Web Remedy Prescribed

An HMO taps Crystal Decisions' platform to offer quick, easy access to claims, costs data.

As U.S. health care costs soar and health insurance companies get most of the blame, many of those companies are turning to the Web to improve customer relations while reining in administrative costs.

Health maintenance organization CorVel Corp. recently deployed Crystal Decisions Inc.s Crystal Enterprise information delivery platform at its CareMC.com managed care Web site to make reports on health care claims and expenses available to its corporate customers.

By using Crystal Enterprise at the site, CorVel hopes to give employers self-service access to medical claims information in the interest of reducing calls to its call center and allowing its customers to find information faster and more easily. The HMO plans to extend those capabilities to health care providers and individual employees.

"Were trying to reduce administrative costs and be an interface between the provider and the payer community," said Gordon Clemons, president of CorVel, in Irvine, Calif. "The role for an organization like ours is to build a bridge and connect information."

Crystal Enterprise combines report creation and analysis tools with a content management and delivery system and is the top end of Crystal Decisions reporting software. Crystal Decisions, of Palo Alto, Calif., is an affiliate of Seagate Technology LLC.

CorVel serves three constituencies: companies that pay for its health and disability insurance and worker compensation coverage, the companies employees, and health care providers. Although the CareMC.com site caters to all three constituencies, so far employers have taken the most advantage of the reporting capabilities, Clemons said.

"Were initially targeting the executive management decision makers at the larger companies," Clemons said. "They can see how [claims] are going month to month, what are the trends; they can see where there are serious-injury patterns and whether its a safety issue or a work environment issue."

Clemons said the reports have enough intelligence built into them to help executives decide where to take action. Reports can show what kind of injuries are being reported by what divisions on one panel, then suggest actions that decision makers can take to remedy the situation.

"Its attractive to the decision makers," said Clemons. "They get excellent base reporting and a colorful graphical presentation—plus, they can access this information over the Internet much more quickly and on their own schedule without generating any paper."

The company is now finishing the second version of the Web site, which went live in January. The update will provide executive dashboards that users can tailor to the information theyre most interested in reviewing.

Clemons said deploying this service has had a positive impact on CorVels ability to win customers, even against larger competitors.

"People see what it does and reach a conclusion on their own with no sales pitch," Clemons said, noting that CorVel recently signed 50 new customers in one week and has seen transaction volume triple since January.

"Theres a huge amount of time spent in the way health care gets delivered," Clemons said. "You can easily lose a month out of your life. The Web site allows you to move through that process more rapidly. Its changing the way health care is delivered."

Clemons said he expects providers and patients to be a harder sell on the service but said CorVel plans to offer physicians access to images, such as X-rays and MRI scans, at the site.

While this would require the company to add more storage capabilities to handle the large size of the images, it would also enable physicians—who, Clemons said, tend to have "strong negative feelings" toward insurance companies—to more easily manage large volumes of digital images. They could scan through the images indexed by patients.

"Ultimately, the benefit would be shrunken time delays," Clemons said.

Clemons said he hopes that within a year, patients will use the site more for maintaining personal health care records and managing benefits, although toll-free numbers remain the preferred method of contact for patients today.

Other health insurance companies are also finding the Web to be their customer service salvation. Blue Cross Blue Shield of South Carolina is using Miami-based ClientSoft Corp.s ClientBuilder Developer legacy integration software to provide data from legacy back-end systems to its My Insurance Manager service for members and providers at its Web site.

"Were using it to help our customers find information that they would other-wise have to call our call center for," said Wayne Roberts, vice president of IS operations at the Columbia, S.C., health insurance company.

Members and providers can check the status of claims, eligibility and benefits authorization, as well as get more general information about coverage. Members can also request new ID cards at the site.

"Were making the information more accessible and easy to get to and reducing our labor costs so that we can cut costs," Roberts said.

Were trying to reduce administrative costs and be an interface between the provider and the payer community.