VIRGINIA BEACH, VA – After more than a year of strategic implementation, Optima Health Plan went live with a new provider network contract management system in mid-December.
With plans to go statewide in 2007, Optima needed a more efficient contract management process than could be provided by Microsoft Excel.
“We expect to double the volume of contracts that are going to be put into our system,” said Rachel Schneider, director of network management and contracting for Optima. The wholly owned subsidiary of Sentara Health Plans currently manages 13,000 contracts in central Virginia, many of which are customized.
Contract management had been an organization-wide issue, said Schneider. Many departments needed data from the provider network and wanted the ability to pull data from a central repository on the desktop. The health plan was also concerned about document inventory and management due to its multiple systems into which provider data is entered.
Schneider expects ROI to be achieved well before the five years that was conservatively estimated and a reduction in full-time employees for data entry, postage and mailing, and auditing and storage costs. “We expect improved accuracy, which will drive better claim accuracy,” she said.
Robert Leong, vice president of health plan product marketing for Kryptiq, noted provider contract management solutions produce added value for plans’ consumer-directed healthcare (CDHC) strategies.
Leong said that health plans are asking what kind of data do they need to provide CDHC products and services and quality and cost transparency to their members.
By making provider network contract data more accurate, real-time and mobile, plan executives can look at such things as HSA product utilization across their provider network to make strategic CDHC design and implementation decisions.
Leong said health plans are just starting to realize they have to put together an IT priority list to achieve their CDHC strategies and looking at IT solutions for added value.