Care management is driven by a need for information derived from each step of the patient provider-payor interaction. This information is utilized in both the direct provision of care, be it clinical, demographic, or purely administrative data, and the "management" of that care through real time and retrospective review. This information comes from a multitude of sources patients, providers, employers, health plans, and insurers. There are literally hundreds of millions of sources of information and transactions totaling more than $1.5 trillion each year. The costs of administering healthcare are staggering. Managing this information efficiently is vital in reducing administrative costs.
It has been estimated that twenty percent (20%) of insurance and health plan administrative expenses are for claims review. (Larch and Smith) HT reduces payors’ costs for remittance advice and payments dramatically. It is estimated that providers spend, on average, $27/encounter. One third of the claims require rework, and it takes 2.5 statements at an estimated cost of between $5.50 and $8.00 each before the patient pays (MGMA). Nearly 30% of patient accounts receivable are over 120 days old and 50% are older than 60 days. HT can affect payments in 3 days.
The health care industry is struggling with these disparate information requirements, but what is most striking from a business perspective is how little is being done in the way of restructuring the actual model of the provision of healthcare services, and in the area of information systems support. Very few health care organizations are fundamentally rethinking the delivery of health care by restructuring their information systems, operations, or workflow.
HT provides a common nexus for information and financial transactions today at low cost. HT provides a real-time healthcare information distribution network. After verification of the patient’s eligibility the transaction process is a seamless, cost effective, front to back transaction, never before available within the healthcare environment.