropriately."

The real collaboration is when the hospital goes back to look at clinical events as they exist today and code them in ICD-10 in these problem areas. They give us real data as they incurred it. We process it and give it back to them and now we both have predictability with how the world is going to look.

FHIT: Providers often say they're not sure they can trust their payers in regard to how they'll use the ICD-10 data. How are you talking to providers about that?

Bonnet: It's funny, if you think about the normal relationship between payer and provider, it's not necessarily contentious or adversarial, but it does tend to be opposite sides of the table. We literally sit down with our provider partners and say "Look, if you fail, guess what? We fail too."

It's just that personal interaction and commitment to two organizations working together. Then, once you start sharing information in ways that you don't normally share it, trust gets built.

So it's not like you can start day one and trust each other. You just have to start working on the problem together. And because we're working on the problem differently than we normally do, we're finding that we're able to build that trust relationship.

At the end of the day, given that the Blues operate a little differently than the other national plans, given we have such a pervasive footprint in our markets, we historically have very good relationships with our providers. So in many ways for us that trust is generally already there.

FHIT: So, what are you going to do with the data?

Bonnet: We've seen situations where the granularity of the new code set in areas such as approach or severity of a diagnosis actually results in something different from an outcome, whether that's a different reimbursement or from an analytics standpoint or the outpatient side. When I compare two physicians and look at the acuity of their populations I have a little bit better visibility and transparency into that. And our clinicians are able to make judgment calls about positive things and how we'll treat Dr. Levy versus Dr. Bob.

Editor's note: This interview has been edited for length and clarity. Additionally, this story was corrected from the original version, which misidentified WellPoint's location. The organization is based in Indianapolis.