Ontario body commissions e-health system

In an effort to cure its ailing, paper-based compensation system, the Workplace Safety and Insurance Board of Ontario (WSIB) has contracted Montreal-based e-commerce company BCE Emergis to provide a new Web-enabled health claims approval and payment system.

The new online system will use a rules-based engine to process and adjudicate the four million claims the provincial body receives each year, as well as automating compensation payments to Ontario’s 27,000 health care providers, said Robert Timlin, director of the WSIB’s provider bill-approval project.

“We expect we’ll be able to process about 80 per cent of our claims through the system, and the other 20 per cent that are more complex will be kicked out to our staff who will deal with then individually,” Timlin explained.

The current, 30-year old claims process is labour-intensive, expensive and slow, Timlin said, so when the new system goes online in July 2002 both injured workers and medical offices should see a significant improvement.

“About a million of the four million claims that we process through our systems today come from injured workers, so when they themselves are out of pocket for health care expenses they will be able to get paid much quicker by the Board,” he said.

“The other side of it is because our current process doesn’t turn around payments to providers very quickly many of them find it difficult to work with us, and in some cases they are discouraged form treating workers because of the administrative overhead for them. So by having a process in place that makes it easier for them to deal with us, workers will have access to better services, and the data the we’re going to be able to collect from the system will help us to identify clients who we need to intervene with and maker sure they get into the best care,” Timlin said.

Although not able to disclose the dollars involved in five-year contract, Ron Loucks, executive vice-president of BCE Emergis’ eHealth Group, agreed that it should result in hugely increased efficiencies.

“We are providing an end-to-end solution for the Board on behalf of the injured workers. This means that an injured worker who requires intensive session of physiotherapy, for example, presents a certified claim number at the physiotherapist clinic, and receives their treatment and the actual billing for the treatment is handled by us on behalf of the Board. The health care providers are not having to fill in paper, have the worker submit it, get it processed, wait several weeks or months for a cheque – it’s all done online just like a point-of-sale transaction,” Loucks said.

Loucks said the new service – which is entirely hosted by Emergis on its own fault-tolerant platform, with only access portals sitting on WSIB desktops – will be modeled on its current system for insurance companies that already processes millions of transactions and links every pharmacy, and about 50 per cent of all dentists’ offices in Canada.

“The public model is not really a lot different (from the private one), because whenever you have a payer involved with any kind of a health care transaction all of the issues around efficiency, accuracy and confidentiality are all shared within the various payer communities,” Loucks said.

Timlin said that although privacy is a valid concern with this kind of concentration of data, “both Emergis and the WSIB have very high standards when it come to security because of the type of information that we deal with on a daily basis.”

He also said that the concept for this type of system has been around for a while, and it is past due for implementation in Ontario.

“Down in the States [compensation boards] do this a fair bit, and in the insurance world in Canada and in the United States [electronic claims] are doing quite well now, so for us it’s almost trying to catch up to these other players.”

The Workplace Safety and Insurance Board of Ontario is at www.wsib.on.ca.

BCE Emergis is at www.emergis.com.