Streamline Health System Administrative Processes
Published on November 21st, 2011
Despite recent efforts to expand opportunities for health insurance coverage, little has been done to apply contemporary information technology to reduce costs overall, and such efforts have generally been focused on service reduction or artificial reductions in reimbursement. Streamlined processes and application of advanced information technology hold the promise for administrative savings and reduction of errors.
The Conference supports legislation to establish statewide databases to verify health insurance eligibility and standardize insurance enrollment and to centralize and streamline credentialing of health care professionals.
Administrative expenses make up a sizable proportion of the cost of health insurance. Recent studies have concluded that administrative costs constitute between 25% and 31% of the cost of insurance, and accounted for over $400 per enrollee per year in 2003. Technology can play a large part in reducing such costs which can, in turn, make health insurance coverage more affordable.
The Conference supports making the delivery of health insurance more efficient through establishment of a statewide enrollment program for commercial insurance, Medicaid, the Medicaid managed care program, Family Health Plus, and Child Health Plus. A centralized process would streamline enrollment by requiring all relevant information to be provided only once, would allow easier movement of enrollees from one program to another, and would reduce paperwork and associated errors. Likewise, such a program could provide important information generally on numbers of uninsured individuals and the performance of the state’s subsidized insurance vehicles.
In like manner, the Conference supports establishment of a statewide physician credentialing database which could be accessed with appropriate security and confidentiality measures by hospitals, insurers, managed care plans, and state regulators to verify the various credentials held by a physician. Currently it takes months for a physician to be credentialed by a payor and at least a month to credential a physician by a hospital for medical staff privileges. Establishment of a standardized and centralized database would shorten the time frames for credentialing physicians, and reduce paperwork for physicians and credentialing authorities. As with a centralized enrollment database, this process would avoid the duplication required of any physician, hospital and payor when a physician moves within the state.
You can download this document, Streamline Health System Administrative Processes, in PDF form.