Portals Ease Health Insurer’s Growth

Providing online services to health insurance group customers and their members has become a competitive necessity rather than a luxury, and not just because customers expect it.

For three years in a row, UPMC Health Plan (a subsidiary of University of Pittsburgh Medical Center Health System) has been the fastest-growing HMO in the Northeast. "Our challenge is to limit staff increases in our membership enrollment and operations areas and still be able to grow our membership numbers at that pace," says Ed McCallister, director of management information systems.

In the past, group customers had to send UPMC HP enrollment information by electronic file transfer or even paper applications, and provider and member interaction was handled by mail and telephone. To avoid the burgeoning inefficiencies of these channels, at the end of 2000 the HMO decided to provide portals for its three main constituencies: employer customers, providers and plan members.

A UPMC HP project team issued an RFP and considered a variety of providers. By January 2001 it had invited Antares Solutions (Westlake, OH) to recommend an implementation approach, which resulted in a contract signing in March. "The Antares solution had a proven track record on security," McCallister says. "Another advantage was that we'd be able to drive the product where we needed it to go," as co-developers.

For the next two months a project team staffed by employees of the two firms performed a gap analysis to adapt Antares' Connexion ii portal solution to UPMC HP's needs, McCallister recalls. "We set a target date for when we wanted to go live and identified milestones for functionality rollout." Plans were made to roll out an employer portal prototype first.

A T1 line was set up between UPMC HP's Pittsburgh site and Antares Beechwood, OH-based data center, where a UPMC HP-dedicated IBM (Armonk, NY) DB2 database was set up to handle twice-a-day batch updates from the carrier's legacy system, McCallister explains. The "Employers Online" prototype was successfully launched in June 2001. A "Providers Online" pilot followed in October, targeting "UPMC Health Systems' two largest billing offices, accounting for over 30 percent of the health plan's activity," he adds.

When the carrier ran activity reports for December 2001 "we found a 57 percent decrease in call volume for those offices," McCallister says.

Members Online went live in August 2002 with 600 employees of the HMO itself, followed by rollout to the company's 36,000 employees this past November. Currently, 227 employer and 600 provider groups are using the HP Online portals. The Member portal will be made available to all UPMC HP insureds during the first quarter of 2003.

UPMC HP has already saved the equivalent of 1.5 full-time employees by enabling group customers to key-in enrollment changes through the Web. While management won't talk dollars, Wayne Szymanski, UPMC HP project manager, reports expenditures "were well below industry standards," and staffing increases are projected to stay disproportionately small.

Rave Reviews

User response to Health Plan Online has been excellent in general, and message functionality that allows direct communication regarding disputed claims has been especially popular. "This is one piece of our application that is unique and we've had nothing but positive reviews," McCallister says.

McCallister is looking to customer reactions to consider what functionality to roll out down the line. Among the coming features on which UPMC HP currently is working is specific claims look-up, which will allow provider groups to follow claims status within defined date ranges, he says.

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Case Study Closeup

COMPANY:

UPMC Health Plan, Pittsburgh, $3.7 billion in assets.

LINES OF BUSINESS:

Health insurance.

VENDOR/TECHNOLOGY:

Antares Solutions' (Westlake, OH) Connexion ii ASP.

CHALLENGE:

Provide secure customer access to health plan information.

Anthony O'Donnell has covered technology in the insurance industry since 2000, when he joined the editorial staff of Insurance & Technology. As an editor and reporter for I&T and the InformationWeek Financial Services of TechWeb he has written on all areas of information ... View Full Bio