Health Plans Collaborate on Landmark Initiative to Reduce Time, Expense

Health Plans Collaborate on Landmark Initiative to Reduce Time, Expense for
Physician Office Practice 'Paperwork'

Savings are estimated in the hundreds of billions of dollars when all of
health care moves to automation and standardization; A watershed development
comparable to what ATMs did for banking, the initiative has broad support
among Ohio physician organizations

Health plans today launched
a landmark initiative to make delivering and getting health care easier for
patients and their physicians by reducing the time, effort, and expense for
the "paperwork" required for each patient office visit. The initiative, which
will simplify information flow between health plans and doctors' offices, and
later between health plans and hospitals, is comparable to what ATMs did for
banks and consumers.


Beginning in early November, America's Health Insurance Plans (AHIP) and the
Blue Cross and Blue Shield Association (BCBSA) will sponsor regional and
statewide initiatives to assess how best to offer physicians access to
multiple insurers through the same information channel (e.g., a web portal) in
a given region of the country for the purpose of conducting key office tasks.
Savings are estimated in the hundreds of billions of dollars as the entire
health care system achieves efficiencies through similar moves to automation
and consistent business practices.


This landmark initiative addresses the need for one-stop service in electronic
transactions that physicians have advocated for strongly, and is a requirement
to achieve the level of savings that is ultimately possibly. It replaces a
cumbersome system in which physician office staff spend considerable time at
considerable expense accessing multiple channels to get the information needed
to complete basic requirements for confirming eligibility, billing, and
referrals. The ultimate goal is to develop regional services that span the
entire country.


The initiative announced today in Ohio already has strong support from local
health plans representing greater than 91% of state residents with private
health insurance, and major statewide physician organizations.


"We applaud the efforts of health plans and providers to continue to work
together to reduce administrative expenses in an effective manner, slowing the
growth of health care costs, which could ultimately make health care coverage
more affordable for Ohioans," said Mary Jo Hudson, Director of the Ohio
Department of Insurance.


Participating health plans are:
--  Aetna
--  Anthem Blue Cross and Blue Shield
--  CIGNA
--  Humana
--  Kaiser Permanente
--  Medical Mutual of Ohio
--  UnitedHealthcare

--  WellCare Health Plans, Inc.



Physician organizations who are supporting the effort to encourage their
members to take part are:
--  Ohio Chapter, American Academy of Pediatrics
--  Ohio Academy of Family Physicians
--  Ohio Medical Group Management Association
--  Ohio Osteopathic Association

--  Ohio State Medical Association



"This landmark initiative in Ohio demonstrates the commitment of health plans
to simplify health care and the potential that exists to achieve savings
through efficiencies in what we used to call 'paperwork,'" said AHIP President
and CEO Karen Ignagni. "We are committed to addressing the needs of practicing
physicians for administrative simplicity, and in that way contributing to
improvements in patients' experience. These are goals that should be hallmarks
for a reformed health care system," Ignagni said.


"This initiative is a great example of collaboration between key stakeholders
to help improve the quality and value of our healthcare system," said Scott P.
Serota, President and CEO of the Blue Cross and Blue Shield Association.
"Streamlining the administrative process for providers will result in
tremendous savings, both in time and resources, and ultimately lead to
improved consumer experience," Serota said.


The Ohio initiative offers opportunities to simplify the work associated with
patient visits and achieve savings, including providing physicians with
information in "real-time" that:


--  Allows office staff to quickly determine key eligibility and benefit
information (e.g., co-pays, co-insurance, and deductibles, and
differences in coverage for services provided in- versus
out-of-network), minimizing time and expense needed for such purposes;
--  Gives physicians access to current and accurate information on the
status of claims submitted by physician offices for payment by
insurers.
This will minimize the need for follow up steps by office staff or
submission of duplicate claims that delay rather than expedite payment
in most systems;
--  Tests real-time referrals and timely pre-authorization of services;
and

--  Provides for the online submission of healthcare claims.



"The Ohio State Medical Association (OSMA) is pleased to participate in the
launch of the multi-payer portal project in Ohio. This new tool will allow
Ohio physician practices to check patient eligibility, benefit coverage, and
claim status all from one source," said Mark Jarvis, Senior Director of
Practice Economics at OSMA. "This project will also help practices simplify
administrative process and reduce some of the confusion in health care
billing. Hopefully, this will give physicians more time to spend caring for
patients by reducing administrative paperwork," Jarvis said.