Connect Archives

March 2008

Saturday, March 1, 2008

Predictive Modeling: Changing the Face of Health Care

Last March, Health First Network published an article about predictive modeling, a highly accurate and powerful tool that is today integral to case management. Even then, after only a year or two of capitalizing on predictive modeling, Health First Network’s leadership, physicians, and case managers were sold on the product. Today, this is practically an understatement. The reality is this: Predictive modeling is changing the face of healthcare delivery.

Too often, the headlines are filled with what’s wrong with health care. Well, predictive modeling is something that’s very right. The data and the case studies are compelling to say the least. This article will merely highlight the positive impact predictive modeling has had on Health First Network and its physicians and members. In the near future, we hope to expand on this information in an upcoming issue of Connect or in the form of a white paper.

Predictive modeling is a sound statistical methodology that identifies and stratifies patients who require care coordination intervention. Through education, coaching, and proactive case and disease management, members become more engaged in their care and begin to comply with treatment plans. Predictive modeling has helped to decrease the cost of care per member, in great part by reducing inpatient admissions and emergency room visits.

The proof that predictive modeling works is in the numbers. Since introducing this tool, the population of WellCare members in case management increased by 54 percent from April 2007 to February 2008; the number of HealthEase members in case management rose 203 percent.

For members who have been active in the WellCare plan for at least two years, the impact predictive modeling has had is as follows by disease:
•Diabetes: Emergency room visits decreased by 33 percent and cost of care per month per member (PMPM) decreased by 55 percent;
•Congestive Heart Failure: ER visits decreased 17 percent and PMPM decreased 90 percent;
•Coronary Artery Disease: ER visits decreased 22 percent and PMPM decreased 73 percent;
•Asthma: ER visits decreased 13 percent and PMPM decreased 36 percent;
•Chronic Obstructive Pulmonary Disease: overall compliance improved by 5 percent.

Bottom line, Health First Network has made great strides with predictive modeling. The ultimate goal is for this methodology to become fully integrated in the care coordination continuum, for the primary care physician, case manager, specialist, and patient to become a team providing comprehensive care, and for patients to become engaged in their health care, becoming greater than 85 percent compliant with their treatment plan.

Health First Network is well on its way to reaching these goals and to changing the face of health care. Predictive modeling allows health care professionals to get their arms round a patient’s complete care. The end result is improved delivery of coordinated care and better clinical outcomes while at the same time achieving significant cost savings. It’s truly a win-win for health care providers and patients.

Clearwave Technology: What Two Practice Administrators Have to Say

Last May, Health First Network did an article about Clearwave, an electronic network and kiosk that reduces costs with patient self check-in and automatic eligibility verification. This innovative HIPAA compliant technology queries health plans in real time to determine a patient’s eligibility and benefits with the simple swipe of a card. The article profiled Gulf Coast Physician Partners (GCPP), the first practice in Northwest Florida to adopt Clearwave. Nearly a year later, here is what Kim Davis, of GCPP, has to say about this technology. We also have the perspective of Dan Manix, of Pensacola Pediatrics, the latest practice to implement Clearwave:

Kim Davis, GCPP, on Clearwave:

Q. - How did patients respond initially, and what is their response now?
A. Some elderly patients were resistant at first, but now that everyone has gotten used to the new system, complaints are far and few between.

Q. How has this technology become an integral part of your organization and its business practices?
A. This system has eliminated the need for a full-time staff member to verify benefits the day before and has helped decrease our denials.

Q. What benefits did you see immediately and what benefits have you seen over the long haul?
A. Initially it was a work in process like anything else, but now it has made the check in process smoother and more accurate.

Q. What all does Clearwave do?
A. It checks eligibility and verifies co-pays and deductible amounts.

Q. Can people now pay their co-pay/past due bills using the kiosk/their credit cards?
A. Not at this time, but this is coming soon.

Q. What impact has Clearwave had on your staff?
A. They love not having to go to multiple websites to verify benefits.

Q. Do you have any specific data demonstrating the power of this technology?
A. Our Nine Mile denials were averaging around 11 percent; now they run between 5 to 7 percent, so this has greatly improved the collection of insurance claims and co-pay/deductible balances.

Q. How long before you anticipate a return on investment?
A. We received a discount because we were the initial location using Clearwave in this area, but I think it should pay for itself within the first year.

Q. Can you describe the kiosk?
A. If anyone has been to the airport and seen the kiosk system to check in for a flight, it is very similar to that process/touch screen with patient privacy screens available, if needed.

Q. Can you describe how people use Clearwave?
A. On their initial visit, patients have to register; it takes about two minutes. After that, they select “returning patient” and put in their name and date of birth. The system retrieves the patient’s information and populates the fields automatically. Or, patients can slide their insurance cards if it has a black magnetic strip like a credit card.

Q. Looking back, why was adopting this technology good for your practice and its patients? A. Clearwave greatly decreased our denials, increased collections, and made the check in process faster for patients. It also reduced the need for patients to wait in line at the front desk.

Q. For another practice considering using this technology, what would you say to them?
A. Be patient with the process and do not stop using the system when you get patient complaints. Once people get used to this technology, they love it.

Dan Manix, Pensacola Pediatrics, on Clearwave:

Q. How long have you been using this technology?
A. Pensacola Pediatrics began using Clearwave kiosks last December, so we’ve had several months to gauge its impact on our practice.

Q. How did patients respond initially, and what is their response now?
A. Frankly, it was mixed. Some people resist change so we heard from a vocal minority that the kiosks were impersonal, weren’t sanitary, and not private enough. Grandparents who brought children for appointments presented a need for special attention. However, many people were pleased with the technology and felt it showed that our physicians are keeping pace. The screens are so easy to use that young children would do the input, and many moms felt that, for the first time, they were in charge of check in and didn’t have to depend on staff.

Q. What benefits have you seen as a result of the kiosks?
A. We see nearly 300 children in our office every day. This meant one staff person would spend at least four hours every day calling insurance companies for every patient on the schedule to determine that we were, indeed, the primary care providers and that benefits were in force. Without this information, physicians risk not being reimbursed for their services. Thanks to Clearwave, we’ve recovered at least a half a person a day, which translates to about $13,000 a year. Another immediate benefit was that, at checkout, there was no guessing game regarding co-pays. Even better, with all the large deductible plans in effect, we can tell how much of a patient’s deductible is left, which improves our ability to receive payments.

Q. What all does Clearwave do?
A. Clearwave lets patients check in by entering seven bits of information on a touch screen. It allows us to customize messages to patients, and it invites them to take a seat. Behind the scenes, it takes the information, connects to each patient’s insurance company’s database to confirm eligibility, co-pay, unpaid deductibles, etc. Clearwave then alerts our check-in staff if the patient’s insurance is good to go, at which time we check people into our electronic medical record system. If the insurance doesn’t check out, our staff can help smooth the way for the patient’s visit. Clearwave also gives us a way to get current phone numbers in case their doctor/nurse needs to contact patients later.

Q. Can people now pay their co-pay/past due bills using the kiosk/their credit cards?
A. Clearwave is working on this and expects to release it soon. It will be a super deal for us because of the number of patients we see and the pressure that puts on the staff to insure that the co-pay is collected.

Q. What impact has Clearwave had on your staff?
A. We haven’t reduced staff, but we’ve redeployed members of our team to help with other duties such as scanning. There is no question that, anecdotally, the check-in/check-out process has improved. Wintertime is the busy season for pediatricians. In year’s past, we would have waiting rooms, as well as the parking lot, full. This year, I’ve rarely seen the parking lot full even though last month we saw 11 percent more patients than we did a year ago. Clearwave has some role in that improvement.

Q. Do you have any specific data demonstrating the power of this technology?
A. Our denials have been reduced on the order of 7 percent, but I have several processes involved, so I can’t say for certain how much Clearwave contributes. We’ve also reduced the number of statements we send each month from around 2,000 to around 1,500. I believe it’s because we’re collecting at the window better and not letting charges create statements. At $8 per statement, you’re looking at $4,000 a month in labor and materials.

Q. Can you describe the kiosk?
A. It’s a small touch screen unit that plugs into power and into our Internet. We added the privacy screen, which protects the information from being seen by anyone other than the person entering the data.

Q. Can you describe how people use Clearwave?
A. It takes all of 30 seconds or less for a person to swipe his or her insurance card, edit information that needs updating, and then take a seat. The screens are easy to read.

Q. For another practice considering using this technology, what would you say to them?
A. If you have a busy practice and want to improve efficiency, as well as improve collections and reduce denials, get Clearwave. Be prepared for some resistance to change, get your staff to turn up the “nice” and watch for those who need help but don’t ask for it. Also, get hand sanitizers and privacy screens, make sure you’ve got plenty of bandwidth, and go for it.

Q. Any additional thoughts you’d like to share?
A. Clearwave has the most phenomenal service. If you have a problem of any kind, or if you have an idea about a report or interface you’d like to see, Clearwave responds within two or three minutes…literally. They are really service-oriented. I’d also like to thank Health First Network for negotiating a discount for early adopters.

A Closer Look at the Imaging Center

The Imaging Center of Pensacola typically greets its first patients each morning at 7 a.m. From this time on, no two days look alike at this cutting-edge, rapidly evolving, and ever-growing center for radiology. The Center is not just a leader in health care but also in the field of high technology.

Staying ahead of the curve can be a daunting task, but the Imaging Center of Pensacola’s 25-person team rises to the occasion every time. Perhaps this is why General Electric (GE) has dubbed the Center one of its flagship practices and invites people from Puerto Rico, Arkansas, Tennessee, and all over the United States to see its technology in use and learn from the best right here in Northwest Florida.

The Imaging Center of Pensacola recently began imaging patients with its 3 Tesla, 16-channel HDX MRI by GE. The 3T scanner has capabilities for ultra detailed images in vascular, neuro, breast, and orthopedics that are not possible with only a 1.5T scanner. While The Imaging Center of Pensacola is best known for its unparalleled MRI services, it also offers CT scans, ultrasounds, and X-rays.

The technology is impressive, but the people behind it – well, they are simply top-notch. To them, mediocrity is not an option. They realize how important what they do is to the physicians who refer them and, ultimately, to patients.

“This is not a ‘punch-the-clock’ kind of job,” said administrator Sherrin Sowers. “We treat patients as people, and we try our best to step into their shoes.” Understanding that patients are concerned and anxious, the physicians and staff hold steadfast to quality, responsiveness, convenience, and caring.

Here are just a few examples of how the Imaging Center of Pensacola delivers on this promise: there is always a physician/radiologist on site, they use only the most advanced technology and offer online scans for physicians to access quickly, and all aspects of the business from transcription services to billing in handled in house.

Furthermore, consider these great benefits offered by the Imaging Center:
•Easy, personal scheduling (no voice recordings)
•Appointments available on short notice or on same day for tests
•Tests results communicated immediately to referring physician
•Courier service allows for previous test results from other offices to be brought to the Center so they, along with current results, can be compared and analyzed immediately
•Nurturing environment for children (staff trained to work with kids)
•Convenient parking, near the entrance

Health First Network is pleased to have this innovative organization as part of the network and looks to its physicians, Dr. John Sowers and Dr. Terral King, for their expertise and best practices.

On the flip side, the Imaging Center of Pensacola, which recently celebrated its 10-year anniversary, is gracious for its strong relationship with Health First Network. “Above all, the network steps in and acts as an interface with insurance companies when needed. By helping us resolve claims issues and supporting the business end of things, we keep our focus on medicine, technology, and helping patients,” said Sherrin.

Health First Network Helps Create Seamless Transition

Recently one of Health First Network’s carriers, Vista, acquired a group of about 100 employees. The company made the decision to go with Vista late in the game, making for a rushed turn-around time. Getting people enrolled and having identification cards printed quickly was a challenge, and, in one case, nearly left an employee in a pinch.

This particular employee had a series of doctor’s appointments set up. However, her appointment crept up before her name was in Vista’s system. Fortunately, Health First Network stepped in and acted as a liaison between Vista, the patient, and the physician’s office. As a result, the patient made the appointment.

This provided a seamless transition for all and saved the provider time, confusion, and money. Instead of having to fill a cancellation and schedule another appointment, things progress as originally planned. This is just one small example of the little things Health First Network does every day on behalf of its physicians.

Health First Network Performance Survey Results

Every year or two, Health First Network does a performance survey to determine, well, how the organization is doing in regard to serving its members. We are pleased to share this year’s results, which continue a positive response. First, network leadership is encouraged by the percentage of people who read Connect – 80 percent of respondents.

Next, use of the Health First Network website is on the rise with 46 percent of survey participants indicating they visit the site. While our hope is that number continues to grow, we are excited that is attracting visitors.

As for the network’s performance, we scored about 80 percent satisfaction in every category surveyed. Here is a break out of the results:

•Calls are returned promptly and to your satisfaction: 83 percent strongly agreed or agree
•Staff is courteous and helpful: 87 percent strongly agreed or agreed

Provider Relations:
•Staff is knowledgeable of Health First Network operations: 88 percent strongly agreed or agreed
•Adequate written information regarding Health First Network is available: 85 percent strongly agreed or agreed
•Calls are returned promptly and to your satisfaction: 82 percent strongly agreed or agreed
•Staff is courteous and helpful: 83 percent strongly agreed or agreed

•Process is effective: 80 percent strongly agreed or agreed
•Staff responds to my requests in a timely manner: 80 percent strongly agreed or agreed
•Staff is courteous and helpful: 83 percent strongly agreed or agreed

We offer a big thanks to every one who participated in the survey. The more feedback we receive, the better we are positioned to deliver on our commitment to service.

“My Favorite” Feature Added to the Health First Network Website

More and more people are visiting Health First Network’s website ( and one of the things we have learned through user feedback and data collection is that people find the database helpful. Both physicians and administrators use the database to look up referrals so the Health First Network team pondered, “How can we make this function even better?”

The answer was clear: add a new favorite function that allows users to add doctors to their “favorites list” for quick and easy access. The new feature was recently unveiled and has already received positive feedback. This small upgrade demonstrates just one more way that Health First Network is constantly trying to improve on ways to better serve members.

New Column: Featuring Practices and Providers

Last issue, Health First Network introduced a new column that will spotlight a network practice or contracted provided in each issue of Connect. The organization’s leadership hopes to promote the great work being done and the high quality of care being delivered by our members and affiliates.

To be considered for this column or to share your story, please contact Jenny Caillouet at or 850.438.4487.

Welcome New Members

Health First Network would like to welcome the most recent physicians who joined the Network:
•Raina C. Alexander, M.D. – Family Practice, First Physicians Group PA
•Mark Boatwright, M.D. – Medical Oncology, Sacred Heart Medical Oncology Group
•John M. Boden. M.D. – Internal Medicine, 21st Century Oncology, Inc.
•Jeneile R. Cordell, M.D. – Pediatric, University Ped’s Program @ Sacred Heart Hospital
•Joshua Allen Davis, M.D. – Family Practice, Baptist Physician Associates LLC
•Steven D. Eilen, M.D. – Cardiac/Cardiovascular Surgery, Cardiology Consultants PA
•Ned W. Farber, D.O. – Family Practice, Gateway Medical Clinic
•Jaime A. Foland, M.D. – Physical Medicine/Rehabilitation, Emerald Coast Spine, Sports Medicine & Pain, PA
•Mohamed K. Helmi, M.D. – Pulmonary Disease, Pensacola Lung Group
•Hillary O Hultstrand, M.D. – Family Practice, Gulf Coast Physician Partners
•Derek Jimenez, M.D. – Nephrology, Pensacola Nephrology, PA
•Evan P. Malone, M.D. – Internal Medicine, Baptist Physician Associates LLC
•David E. Mann, M.D. – Medical Oncology, 21st Century Oncology Inc.
•Richard T. Parmley, M.D. – Pediatric Hematology/Oncology, Nemours Children’s Clinic
•Hejal C. Patel, M.D. – Radiation Oncology, Pensacola Radiation Medicine PA
•Lorraine G. Ripps, M.D. – Pathology, Gastroenterology Associates of Pensacola, PA
•Stephanie A. Salas, M.D. – Internal Medicine, Baptist Physician Associates LLC
•Nirmal B. Singh, M.D. – Hospitalist, Sacred Heart Medical Group
•Enrique A. Wulff, M.D. – Neurology, Child Neurology Center of NW FL PA
•Cesar B. Yepes, M.D. – Cardiology/Cardiovascular Disease, Northwest Florida Heart Group