Physicians Plus Insurance Corporation

Improve Member Services Through Business Processing Solutions

When Physicians Plus Insurance Corporation began searching for a service provider to help them maintain their record of quality and service excellence, they turned to Perot Systems.

The Challenge

Physicians Plus Insurance Corporation (Physicians Plus) was very explicit about its relationship expectations from Perot Systems. They needed access to state-of-the-art applications, as well as a depth and breadth of skill sets to deploy and enhance their competitive advantage.  Physicians Plus also required cost-effective, high-quality business processes and strong project management skills to ensure initiatives were scaled, scoped, and executed accurately, on time, and in budget.

The main goal of the relationship was to take customer service to a new level, create greater back-office efficiencies, and strengthen Physicians Plus’ competitive position in the marketplace.

The Solution

Under a 10-year agreement, Physicians Plus gained access to Perot Systems’ payer enterprise applications through an ASP environment, as well as some of Perot Systems' claims, consulting, and HIPAA remediation services.

Perot Systems began by implementing and integrating a portal solution to help Physicians Plus maximize the benefit of existing information systems. The portal provides Web-enabled provider access, transaction processing, and reporting capabilities. At the same time, Perot Systems’ ASP vehicle was implemented to assist Physicians Plus’ management with critical clinical and financial decisions.

At first, this capability was combined with McKessonHBOC’s AMISYS® health insurance and managed care enterprise information system, but in March 2003, Physicians Plus selected Perot Systems’ DIAMOND® 950 claims administration solution.

A transition plan was created to convert Physicians Plus from the AMISYS platform to the DIAMOND system, which helped Physicians Plus achieve a number of cost-effective benefits.

Perot Systems now provides claims, billing, and enrollment transaction services, as well as system and database administration, automation, and programming support. Other projects Physicians Plus is planning to initiate include reporting and long-term IT strategic planning.

The Results

Since Physicians Plus and Perot Systems began working together in 2000, the health plan has:

• Achieved NCQA Excellent status in every product line it sells. 
• Ranked in the top 15 nationally among HMOs with the highest HEDIS scores. 
• Branched into pharmacy management services for other HMOs. 
• Achieved the Wisconsin Forward Award “Mastery” status.
• Garnered statewide attention for its use of Perot Systems’ Web portal technology.

The health plan has also achieved three years of record profits and realized growth curves that exceed its forecasts.

Bill Jollie, Physicians Plus executive vice president, said, “We could not have accomplished this track record without Perot Systems’ strong transactional, IT, operational, project management, and strategic support.  The whole of these parts is more than their sum. They make Perot Systems a cherished business relationship and key ally as we plan the next several years.”

Perot Systems also helped Physicians Plus create a “virtuous circle” in which they can identify projects that lower the health plan’s system costs, while improving the quality and efficiency of service. Specific examples include:

• Added more structure to the old post-production audit process resulting in fewer errors.
• Automated the COB for third-party recoveries, saving approximately $1 million for Physicians Plus providers and helping keep rates low.
• Moved to near real-time Pharmacy Transaction Files updates eliminating wait time for activation of benefits and reducing errors, which translated into $20,000 per month savings.

Other significant enhancements from the relationship include:

• Utilization of Internet capabilities to streamline daily interactions, reduce administrative paper loads, increase employer visibility, and enhance responsiveness to customers.
• Creation of a cost-effective DIAMOND system conversion allowing HIPAA-compliance throughout the transition.
• Co-management with Physicians Plus of more than 2.5 million transaction processes each year, earning them the best BPO customer rating of any HMO in its service area.
• Implementation of the DIAMOND environment to enable a high first-pass rate for healthcare claims adjudication, customized flexible business rule configuration, and secure Internet portal services for e-business.

Physicians Plus and Perot Systems will continue pursuing many strategic areas over the course of their 10-year relationship.