American Health First and IBM Lotus Software
 Redefine Industry Through e-Business
Release - September 2002

      Efficiency is key to the success of most small businesses, yet these entities often are required to adapt their office procedures to fit the controls of the market’s available computer programs, instead of the programming fitting the specific needs of small business. However, American Health First Incorporated, and its computer programming consultant firm, Anesis Incorporated, used IBM’s Lotus iNotes Web Access to design a new system for real time access to account records for healthcare providers. The company named the product “Eligibility Management System” (EMS) and has a patent pending.

     American Health First is a service company that provides reimbursement solutions for non-funded healthcare patients. Headquartered in Houston, the company has installed EMS in nine of their client hospitals in Louisiana and Texas.

     “Our goal was to design a program that would allow healthcare providers to instantly track our productivity over a secure network,” said Alphine Freeman, President and CEO of American Health First. “This program aligns the management process of patient requirements for third party resources with proactive notices to help track the status of each applicant along with the dollars for each patient. Now, hospital Chief Financial Officers will know at all times exactly the revenue in their pipeline based upon approvals and payment percentages, and exactly when they should expect to receive the funds.”

     “We’ve seen a 30 percent increase in productivity measured by cash in the door over the past 6 months, since we’ve employed the EMS system,” said Scott Ulrich, Business Office Director at Doctors Hospital Parkway and Tidwell. “When I started working with American Health First ten years ago, using companies to find third-party resources was considered a luxury in the healthcare field. Now, it is a necessity to help keep hospital doors open.” 

     “Hospitals are required to provide emergency care to everyone who comes in,” said Ulrich. “In our case, we are not tax supported, nor do we receive stipends for caring for non-funded patients. So, it is critical to find resources to pay for the healthcare services we provide these patients. Without service reimbursements we wouldn’t be able to stay open very long. With this system, we know exactly where we stand financially 24 hours a day with the touch of a button.”

     At a time when many hospital emergency facilities are closing due to costs, the Eligibility Management System is considered a breakthrough. “Before, we either suffered the losses or had to make time to manually inform American Health First by calling or writing to see if they could qualify patients for reimbursements,” said Ulrich. “Now, it’s done electronically as the patients enter and I don’t have to worry about anyone being lost in transition. I get 100 percent of our uninsured patients referred and I know their status via the system at all times. This allows the hospital to have more accurate accrual expectations and better expenditure planning. “ 

     Anesis Inc. designed the Eligibility Management System in partnership with American Health First. “We take existing programs and technology and modify them to meet our customers’ business processes,” said Marvin Greely, President of Anesis. “The American Health First application is a stand alone operation at each hospital. They wanted to create a secured network that would tie all the appropriate parties together for immediate access to the same information for top efficiency. We selected IBM’s Lotus iNotes Web Access because of its web capabilities to give the hospitals all the diversity of location with a single concentration point for control of the application.

     “With this application,” said Greely,” there is no software for the hospital to install or upgrade, and no on-site maintenance for the hospitals.” Personnel with approved access and the proper password can go on the Internet and access their hospital database, and only their specific database, from any computer in the hospital. This means that if the computer in use crashes, the hospital employee simply moves to another computer because EMS is on a Lotus iNotes server located at Anesis’ control center. 

     “Lotus iNotes has an inherent high-end security code that exceeds the Federal HIPPA guidelines,” said Greely. “This Lotus software is designed as an integrated system in separate locations so that all locations can talk to a single control center and have security and collaboration, which allows proactive and reactive data management to help employees get their job done. It’s a collaboration between email and data base, all in one server.”

     “Lotus iNotes Web Access is the perfect solution for small businesses running these types of applications,” said Dean Marsh, Director of Messaging Solutions, Lotus Software, IBM. “Lotus iNotes Web Access provides a low-cost, easy-to-use Web client that allows American Health First to leverage the Web to communicate and collaborate with their hospital partners.

     “Hospital employees can access patient records via the Internet from any computer in any location, simply by clicking on a browser and accessing the Eligibility Management System,” said Marsh. “This improved sharing of information saves time and resources, as well as increases productivity. Plus, it all happens over secured lines and on a dedicated server, so there is not risk of patient information being misused or falling into the wrong hands.

     “The success of American Health First and its Eligibility Management System just shows that we’re meeting our goals,” continued Marsh. “Lotus Software products and services were designed to reflect IBM’s unique understanding of the new ways in which individuals and businesses must work together to achieve such solutions.

     “Lotus Software is redefining the concept of conducting business through collaboration, practical knowledge management, e-business and other ground-breaking ways of connecting the world’s ideas, thinkers, buyers, sellers and communities via the Internet.” said Marsh. “We are able to maximize our reach by working through the direct and extensive channels of our Business Partners like Anesis.”

     Currently, use of the Eligibility Management System is available to healthcare clients of American Health First, Incorporated. For more information, contact American Health First, 5300 Hollister, Suite 510, Houston, Texas 77040-6015. Phone numbers: 713-895-7131, fax 713-895-7231. Website: americanhealthfirst.com.

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