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It’s not just HIPAA, it’s good business

If you’re a typical case manager, you likely spend more than 50% of your time pushing paper, 10% of your time faxing documents, 10% of your time on the telephone, and only 2% to 3% of your day with patients, says David Kibbe, MD, MBA.

"It doesn’t make good sense to use a nurse’s time this way. Big payers are recognizing the fact that automation is going to be the only way to remain profitable," adds Kibbe, chief executive officer of Canopy Systems Inc., a Chapel Hill, NC, health care technology company.

Rising costs are increasing the emphasis on efficiency in health care, and that is going to mean adapting technology and eliminating paper pushing, Kibbe adds. "Anyone who thinks he or she is going to stay valuable without trying to be more efficient in health care is in trouble," he says.

Payers are spending an enormous amount of money to re-engineer their systems to comply with regulations mandated by the Health Insurance Portability and Accountability Act (HIPAA), Kibbe points out. "And when that happens, they are not going to want to maintain 600 cubicles of people doing low-end clerical work. They’re going to want automation from everyone they deal with," he says.

And while changing from a paper-based to a computer-based system may be a headache at first, ultimately it will allow case managers to spend more time doing what they are trained to do — improving patient care.

"Automation allows case managers to focus on appropriate care, adherence to guidelines, and explaining options to patients. With complex patients, they need to conduct medication reviews, help patients with pharmacy issues, and do many things that are important to quality of care and cutting costs. But they can’t do it if they spend all their time pushing paper or faxing information," he says.

Case managers have a lot of good clinical and administrative information available to them, but it’s going to be necessary to update their business office information system so they can instantaneously communicate changes in patient status with the business office and payers, Kibbe says.

"One of the major issues is business-to- business automation. It involves a complex set of administrative and clinical information that case managers have within their normal workload. It’s not just HIPAA requirements. It makes good business sense to have this automated," he adds.

Health care costs are going to continue to go up, particularly as the baby boomers age, putting an even bigger strain on hospitals, health care systems, and other providers.

"There is going to be a huge emphasis on doing things more efficiently. We spend between 25 cents and 30 cents of every health care dollar pushing paper. And this sometimes leads to clinical events that are costly," Kibbe says.

For instance, patients who take numerous medications can experience side effects and end up in the emergency room. Or they can’t afford to take their medicine, leading to a need for greater acute medical care.

"This is an area where management of individual patients and groups of patients is going to be critical, particularly using information technology that is secure and Internet-based," he says.

Health care providers and insurers are going to have to automate their admissions, discharge planning, utilization review, coordination of benefits, denial management, coordination of information and communication with the business office, and other parts of the health care system, Kibbe says.

"Over time, there is going to be increasing collaboration between the payers and case managers, not only in the hospital but for large provider organizations of any kind. It will be good for the case managers because they will be able to spend more time with their patients and communicating with physicians," he says.

Canopy Systems provides software for hospital case managers that help them collect, manage, store, and transmit information between themselves, the patients, payers, and other providers. "We are seeing a demand for our software as hospitals bring case management out of the Dark Ages. They are replacing lists, sheets, and other inefficient methods and replacing them with software tools," Kibbe says.