Health Net 2001 Annual Report Download - page 11

care and clinical trial information, and online health evaluation tools, such as a health risk calculator
and weight-loss guide.
Provider/Payor Connectivity. Provider/payor connectivity solutions enable health care providers and
health care payors, including delegated medical groups, to electronically exchange administrative,
financial and clinical information. We began the MedUnite initiative in 1999 to develop a provider/
payor connectivity solution. MedUnite has subsequently come to include six other nationally prominent
health plans. MedUnite operates as a stand-alone enterprise in which we retain a minority ownership
interest. MedUnite, which is designed to provide on-line internet provider connectivity services
including eligibility information, referrals, authorizations, claims submission and payment, commenced
pilot operations in California and on the East Coast in 2001. Through our subsidiary, Health Net of the
Northeast, Inc. (formerly Physicians Health Services, Inc.), we also employ another provider/payor
connectivity solution in the Northeast. This solution is supported by NaviMedix, Inc. (‘‘NaviMedix’’)
and currently provides Internet-based connectivity services to physicians in the tri-state area of
Connecticut, New York and New Jersey. We hold a minority equity position in NaviMedix.
Online Enrollment and Billing. We continue to develop online enrollment and billing initiatives for
our commercial health plan and TRICARE lines of business. These initiatives permit health plan
members/beneficiaries to enroll in health coverage, pay applicable fees, and select a primary care
physician using the Internet. Additionally, our member services and enrollment employees will perform
enrollment and billing activities through the Internet using these innovative solutions. Both enrollment
and billing initiatives commenced pilot operations in 2001.
MANAGEMENT INFORMATION SYSTEMS. Effective information technology systems are
critical to our operations. Our information technology systems include several computer systems, each
utilizing a combination of packaged and customized software and a network of online terminals. The
information technology systems gather and store data on our members and physician and hospital
providers. The systems contain all of our necessary membership and claims-processing capabilities as
well as marketing and medical utilization programs. These systems provide us with an integrated system
of billing, reporting, member services and claims processing, and the ability to examine member
encounter information for the optimization of clinical outcomes. In this connection, as set forth above,
we are in the process of developing and implementing online enrollment and billing solutions for our
health plan and TRICARE operations, which we believe will simplify and expedite administrative
functions.
PROVIDER RELATIONSHIPS AND RESPONSIBILITIES
PHYSICIAN RELATIONSHIPS. Under most of our HMO plans, each member upon enrollment
selects a participating physician group (‘‘PPG’’) or primary care physician from the HMO’s provider
panel. The primary care physicians and PPGs assume overall responsibility for the care of members.
Medical care provided directly by such physicians includes the treatment of illnesses not requiring
referral, as well as physical examinations, routine immunizations, maternity and child care, and other
preventive health services. The primary care physicians and PPGs are responsible for making referrals
(approved by the HMO’s or PPG’s medical director) to specialists and hospitals. Certain of our HMOs
offer enrollees ‘‘open panels’’ under which members may access any physician in the network, or
network physicians in certain specialties, without first consulting their primary care physician.
The following table sets forth the number of primary care and specialist physicians contracted
either directly with our HMOs or through our contracted PPGs as of December 31, 2001:
Primary Care Physicians ..................................... 53,765
Specialist Physicians ........................................ 114,652
Total ................................................... 168,417
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