Health insurance industry foes often point to insurers as a barrier to healthcare reform that could result in lowered costs and increased efficiency.
Health insurers are nothing more than third wheels that complicate the healthcare system, critics charge. But if a pilot program in Ohio takes off, the foes may have to revise that statement.
America's Health Insurance Plans, Blue Cross and Blue Shield Association, eight health insurers, and five Ohio physician organizations will begin a pilot project next month that will look to reduce health insurance paperwork and free up physicians' offices from administrative headaches. The project, which was announced this week, will create a one-stop Web portal for electronic transactions. Ninety-one percent of all Ohio residents insured through private carriers will be part of the project.
Mark Jarvis, senior director of practice economics at the Ohio State Medical Association, one of the five physician groups taking part in the pilot, said the project includes about 20,000 of the 30,000 licensed doctors in Ohio. Though five physician organizations are taking part, hospitals are not included in the initial pilot but organizers hope to bring hospitals on board once they see the program's benefits.
Physicians, who reportedly spend three-and-a-half hours per week dealing with health insurance eligibility, benefit, and claims information, have long complained about how health insurance paperwork is a drag on their time and how it distracts them from focusing on their patients.
The current system is cumbersome and forces physician offices to devote time calling insurers and toggling through myriad health insurer Web sites.
In this pilot, the insurers will create one online home in which physicians can find eligibility and benefit information, as well as up-to-the minute claims data. If this kind of program became the norm throughout the healthcare system, AHIP suggests "hundreds of billions of dollars" could be saved via automation and consistent business practice efficiencies.
Karen Ignagni, president and CEO of AHIP, likened the project to bank ATMs.
"It's a step that will ultimately transform our system into one that takes advantage of the technology for the benefit of clinicians and their patients," she said.
The program will provide physicians real-time information, which will:
- Allow office staff to quickly determine key eligibility and benefit information, such as copays, co-insurance, and deductibles, and differences in coverage for services provided in- versus out-of-network
- Give physicians access to current and accurate information on the status of claims submitted by physician offices for payment by insurers
- Test real-time referrals and timely pre-authorization of services
- Provide online healthcare claims submissions
"We can see all the elements being in place to actually achieve the kind of simplification that physicians are looking for that will help patients because physicians will have more time to focus on them, which is exactly as it should be," says Ignagni.
Jarvis said the project will reduce claim denials because physicians will be able to quickly find eligibility information. This is much easier than having to make phone calls to health insurers or search for that information on the insurers' sites, he added.
Given the timing of this pilot project, many cynics will ask: If physicians want administrative simplification, why has it taken so long for health insurers to develop this pilot? And are health insurers developing this pilot in response to healthcare reform?
Ignagni said the reason the pilot is happening now is not because of health reform, but because the technology is now available and AHIP has been focused on creating the pilot program for "a number of months."
Ignagni added that a similar project in New Jersey is also in the works, and the collaboration could spread to other parts of the country.
This pilot program has the potential to serve as a trailblazing project that could change healthcare administration processes. These aren't small, regional health insurers that we're talking about. It's Aetna, Anthem Blue Cross and Blue Shield, CIGNA, Humana, Kaiser Permanente, Medical Mutual of Ohio, UnitedHealthcare, and WellCare Health Plans, Inc. These are some of the largest and most influential health insurers in the country.
If they find successes and cost savings through this pilot, these insurers will likely look to expand the program to other states.
Administrative simplification is not an exciting topic, but it could serve as a way to reduce health costs, improve physician/health plan relations, and remove some of the complexity in a healthcare system that so many Americans don't understand.