Forms Automation for Health Payers

The costs of paper-based processes

Like much of the healthcare industry, health insurance organizations or "payers" are under intense pressure to reduce soaring costs. At the same time, competitive pressures and strict medical regulations require better quality, accuracy, consistency and service to members and providers.

Automating manual, paper-based processes represents a significant opportunity to address all of these challenges. While there has been a rapid move to electronic claims processing, over 25% of all claims are still paper-based and processed manually.¹

According to America's Health Insurance Plans (AHIP), the average cost of processing these paper-based insurance claims is $1.58, nearly twice the 85 cents of processing an electronic claim. In total, over $286 billion is spent annually on paperwork and administrative claims processing -- enough to cover all of the uninsured and provide full prescription drug coverage for everyone in the United States.²

Put another way, with over 1.5 billion paper-based health claims still processed manually, health plans could save over $4.3 billion by converting these claims to electronic format.

Another key factor driving forms automation is the growing importance of consumer directed health care (CDHP). As consumers take more control of their healthcare, more efficient tools and processes (such as faster, easier enrollment and claims submissions) are becoming a key part of their health plan purchase decision. Indeed, Gartner ranks CDHP as one of the top drivers of technological change for health plans through to 2010.³

Microsoft's forms automation solution

Microsoft's forms automation solution is a scalable, standards-based solution to help health payers gather information and extend the reach of forms-driven business processes using a Web browser to employees, consumers, providers, brokers, and employers. This solution offers health payers an "adaptive forms platform" to connect people to processes; streamline business processes; and make data collection, distribution, and integration more cost-effective than is possible with paper-based forms.

Forms automation in action

The most common needs for forms automation are seen in these processes:

• Case management
• Referrals and authorizations
• Health risk assessment
• Coordination of benefits
• Subrogation and recovery
• Provider contracting
• CDHP application for benefits
• Accidental injury report

By streamlining these processes, health payers can:

• Dramatically reduce claims and administration costs
• Enhance the customer experience with faster, more efficient enrollment, claims and customer service processes
• Work with providers to deliver more coordinated and evidence-based care
• Respond faster and more precisely to RFPs
• Make it easier for employers to install, administer, and update subscriber programs

There are four primary benefits of this solution, which allow you to:

• Design forms with minimal IT involvement
• Gather information more accurately and efficiently with support tools built into the form
• Extend forms-driven processes securely beyond the firewall
• Automate workflow forms processes

Design forms with minimal IT involvement

By offering libraries of prebuilt data connections and template parts, IT organizations can greatly accelerate the development time of sophisticated form solutions. Developers can simply insert entire sections of forms that are frequently used, or apply predefined data connections instead of trying to remember complex connectivity procedures. More important, however, IT organizations that offer a single library of template parts and data connections maintain control over the information that your forms have access to.

Easily upgrade forms without interrupted business processes

With side-by-side form upgrades, your administrators can deploy new versions of forms with no downtime. Instead of removing a form from the server during working time, potentially stranding large numbers of users, InfoPath Forms Services enables you to update form templates on the fly and helps ensure those who access the form are getting the correct version. Built-in tracking capability within InfoPath 2007 templates helps the system know when forms were last updated and helps ensure the data submitted matches the requirements of the latest version.

Office InfoPath 2007 can design sections of forms for reuse within other forms

Gather information more accurately and efficiently with support tools built into the form

Our forms automation solution using InfoPath client provides a rich experience that goes beyond what you typically find with a Web-based form. For example, InfoPath provides:

• Data validation. The form controls-from radio buttons to fields and drop-down lists-provide validation features that provide quick feedback to users when they add information that is incorrectly formatted.

• Help. Screen tips explain to users what information is required in any particular part of the form.

• Conditional Formatting. Rules and conditional formatting can also be used to guide the user experience for completing a form, including the ability to show or hide optional form sections based on information entered.

• Merged Data. You can use InfoPath 2007 to easily merge the data in multiple forms to one document.

Extend forms-driven processes securely beyond the firewall

With Office InfoPath 2007 and the InfoPath Forms Services capabilities of Office SharePoint Server 2007, you can administer and deploy your business forms beyond the corporate firewall. InfoPath forms can be deployed in a variety of ways, including to Web browsers and mobile devices. InfoPath Forms Services can render InfoPath form templates as browser-based forms that do not require a local installation of InfoPath. In fact, browser forms offered by InfoPath Forms Services require no software download whatsoever. Your external users gain the benefits you have built into your InfoPath forms-including data validation, calculations, and repeating and optional sections-without having to wait for application updates or lengthy downloads. To help ensure the broadest possible reach, your external users can complete Web-enabled InfoPath forms using Microsoft Internet Explorer, Safari, Netscape, and Mozilla Firefox browsers. Mobile devices with HTML-based browsers can access and complete InfoPath forms as well.

InfoPath forms can be deployed as e-mail messages, enabling users to fill out and submit the form simply by replying to the message. Microsoft Office Outlook 2007 can host InfoPath forms, so organizations can send forms and gather information more efficiently than ever. By deploying InfoPath forms as Outlook e-mail messages, you can enable people throughout your organization to complete forms quickly and easily using the familiar Outlook environment.

Complete forms online or offline

InfoPath 2007 enhances your ability to work with forms online or offline so you can complete the forms anywhere, anytime. With InfoPath 2007, form data such as drop-down lists can be cached on a user's computer (rather than on a server), so users can work with forms either online or offline. People can take a form along on a laptop or mobile device and complete it whenever it's convenient-such as on the plane after a business trip.

Reduce Development Time for Your Browser-Based forms

With the InfoPath Design Checker, organizations can maintain consistent functionality and appearance across their browser-based and InfoPath client forms. Using the Design Checker, developers can create a single form template for browsers and InfoPath client environments. The Design Checker can disallow InfoPath form controls that are unsupported in the browser environment so form designers can quickly build forms with maximum compatibility.

Information Rights Management

Information Rights Management helps prevent others from using or distributing forms inappropriately -- both online and offline, inside and outside of the firewall. Record managers and administrators can define exactly how users can use data, and can place limitations on who can open, modify, print, copy, and forward certain confidential information, for example. Administrators can also build Information Rights Management (IRM) properties directly into form templates. Content is protected with RSA 1024-bit Internet encryption and authentication so that information will be safe in transit online and offline and will remain with the document, no matter where it goes. For example, encrypted content stored on a lost USB drive will not be accessible and viewable to any unauthorized viewer, regardless of location.

NOTE: Information Rights Management (IRM) is not available with browser-based forms. IRM only works with the InfoPath client.

Protect access to SharePoint template libraries and data connections

A form template with a direct connection to a database may provide an untrustworthy user with a way to access proprietary information. With SharePoint template libraries, access is password protected. Users are authenticated when they log on to their computer (this is enforced by IIS). This enables IT organizations to maintain control over the information that your forms access.

Automate workflow forms processes

Word and Excel can be quickly converted to InfoPath form templates

Office InfoPath 2007 makes it easy to convert Word documents and Excel spreadsheets into forms, and to build structure into your information-gathering processes. With the Import Wizard, you can import the form, and then the InfoPath Design Checker examines the conversion, identifying each field and table in the form. If the wizard discovers an ambiguous or unsupported element in the form, it flags the element and prompts you to insert a proper InfoPath control as a replacement.

Create PDF or XPS records of your form data

With the addition of a free plug-in, you can create a Portable Document Format file (PDF) or XML Paper Specification (XPS) version of your completed InfoPath form for archival and records management.

Sources:

1. America's Health Insurance Plans (AHIP): An Updated Survey of Health Care Claims Receipt and Processing Times, May 2006
2. International Journal of Health Services, Harvard Medical School, February, 2005
3. Gartner: Hype Cycle for Healthcare Payers, July, 2005