The flow of information is the life–blood of just about every business — ensuring that important data gets from point A to point B as quickly and efficiently as possible. And the health care industry is no different. So when that information is directly connected to the health and well–being of patients — that's when maintaining efficiency takes on an even greater urgency and importance. For Georgia–based Memorial Health, the information needed to make vital decisions is kept on the move by FileMaker Pro — the award–winning database software application from FileMaker Inc.!

Business Challenge

Located in Savannah, Memorial Health operates one of the most active managed–health organizations in the Southeast. Memorial Health provides managed health care services to approximately thirty client companies with more than 55 thousand people while also operating a tertiary–care teaching hospital. And when decisions are made on matters of patient care, medical director Dr. Richard Lachiver is there to see that they're made in an accurate and timely manner. "When doctors have a patient on whom they want to perform a procedure," he explains, "they tell us about the case and the circumstances, and we make a judgment on whether the procedure is permissible under the client's coverage plan. We also have a disease management program, a new concept under which patients with chronic complaints — diabetes, asthma, and the like — are helped to get managed treatment that's both effective and efficient."

Information moves through Dr. Lachiver's department in constant streams – case histories, diagnoses, documentation of claims — but his staff never loses sight of the fact that there are real people on the ends of each stream. So it's one of Dr. Lachiver's priorities to ensure that claims are processed as quickly and accurately as possible. "We'd been leasing proprietary claims management software, a cost running between $100,000 and $150,000 a year," he recalls, "but we had to generate claims management letters by hand, typing the information into the system and then printing out the letters. There were stacks and stacks of paper."

I had been using FileMaker Pro personally for years and we were using the software elsewhere in the organization for scheduling patients and other functions. I just kept adding functions to it — and ended up with the system we have now. You name it — we can do it on FileMaker Pro.

— Dr. Richard Lachiver, Medical Manager, Memorial Health

It was an inefficient system from the company's perspective — and delays in approval for claims meant delays in care for patients. But about a year and a half ago, Dr. Lachiver began to experiment with FileMaker Pro. "I had been using FileMaker Pro personally for years," he says, "and we were using the software elsewhere in the organization for scheduling patients and other functions. I just kept adding functions to it — and ended up with the system we have now. You name it — we can do it on FileMaker Pro."

Successful Solution

FileMaker Pro offers an approach that's more efficient — and also more cost–effective. Instead of spending up to $150,000 a year to lease software, Memorial Health owns its FileMaker Pro system outright. "The cost now is essentially $0 on an ongoing basis," Dr. Lachiver comments. "The cost to us initially was about $2,000 for the software and another $1,500 for a server. There are no recurring costs."

Now, FileMaker Pro stands at the heart of Memorial Health's claims management operation, and there's a staff of 15 to 17 people working in a network of about 50 databases containing tens of thousands of records relating to individual claims. "We collect clinical information from the doctor on each case," Dr. Lachiver explains, "and all the necessary documentation. Once entered into FileMaker Pro, we can examine the documentation all at once — and if the case is approved, we just press the 'yes' button, and FileMaker Pro automatically generates the letter authorizing the procedure, complete with a unique authorization code that will allow the claim to be paid.