HEALTHCARE ENTERPRISE: eMids Offers a Variety of IT Services to Providers & Payers
Nashville Company Offers Offshore Option of High-Volume Clients
For Nashville-based eMids Technologies, the third time was the charm.
Founded in 1999 by five friends who met at the National Institute of Technology in Calicut, India, the company launched as a dot-com enterprise, but a little too late to reap the rewards of the bubble. The company revamped quickly to offer programming services, but economic challenges after Sept. 11, 2001, took their toll on the young company.
Those early hurdles, said eMids President and CEO Saurabh Sinha, were “a blessing in disguise because they really made us think hard about how to survive. We knew we had to be good at a few things rather than doing many things.” That’s when eMids executives settled on the healthcare industry, which Sinha described as “a laggard in adopting certain best practices, which other industries adopted very quickly, like telecomm, banking and financial services.” Then it was time to immerse themselves in healthcare’s intricacies, “trying to understand this giant system and understand how the dollar travels,” said Sinha, adding, “As with any large system, there are inefficiencies that have been built over decades and decades of evolution, and those offer opportunities for us to grow.”
A 2004 visit to Middle Tennessee prompted the decision to headquarter the operations in Nashville. Two of the original five partners, include Sinha, remain with eMids, which today boasts nearly 600 employees, program management and sales offices in Chattanooga and Boston, and a development center offshore in Bangalore, India. “We have been fortunate the last few years,” Sinha understated.
eMids clients generally fall into two categories — either healthcare providers or healthcare payers, and the company offers information technology and business-process outsourcing services.
IT from eMids
Providers who turn to eMids for help receive that assistance in three ways.
The first is in answer to interfacing and integration needs. It’s easy to buy software products and yet quite a challenge to ensure those products deliver what’s advertised, enhance a provider’s workflow and mesh with other IT initiatives of the practice. “Lack of integration really stems from lack of standards. If standards were there, integration would be an easy job, but it’s not,” Sinha said. “We are responsible for making it successful.”
eMids’ second IT service to providers is in the arena of compliance, and Sinha pointed to HIPAA 5010 and ICD 10 as areas where providers need help these days. HIPAA 5010, which goes live on Jan. 1, 2012, is the latest version of transaction standards for processes such as authorizations and referrals, remittances and reimbursements. ICD 10 is the latest iteration of the International Classification of Diseases, used to code health claims. The compliance deadline for the new version is Oct. 1, 2013.
And then, of course, there’s “meaningful use” and ensuring that information-technology initiatives meet those standards set by the Centers for Medicare and Medicaid Services. Financial incentives are the CMS reward for meeting meaningful-use criteria. “Obviously, providers depend on their vendors to make sure they get a meaningful use-certified platform; but as they implement the platform, they may need assistance in actually generating the kind of reports they need to meet meaningful use standards,” Sinha explained. “Just buying a platform that is certified does not entitle them to anything. Meaningful use requires practice and behavior … not just the purchase of technology.”
The third IT service that eMids offers is verification and testing. While some providers simply use the vendors to conduct testing, others want an independent assessment to ensure the IT solution works the way it should.
On-site program managers who are eMids employees are needed for projects in any of these three areas “to understand the requirements of the client and communicate that to the team,” Sinha said. “Whether the team is sitting in Nashville or offshore, it doesn’t matter. We still need somebody at the client’s site who is well-versed with healthcare, understands the requirements and really manages the program.”
eMids’ program managers are senior executives with more than 15 years of experience, thus their presence on site is a valued asset, Sinha added.
eMids also offers providers business-process outsourcing services.
For one, the company has 35 medical coders on staff both onshore and offshore, and all are trained to meet American coding standards. eMids charges per chart coded, thus allowing providers to pick up additional coders when work flow demands. “A correctly coded medical chart is an outcome,” Sinha said.
Another BPO service is billing and payment posting, and yet another is denials management. Claim denials are a frustrating and time-consuming headache, and particularly for smaller practices, staff simply may not have the time to address them. “They’re usually ignored. Then you have a challenge where the revenues aren’t coming in or the cash flow is affected,” Sinha noted. “And if the coding isn’t done correctly, you will always get denials.”
eMids works with providers to help ensure that claims are handled correctly on the front end. “If you’re doing it correctly the first time, you don’t have any downstream inefficiencies to deal with. You will simply get paid,” he said.
Help for Payers
Medicare Advantage (MA) plans are a substantial chunk of eMids’ payer business, and the reason is because of their continual efforts to drive down costs. “CMS is really tightening the screws on many areas of spending so driving costs out of the system is a big need. Also, retaining members is another very big need,” Sinha said. “It’s very complicated now. How do they ensure that their future revenue base is not under threat?”
MA plans are looking to use technology to automate workflows, on the one hand, and to better understand their members on the other.
“Do I know my members well? What are their preferences? Which members need preventative care versus members who are leading a healthy lifestyle and should be encouraged?” Sinha said MA plans should be asking these questions and using good data intelligence and technology to find the answers. The same goes for identifying and incentivizing good providers, he added.
Onshore & Offshore with Agility
eMids offers clients the option of offshore services, thanks to its Bangalore operation. “Different customers engage with us differently. We’re not wedded to any particular engagement model. If a customer is comfortable with an onshore and offshore model, then we offer that,” Sinha said. No matter the model, the U.S.-based program managers are in charge of interacting with the customer and making the engagement a success, he said.
Whether an offshore model is more cost effective normally depends on volume. “I would say for low-volume work, it’s not really cost effective, but for higher-volume work, definitely, there’s a lot of savings that can be effected,” Sinha said. “It’s easy to think of offshore as cost effective, but it takes a lot to make it happen. We have, over many years, really matured our delivery model from offshore to ensure that we can bring that cost savings to the table in a true sense.”
eMids operates using a strategy called the Agile Method. That means not only setting long-term goals for the client, but short-term goals, as well. Thus, results are delivered incrementally on a timetable of every three to four weeks. In fact, eMids wrote the book on agility. Entitled “The Black Book of Agile Project Delivery with Distributed Teams,” the volume is available via Amazon and iTunes.
The eMids Name
No, eMids didn’t derive its name from the fact that it’s an “e” company … and, no, “Mids” doesn’t have anything to do with medicine. The five founders of eMids all lived in the E dormitory at NIT in Calicut, and they lived on the middle level. They were known as eMids in college, and the name stuck.