Go ‘e’ or keep bleeding dollars, U.S. healthcare

The U.S. healthcare system stands to save $8 billion a year just by going electronic with six routine business transactions. But realizing the thrift will take an ongoing commitment by all healthcare stakeholders—providers, payers, vendors and government.

Such is the conclusion of CAQH, the Council for Affordable Quality Healthcare. On March 17 the D.C.-based nonprofit published the 2014 CAQH Index, which tracks how fast folks are moving from manual transactions—phone, fax, snail mail—to HIPAA-compliant electronic modes.

This is the second annual CAQH Index report detailing adoption rates and potential savings. Like the first, it looks at six basic transactions: claim submission, eligibility and benefit verification, prior authorization, claim status inquiries, claim payment and remittance advice transactions.

According to a news release, the report reflects data gleaned in 2013 from more than 4 billion transactions and involving 112 million enrollees of private health plans. It also incorporates information submitted by providers during a data-collection process conducted for CAQH by Milliman, Inc.

CAQH said that overall adoption rates of “fully electronic transactions”—those automated at both the payer and provider end—rose only slightly during this period. However, the volume of these transactions grew by double-digit rates for eligibility and benefit verifications, claim status inquiries and claim payments.

The group said about half of all claim payments and remittance advice transactions remain manual. In 2013 health plans processed about 1 billion transactions manually, while healthcare providers handled over 2.4 billion.

“Hospitals should be focusing on patients, not paperwork,” said Joel Perlman, chief financial officer of New York City’s Montefiore Medical Center and a CAQH board member. “By expanding automated electronic communications between providers and health plans, we can reduce healthcare costs, ease administrative burdens and ensure that key stakeholders in our healthcare system communicate with each other more effectively.”

CAQH has posted the full 2014 report in PDF format. The organization is seeking participants for its 2015 edition, sweetening the pot by offering payers and providers a confidential assessment of their performance versus that of their peers.