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Premier Managed Care, Inc.

Premier Managed Care, Inc. provides Workers' Compensation case management services to more than 4,800 employers in Ohio. Premier Managed Care is a subsidiary of Simon Compensation Services, a third-party administrator. Both Premier Managed Care and Simon Compensation Services are based in Columbus, Ohio.

Challenge

Since its founding in March, 1997, Premier Managed Care, Inc. had utilized a stand alone computer system to process and transmit its workers' compensation case management data. While Premier's executive management was initially satisfied with their computer system's performance, the software application began to developed serious problems.

Richard DeStefano, President of the Columbus, Ohio-based managed care organization, explains, “Unfortunately, we found that our software vendor was not very responsive to our requests for assistance. In some cases, it would take up to half-a-day to get a return telephone call from the support people.”

These problems were coupled with the fact that the software did not include an automated check writing capability. According to DeStefano, “Because we didn't have automated check writing, we had to hire temporary workers to manually write and type checks. The cost of the temporary workers-nearly $13,000 per year-had become our biggest problem.”

Despite repeated requests, Premier's software vendor was unable to provide an effective check writing application. At the same time, software incompatibilities had made running 1099s for its client's vendors cumbersome and expensive. DeStefano said, “By November of 1998, we had become very dissatisfied with our vendor's customer support services and inability to offer the software capabilities we required. Premier Managed Care had come to the realization that we needed to make a change.”

Solution

The Claims Advantage™ software is a secure web-based application and accessed over the Internet. All parties are connected over the Internet and remote access allows all documents to be viewed, routed, faxed, printed or e-mailed from any PC with an Internet connection. There is no hardware or software to install, maintain or upgrade and all system user training, administration and maintenance is done by PBM.

According to DeStefano, when Premier purchased their original computer system, he and other members of his management team did not fully consider the importance of their vendor's support services. But now, as they compiled a list of prospective software providers, the level of support services became a significant factor in their selection decision.

Following several strong recommendations from executives at other managed care organizations; Premier Managed Care contacted PBM and requested a demonstration of the Claims Advantage™ system. “We were immediately impressed by Claims Advantage's processing speed, ease-of-use, and the software's incorporation the check writing and 1099 generation modules that we needed,” says DeStefano. “Only time would tell if the PBM Client Services staff would live up to their assurances of prompt, effective support service. But based on the experiences of several of our MCO peers, we made the decision to switch to the Claims Advantage™ system.”

In discussing Premier's selection process, DeStefano noted that the Claims Advantage™ software application resides on PBM's servers. “We ran our existing application on our own on-site server, which had begun to experience operating problems. Keeping our current software system would have required an investment in a costly server upgrade. By changing over to Claims Advantage™, we were able to forgo the server upgrade.”

Value Delivered

Two months after installing Claims Advantage™, DeStefano says his staff has found that both the Claims Advantage™ software and customer support team have, “worked as advertised.” He says, “We generally have up to 10 PCs logged on to the Claims Advantage™ Internet site all day long during the week, and sometimes on weekends. We have two ISDN lines that connect us with PBM's servers, and we have never had a problem accessing the system.”

DeStefano says that a typical call to the Claims Advantage™ Help Desk is returned within 15 - 20 minutes, if it is not answered right away. “After experiencing the level of support we have receive from PBM, we now consider support service to be one of the most important factors in choosing a vendor.”

On a daily basis, Premier Managed Care writes 200 to 300 checks to providers. Previously, the firm's check writing process consumed about eight hours per day. With the installation of Claims Advantage™, Premier Managed Care is able to generate its daily check run in one hour, resulting in savings of nearly $700 per week. “With Claims Advantage's ability to bundle payments, we're seeing significant savings in postage.”

Success stories and like Premier's, and other system concerns are voiced at the user's group meeting PBM hosts every quarter. DeStefano says, “The user meetings are a great opportunity to bring any software questions directly to the PBM staff. It's very helpful to get together with other MCOs to work on common issues and challenges.”

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