Q&A: WellPoint's John Jesser and Availity's Julie Klapstein

In March of this year, WellPoint and Availity announced a strategic partnership with Availity--
a health information network that connects health plans and providers. Anne Zieger, Editor of FierceHealthcare, recently chatted with WellPoint Vice President of Healthcare Management John Jesser and Availity CEO Julie Klapstein about the collaboration, what it means for both parties, and what it could mean for the future of healthcare. Click on the icon to listen to the full interview, or read the transcript below.

Anne Zieger: What is it that your companies do? And what do you do for your companies?

Julie Klapstein: Availity is a health information network connecting health plans and providers, including physician's offices as well as hospitals, and we improve the workflow between the physicians, hospitals and the public, and improve quality of healthcare and lower costs.

John Jesser: WellPoint is the largest health insurance company in the country. We serve approximately 35 million Americans with our different health plans. I oversee the health portion of that for the physicians and hospitals in the five states in the central part of the country-Ohio, Indiana, Kentucky, Missouri and Wisconsin. I also focus on our provider connectivity strategy across the company and how we can make our interactions with physicians and hospitals more simple.

AZ (to JJ): When did you first become aware of Availity and what kind of problems was WellPoint facing that made you decide to investigate what Availity can do for you?

JJ: Well, I've been working with providers on and off directly for about 20-some years, and I knew that the way that we exchange information--which used to be paper, and then, you know, telephone and kind of move to fax, and then a little bit of electronic activity-we knew that there [had] to be an easier way. So we began looking for solutions at WellPoint, oh, probably five or six years ago, starting with some mail techniques and some distribution lists, and so on, building our own web portal. But I became aware of Availity, oh, probably a year and a half ago. I thought the concept was fascinating, that we could take these transactions that happen all day long between healthcare providers and health plans and make them uniform and easy for doctors' offices to work with. So, about a year and a half ago.

AZ (to JK): When your organization began to talk to WellPoint, what did you see as the most important benefits you could offer? What made [it] seem like a click for you on your end?

JK:  Well, we're all about addressing the issue of healthcare costs being high and continuing to grow, and we wanted to make sure to eliminate costs wherever possible, and help physicians and hospitals spend more time with patients and less time on paperwork. When we first started talking to WellPoint, they really shared our belief and commitment that real-time information available at the point of care was what it's all about; that was an excellent way to reduce costs and eliminate waste in healthcare. They very much believed that a multi-payer portal-a multi-payer health information exchange, where health plans were collaborating on the same platform-was the way to go, and would be the best thing to deliver to their own providers and ultimately assist their members. So, they very much were aligned with what Availity is all about-principles that we set up for the company.

AZ: Just to be clear, you're talking about primary focus on processing claims, remittances, those types of things, and certainly clinical data that's contained within, but not serving as an EMR?

JK: Well, first of all, we're going to focus on-John, I'll speak for you-kind of laying the highway of information exchange; when you lay that highway, you want to start with what I'll call kind of the bread-and-butter transactions between physician's offices, hospitals and health plans. And real-time information is really focused, first on the eligibility and benefits transactions; in other words, the provider's office wanting to know that that member is part of that health plan, and what their benefits are and what they're responsibility is for payment and what the health plan responsibility is. So that's one of the first transactions that Availity and WellPoint are going to focus on. We're also going to be focusing on what's called commonly the authorization and referrals-such as getting a radiology pre-certification-and also claim status: In other words, providers want to know, ‘What's the status of the claims that I submit?' And then of course, claims through the web as well, so all those will fill real time transactions that Availity and WellPoint deliver to provider offices. And then we'll follow it up with the clinical transactions, after that information highway is laid.

JJ: I agree with [Julie] 100 percent. The main percent of what providers do all day long with health plans surrounds those bread-and-butter administrative transactions; finding out: "Is the person covered? What are their benefits? Did my claim get paid?" And so, we knew that if we could solve that, and create one provider desktop they could use for the majority of patients that come in their office, and then they would become comfortable with using that, that, it lays the pipe to, as Julie was saying, to then follow-through and start to exchange clinical information. The clinical information is the Holy Grail; getting it into the hands of providers and consumers at the point of care so that better decisions are made [is] immediately a follow. It's Maslow's hierarchy of need: You have to provide food and shelter before the doctor's office is ready to start talking to you about somebody needing a diabetic retinal exam. You really need to solve the biggest headache they have, which is transactions that go on all day long.

AZ (to JJ): Why did WellPoint decide to make an investment in Availity rather than simply contract for services? It sounds like you're telling me that this is pretty strategic for the company, but put it in your own words, please.

JJ: Well, I think I'll put it in your words: It's pretty strategic for the company. If you go back 15 years ago, the pipe between providers and health plans was paper, and it was the mail and it was the fax. But, I really believe that the multi-payer portal is going to get a lot of usage because it's going to solve a lot of problems and make life simpler. We wanted to be a part of that. It's primarily to help in the driver's seat with the other owners designing it and crafting the future connecting strategy.