Health plan, physicians to speed health care delivery
Patient eligibility can be verified on the Internet
Thanks to a cooperative effort by health care providers and four large health plans, physicians in Washington state can verify a patient’s eligibility for coverage over the Internet in a matter of seconds.
The new program, created by members of the Washington Health Care Forum, a group of leaders from health care provider organizations and health plans, allows physicians and hospitals across the state to devote more of their resources to patient care and less to administrative processing.
With the new system, any questions about whether a patient is eligible for service can be answered over a secure Web connection in just four seconds. Previously, a physician office staff member had to use complicated telephone voice-mail systems that could take 10 minutes or longer, according to Tom Curry, executive director and chief executive officer of the Washington State Medical Association and a member of the forum.
The state’s four largest health plans, covering nearly half of the state’s population, have put patient eligibility on the system.
"We see it as a first step. Eligibility verification on-line is a good thing, but there are other parts that can be added," Curry says. The next step is to create secure Web connections for authorizing referrals of patients to specialists, he adds.
"The potential savings in time, money, and hassles are enormous. The patient benefits by getting better health service and lower cost, and this is just the first step," says Leo Greenwalt, president of the Washington State Hospital Association.
CEOs who are in the forum have assigned staff members to work on simplifying other administrative processes that currently add time and take money away from patient care, he says.
For example, the largest managed care product of one health plan requires approval for all referrals, but they approve every referral.
"In an environment where revenues are dropping and administrative expenses are skyrocketing, where margins are disappearing and medical practices are having a harder time remaining viable, this is a move in the direction of reducing administrative overhead. We have made the intellectual commitment that we’ve got to come up with a solution to the increasing administrative burdens being placed on providers," Curry says.
Physician office participation in the Internet verification program is strictly voluntary. "But it’s hard to find anyone who isn’t already online or who wouldn’t like to reduce administrative slippage right now," Curry says.
The Washington Health Care Forum was formed about 18 months ago to discuss the increasing number of problems in the health care financing and delivery systems. Washington state has a heavy concentration of managed care.
"The mantra at the state medical association is that the best way for physicians and groups to survive in this marketplace is to join together and participate as business partners whenever possible," Curry says.
The health plans began to pay more attention when a group outside the medical association announced a ballot initiative for a single-payer health care system and 40% of respondents to a physician opinion poll said they favored a single payer concept, Curry says.
The initiative did not qualify for the November ballot, and the medical association chose not to endorse it.
Forcing a sit-down
"The initiative had the useful benefit of forcing both health plans and the medical community to sit down and start talking about what we could do to clean up some of the duplication and waste in the administrative side of things," Curry says.
"We believe that the bulk of that 40% comprises physicians who were so abjectly frustrated by the complexity of their relationship with payers and the confusion that is rampant in the system that they had the view that nothing could be worse," Curry says.
The CEOs in the forum signed a letter asking their personnel to make something happen. Their first project was formation of a working group that led to putting the patient eligibility on the Internet.
The forum has opened lines of communications between the providers and the payer community. Its overall goal is to make the health care system simpler and more efficient to navigate for consumers, physicians, and hospitals.
"We have a long history here of collaboration, punctuated by moments of animosity. We went through several months of getting together and talking, sharing frustrations and concerns, and looking for common ground. They want to stay in business, and we want to stay in business," Curry says.
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