Blue Shield of California, Affiliated Hospitals Credit Partnership for Improving Efficiency, Reducing Unnecessary Costs

BSC's Partnership in Operational Excellence and Transparency (POET) Program Called 'Major Step Forward' in Eliminating Waste in Claims Process - 120 Hospitals Participating, with More Expected

SAN FRANCISCO, Nov. 10, 2010 /PRNewswire/ -- Today executives from Blue Shield of California (BSC), Catholic Healthcare West (CHW), Mission Hospital and the Hospital Association of Southern California hailed an innovative payer-provider transparency program for reducing claims payment time, eliminating unnecessary administrative costs, and improving relationships between BSC and 120 of its affiliated hospitals. The program, called Partnership in Operational Excellence and Transparency (POET), uses a web-based analytics portal developed by MedeAnalytics that consolidates claims data and provides unprecedented transparency for participating hospital.

According to Juan Davila, BSC's senior vice president of network management, by reducing unnecessary claim rework, POET-enabled hospitals have already experienced a 19 percent reduction in claims denials. "This is exactly what we were hoping to see," said Davila. Panelist Dan Martinez, director of patient financial services, Mission Hospital, said his hospital is projecting a 40 percent reduction in denial volume, and a 50 percent reduction in dollars denied. Panelist George Mack, vice president of member relations for the Hospital Association of Southern California, called the program a "major step forward" in driving out waste in the claims process. Panelist Debbie Esparza, director of managed care for CHW's Northern California facilities, noted that CHW has expanded its participation in POET this year. "Hospitals have multiple systems that aren't interoperable. POET provides us with the feedback and more meaningful data to help us find the areas where breakdowns are occurring," she said. Davila concluded, "POET is a precursor to an accountable care organization."

Davila was one of 80 healthcare industry executives participating in the MedeAnalytics-sponsored 2010 Client Summit held Nov. 10-11 at the San Francisco Fairmont Hotel. The conference includes state and national healthcare leaders discussing implementation of healthcare reform and related issues around balancing healthcare quality and cost.

Other presenters today included:

• Jon Giese, director of finance and patient access for Simi Valley Hospital, talked about how, using MedeAnalytics' Patient Access Intelligence solution, his hospital has been able to revamp the front-end revenue cycle, achieve a $25,000 per month increase in cash received at the point of service, and improve overall efficiency for the hospital and patients.
• Anthony "Mack" McKeever, CEO of Bexley Care Trust, a primary care trust in the Britain's National Health System that receives $360 million annually to care for 250,000 residents of the Bexley borough of London, talked about how MedeAnalytics technology has allowed the Bexley to provide physicians with information to better manage patient care and needed resources.
• Jose Rivera, corporate director, physician and professional central business office, Orlando Health, spoke on hospital-physician alignment: how the organization is providing data from 55,000 monthly claims to 496 providers, including 300 physicians and 60 physician practices. The information, provided by MedeAnalytics, helps doctors and managers better manage their practices for improved patient outcomes.
• Cristobol Cintron, analytics AVP, MMM Holdings, a Medicare Advantage plan in Puerto Rico, shared how his organization is using analytics to drive contracting, financial performance and quality improvement. 

About MedeAnalytics

Founded in 1994, MedeAnalytics enables healthcare organizations to improve clinical, financial and operational performance through on-demand analytics and client services. For hospitals and health systems, MedeAnalytics provides solutions to address revenue cycle, patient access, clinical operations, staff productivity, regulatory compliance, finance and accounting, and enterprise performance management. For healthcare payers, the company provides solutions for provider network management, medical management and operations. MedeAnalytics delivers business intelligence to over 800 healthcare organizations using a hosted, Software-as-a-Service (SaaS) model, which reduces up-front costs and enables rapid implementation and exceptional time-to-value. For more information, visit www.medeanalytics.com.