Can a Veteran of ATM Networking Succeed in Health Care Processing?

A veteran ATM network executive thinks he can succeed at building a national health-care transaction-processing system, though similar efforts have a dismal record of failure. The executive, Joseph E. Wolfson, founder of the Metroteller electronic funds transfer network, expects the HealthTransaction Network to begin processing transactions from health-care insurance companies and providers beginning early next year. Switching and pricing plans are still being finalized, but HealthTransaction Network already has commitments from a number of mostly western New York state organizations, including HealthNow/BlueCross BlueShield of Western N.Y., Independent Health, Kaleida Health Systems, Catholic Health System, University Orthopedic Services, and Buffalo Medical Group. “We are not going after the traditional back-end market because we will focus on processing consumer transactions such as insurance-eligibility verification, provider referrals, automated provider forms completion, and consumer payments for copays, prescriptions, and other health-related items,” Wolfson says. To make the HealthTransaction Network different from other batch electronic data interchange organizations and claims clearinghouses, Wolfson is also rolling out a card program enhanced with biometric technology. Wolfson says HealthTransaction Network will work with payers and managed-care organizations to issue cards to employers and workers that contain advanced biometric applications such as patient fingerprint and signature recognition for better identification, a photo image of the cardholder on the front of the card, and stored data that helps providers eliminate paper and automatically fill in electronic payment and referral forms. Biometric-capable card readers and other devices will be supplied to HealthTransaction Network by Interlink Electronics, a Camarillo, Calif., developer of signature-recognition hardware and software. HealthTransaction Network, like other financial-services technology companies and card associations such as MasterCard International, Visa International and Metavante Corp., see a big opportunity in forthcoming card-issuing and transaction-processing deals driven by consumer-driven health care. But earlier national health-care processing initiatives from Fortune 500 companies and others have failed to win a critical mass with regional and local health care systems. Wolfson is basing the future of HealthTransaction Network on the assumption that more than 80% of all health-care claims transactions can be settled at the time services are delivered, with immediate settlement of funds to the provider. But others aren't so sure even the incentive of instant payment will help the fledgling network attract enough providers, including smaller group medical practices. “Most earlier national initiatives failed because they just didn't understand the market and how local and fragmented it can be,” says Ann Geyer, a partner with The Tunitas Group, a health-care technology consulting firm in Mountain Ranch, Calif.