One regional insurer is using a new approach in provider network management, as it aims to tackle a laborious administrative process. Scott & White Health Plan, the 225,000 member insurance arm of Baylor Scott & White Healthcare, Texas’ largest not-for-profit health system, is using an “Automated Employee” technology for data administration associated with setting up provider networks.
The Temple, Texas-based company says it has reduced set-up time for both new provider networks and pay-class by at least 75 percent in the five years since it started automating provider data entry tasks, using software from the company EnableSoft.
“We’re a small shop for a plan of our size,” said Chris Gengo, director of operations systems for Scott & White. “One of the reasons we’re able to be so productive with a small team, and even scale our operation quickly without adding headcount, is because we have an automated solution.”
Scott & White is one of a number of HMO insurers that have seen enrollment increase in recent years, in part related to the state’s expanded use of managed care in Medicaid and CHIP. The provider-owned plan now has 16 different networks, including PPOS, and it is also set for new market opportunities after the merger last fall of the Baylor and Scott & White health systems, which now includes 43 hospitals, more than 500 patient care sites and more than 6,000 affiliated physicians.
In managing HMO networks, though, Scott & White still faces administrative challenges, like other insurers. With new federal medical cost ratio rules, spending on manual data management is coming under new scrutiny.
“The medical and administrative loss ratios mandated by the Affordable Care Act force payers to really examine their administrative costs, and how much they’re paying for routine manual tasks that are just part of the job,” said Richard Milam, the founder and CEO of Orlando-based EnableSoft, in a media release. “Claims reprocessing, pay class changes, panel updates. These are things that payers do every day and they need to find ways to do them more quickly and less expensively.”