WellPoint Q&A -- Page 2

AZ: As you're doubtless both aware, lots of state and regional and other configurations of groups are putting together health information exchanges that are different in nature; they're not as centralized as what you're trying to do. Do you see those as complimentary to what you're doing? As becoming unnecessary if you meet your goals? How do they fit in your vision, or do they fit in your vision?

JK: OK, well I'll take a stab at it. We think they can be very complimentary and we're specifically kind of going beyond the initial RIOs that were set up, which were a little siloed in my view; we weren't sure, long term, where the money was coming from. But if you think about Availity and our focus kind of region by region, rolling out nationally, we really are a health exchange. One example of that is the state of Virginia; picked as vendor of choice to build a health exchange network between providers and payers starting out with the same transactions John and I have been talking about, and then later looking at that pipe, if you will, to exchange clinical information. So, I think folks are starting to recognize on a statewide basis that we, in fact, are the framework and the architecture and the pipes that these health exchanges need, and we also deliver value and lower costs so that you can have an ongoing payment stream from the savings that the health plans and providers gain in these transactions from eliminating paper and phone calls and faxes. I think they can be very complimentary. John, what do you think?

JJ: I agree. I think there's 31 different flavors out there of RIOs and information exchanges, and what we're hoping to do here is, as Julie said, create a standard for communicating and sharing information and actually getting physician offices connected. And then, how that information is stored, and whether those organizations are a helpful part of that or not will sort of all play out. It may very well be accelerated because of the work we're doing with Availity, or in some cases, it may not make sense-there might be a redundancy. But I think that each one will play out. One of the challenges with some of the RIO initiatives is that they self funded-self sustaining-so they're looking for how they can continue to exist financially if they need to sell services or whatever that is. Again, there may be complimentary opportunities as Availity is laid out and they have a path to, perhaps, deliver information.

JK: One of the most promising things that we're seeing, too, is that some of the public sector-Medicare and Medicaid-are looking at combining with the private sector-with the private health plans-to work together to provide a network for a state or region, versus going it alone. I think that's very promising, and in the long term we'll make these health exchanges more viable in the future.

AZ: Can you describe what it's like for providers when they roll out this portal in their organization? Is it one click? Is it requiring some installation? Just because something's on the web, doesn't necessarily mean there's no integration called for.

JK: There's a number of ways that providers can send data over the Availity network. They can either go on the web, like we talked about-of course they'll need a high-speed connection, and unlike when we started in 2001, most of our offices do provide access to their people, to the Internet today. So they can just go to www.availity.com [1] and register and it's a fairly simple process. They do have to sign a piece of paper and send it in right now so we have their signature on file. But then, they're up and connected very quickly, can they can start sending transactions to WellPoint, as well as many other health plans on the same portal. They could also choose, if their practice management vendor has a connection, to send from their practice management vendor, occasionally. We haven't done that yet for WellPoint, but that could be in the future. Or they could send claims over there normal clearing health method, whether they chose Availity or another vendor. So there's a number of ways they can enter data, and the simplest, of course, is through a multi-payer portal like Availity.

AZ: Yeah, that just raises a question for me of whether there's going to be-OK, Day 1 they install the portal and they start putting in new data; what about the legacy data they had a week ago, but they still haven't submitted yet? Is there a way to pull that in?

JK: Usually, legacy data is related to claims or, if you're talking about as we move into the clinical space, you know, health records. But initially, if they're checking eligibility, they're checking eligibility usually for a patient the day before they come to the office, or while the patient's there. We have a unique card capability where you can just take their membership card and swipe it for some of our health plans, or enter the data. So it's normally for some action that they're going to take while the patient's in the office, or the day before. So, [for] old information, they can even check claim status, even on claims that have been sent in the past, so there's really no reason for these transactions to worry about the history. Because all of that data is stored in the health plan systems, so Availity gets access to historical data, as well as new data. We're not actually storing it within Availity, so there's no issue. And, of course, the health plans are keeping that data historically on most of their members.

AZ: As you continue to roll this out, do you envision this as something that patients would have access to? I may be confusing things here, but I'm familiar, for example, with technology where hospitals or doctors offices have kiosks, where a patient can just swipe their credit card and pay on the spot because there's instant adjudication of claims. Does your system strictly [use] B2B phasing, or is there a future as a patient portal, as well?

JK: I'll start with that, John, and [then] I'll let you comment. We have the ability within Availity for certain payers to, not only estimate what they owe or get the actual amount that they owe while they're in the office, and we can actually, through a partnership we have with another company, we can take their credit or debit card, or even their check, and actually process the patient portion of the bill right while they're in the office. Obviously, we're just getting connected to WellPoint, so that will be something that we'll be looking at down the road.

JJ: We're interested in absolutely every possible way to make administration of claims and collections and billing and all these things as simple as possible. So we're going to look at everything Julie and Availity is piloting and we're going to look to adopt those things that we can make work. I know that both Availity and WellPoint and the other Availity owners will also continually look across the industry at the capabilities to make this as user friendly and simple as possible. That's what healthcare has needed for a long time, and the technology is now here; what it takes is, now, leadership, so we're happy to be doing this.

JK: Right, and I think that shows, when the health plans get together and collaborate on a single portal, especially as owners, they can roll things out very quickly. They can make it easier for the provider's office because the provider is dealing with all health plans of a similar manner. We can go into a new region, say, and roll out these cards all at once. So the collaboration idea has a lot of merit to make it so much easier on the providers so they're not dealing with health plans in a different manner.

JJ: And even the non-owner health plans, the goal is to make this make sense; that it's just a lay up for owners and non-owners. That's the goal. We, as an industry, need to no longer compete on some of these bread-and-butter transactions. A doctor's office does not like one health plan more than another because they can look up eligibility this way or that way. Some of these things, they're commodity transactions, and so, as an industry, we're at the point where we really need to, where us competing over these things only adds complexity.