Health Directions Announces National Launch of Provider Credentialing Services

AUSTIN, Texas, Feb. 6, 2012 /PRNewswire/ -- Health Directions, a Chicago-based national healthcare consulting firm with an office in Austin, Texas, announced a new credentialing service offering today which will help streamline credentialing services and reduce costs for the organizations it serves. 

The new service evolves from Health Directions' previous experience in credentialing and its unique service offerings. Currently, Health Directions is providing credentialing services for more than 400 providers and is on track to credential an additional 60 providers in the first quarter of 2012. These providers include physicians, nurse practitioners, psych providers and physician assistants – representing more than 26 specialties.  The credentialing responsibilities for these providers represent 19 different payor groups and three healthcare systems totaling 18 hospitals.

Initial credentialing is one component of a process that payors use when providers seek to join their health plan networks.  In addition, providers must be re-credentialed by payors every three years and by hospitals every two years, after their provisional year. Currently Health Directions is credentialing providers for 19 different payor groups, three hospital systems and 14 hospitals facilities, including Seton Healthcare Family.

"Health Directions has developed deep experience in provider credentialing across the country," says Sabrina Burnett, Vice President, Health Directions.  "We serve as a one-stop shop and liaison between the provider and the credentialing organization providing the benefits of centralization while leveraging our expertise and relationships with payer representatives, government contacts and medical staff coordinators. Because each state has unique credentialing requirements for both private insurance and Medicaid, the process can be complicated," Burnett says. Health Directions uses cloud-based credentialing software and serves as the data center to communicate with providers and collect the information needed for each unique credentialing program.

"We've gained significant efficiencies by turning this often frustrating process over to Health Directions," says Bruce Broslat, Vice President and Chief Operating Officer, Seton Management Services Organization. "The team there has the experience and tools to handle the credentialing needs of our entire Physician Enterprise."

About Health Directions

Health Directions is a national healthcare consulting firm focused on improving the financial, operational and strategic performance of physician practices and their affiliated hospital partners. Health Directions works with medical groups and hospitals to increase their net revenue, enhance physician satisfaction, take full advantage of Health IT and strengthen their strategic position. Founded in 1985, it has grown to become a leading provider of high-value guidance to medical groups and hospitals.  For more information, visit www.healthdirections.com.

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Health 2.0 and ONC Launch Three New Challenges Through the Investing in Innovation (i2) Initiative

SAN FRANCISCO, CA--(Marketwire -01/30/12)- Over the past few weeks, Health 2.0 and the Office of the National Coordinator for Health Information Technology (ONC) announced the launch of three new Investing in Innovation (i2) Initiative competitions that challenge developer communities with creating innovative health information technology (HIT) solutions. The i2 program promotes the use of technology to drive better outcomes, engage users in their health and improve health care quality. The Health 2.0 Developer Challenge program is now accepting submissions for three new challenges, "Health Innovations in Commuting Challenge," "Discharge Follow-Up Appointment Challenge" and the "EHR Accessibility Module Challenge."

"Health 2.0 is proud to launch these three new Developer Challenges. The burgeoning Developer Challenge program has witnessed a tremendous increase in both number and quality of competition submissions," said Indu Subaiya, CEO and Co-chair of Health 2.0. "While Health 2.0 is many things, its innovation competitions are one of its most forward-thinking divisions -- thanks to the i2 program, we play a role in spurring innovation and improving the U.S. health care system."

Commuting is a component of daily life for 120 million Americans and has been shown to correlate with health problems including high cholesterol, recurring neck and back pain, and higher stress levels. The "Health Innovations in Commuting Challenge" calls on innovators to design concepts that would improve the health of commuters through enhanced data collection, exchange and analysis. Participants are asked to demonstrate an understanding of the ways in which commuting is correlated with health factors and to express the ways in which their models are innovative in diminishing commuting's deleterious effects on health. Submissions are due on Monday, March 5, 2012. The winner will present the submission on an ONC-hosted webinar and will have opportunities for future collaboration with industry leaders. For more details visit the "Health Innovations in Commuting Challenge" website.

Individuals with disabilities constitute 19 percent of the population five years and older, yet account for over a quarter ($400 billion) of all health expenditures. Accessibility and usability in health IT are high priority issues for the disability community. The "EHR Accessibility Module Challenge" tasks multi-disciplinary teams with creating and testing a module or application that makes it easy for disabled consumers to access and interact with the health data stored in their EHRs. Submissions are due on Monday, July 23, 2012. Prizes will total $85,000. The first place winner will receive $60,000 and a demo opportunity, the second place winner will receive $20,000 and the third place winner will receive $5,000. For more details, visit the "EHR Accessibility Module Challenge" website.

Nearly one in five patients from a hospital will be readmitted within 30 days, a large proportion of which can be prevented by improving communications and coordinating care before and after discharge from the hospital. The "Discharge Follow-Up Appointment Challenge" tasks developers to create easy-to-use web-based tools to make post-discharge follow-up appointment scheduling more effective and to facilitate collaboration between providers, caregivers and patients. The first place winner will receive partnership consideration with a pilot test bed community such as an ONC Beacon Community or a member of CMMI's Community-Based Care Transition Program, in addition to $5,000 to support a three-day site visit to the pilot community. Submissions are due on Monday, April 30, 2012. For more details visit the "Discharge Follow-Up Appointment Challenge" website.

"The Discharge Challenge is special because it serves as a follow-up to the very successful 'Ensuring Safe Transitions from Hospital to Home Challenge.' It gives teams that participated in the Safe Transitions Challenge the opportunity to build on their innovations and gives new teams that did not participate in the challenge the chance to provide innovative approaches to improving the care transition process," explains Matthew Holt, Co-Chair of Health 2.0. "Challenges are one means to positively expedite the implementation of technology in the health care space."

About ONC
ONC is the principal Federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information. The position of National Coordinator was created in 2004, through an Executive Order and legislatively mandated in the Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009. For more information, see http://healthit.hhs.gov/.

About Investing in Innovation (i2) Initiative
The Investing in Innovation (i2) program utilizes prizes and challenges to facilitate innovation and obtain solutions to intractable health IT problems. Aligned with the Administration's innovation agenda, i2 is the first federal program to operate under the authority of the America COMPETES Reauthorization Act of 2010, signed into law by President Obama on January 4, 2011. For details see http://www.health2challenge.org/onc-i2-challenges/

About Health 2.0
The conference. The media network. The innovation community. The Health 2.0 Conference is the leading showcase of cutting-edge innovation transforming the health care system. Since its beginning in 2007, Health 2.0 has served as a community resource for search and online tools to help consumers manage their health and connect to providers. Now that the industry has caught up, Health 2.0 covers the entire cloud, web, mobile and unplatforms technology revolution that is shaking up every sector of health care. For more, visit http://www.health2con.com.

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Health plans launch own exchanges ahead of public versions

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St. Paul, Minn. — Commercial health insurers are scrambling for position as a key part of the federal health law threatens to upend their marketplace in two years.

Health plans are trying to lock in business before government-sponsored health insurance exchanges go online in 2014. Several large insurers are launching private insurance exchanges to protect themselves against competition from the public exchanges.

Not since the advent of Medicare and Medicaid in the 1960s has there been such big changes looming on the horizon for health insurers. In less than two years, the federal health care law will usher in more restrictions on premium increases, tens of millions of new customers, and a way for consumers to comparison shop online for their health insurance.

An estimated 1 million Minnesotans will eventually get their health insurance through an exchange.

Sabrina Corlette, research professor at Georgetown's Health Policy Institute, said those are just a few of the changes coming in 2014. Just how insurance markets will shake out is anyone's guess, she said.

"Insurance companies are grappling with the uncertainty like everybody else and trying to look two years down the road and how to position themselves," Corlette said. "[What] also needs to be watched closely [is] that it's working for the consumer."

Corlette says there's a lot of jockeying going on as insurers try to position themselves to either maintain or expand the market share they currently have. That's no simple task given the shifting sands.

The prospect of public insurance exchanges are driving some of the maneuvering. As laid out in the health care law, they will allow consumers and small businesses to comparison shop for health plans. Now, a spate of new privately-run online insurance shopping sites are cropping up to cater to small businesses struggling with rising premiums, including "My Plan by Medica" in Minnesota.

Last August, United Health Group's subsidiary OptumHealth bought Connextions, an exchange company based in Florida. Then in September, three large, independent health insurers invested in Minneapolis-based Bloom Health's private exchange.

Medica's John Naylor said public or private, the basic concept of an exchange — allowing employees to choose among many different policies online — is a good one.

"We have seen a trend of giving consumers more choice. And in health care, it's an industry that with the exchanges out there coming in 2014, there's a lot of focus and energy around how do we give employees choice," Naylor said.

But with many private exchanges, there's only so much choice. On the public exchanges, users will be able to choose among a variety of plans offered by different insurers who are competing for business.

Not so on some of the new private exchanges. They may offer plans from only one insurer — the one that's providing the exchange. That's the case with both My Plan by Medica and the Blue KC Exchange from Blue Cross Blue Shield of Kansas City.

Blue Cross' Ron Rowe said the goal is to get people used to dealing with an exchange and the company's products before there's additional competition from the public exchanges.

"Our thought is that at least today we're better off to develop a relationship with them, have them used to getting their service from us, feeling good about the service they get from us, developing some rapport, some trust," Rowe said.

Rowe said the hope is to develop some customer loyalty, so Blue Cross won't lose business to the public exchanges once they go online.

Washington and Lee health law professor Timothy Jost said the private exchanges may help insurers fend off competition once the public exchanges go online.

"It's not all that easy to switch a plan once you have a plan in place; people are used to using the doctors and hospitals associated with a particular plan," Jost said.

Exchanges are also allowing employers to cap the amount they pay for workers' health coverage. Employees get to pick from a range of plans, some of which may require that they pay extra.

Abir Sen of the Minnesota-based private exchange Bloom Health said that approach is attractive to small businesses. He said it's a way for them to gain control over unpredictable, but growing health care costs.

"This is very much a market-driven solution where the market is telling us here's what we need and the industry is responding accordingly," Sen said.

But over time, capping employer contributions could leave workers shouldering an ever-growing portion of premium costs.

The big question for insurers is if they build exchanges, will small employers come?

Economist Paul Fronstin, director of the non-partisan Employer Benefits Research Institute said small business owners will approach both private and public exchanges with caution.

"Enrollment in both is going to start off slow and grow over time as employers see how they're working and get more information about them," Fronstin said.

Corlette said cost will be the deciding factor in whether businesses buy insurance from either a public or private exchange.

"It's got to be affordable. And if you're offering them an alternative, it's got to be cheaper than what they can currently get," she said.

Corlette says the exchanges also need to provide decent coverage that's easy to administer.

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