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$8 Billion Annual Savings Opportunity for U.S. Healthcare With Adoption of Electronic Business Transactions

$8 Billion Annual Savings Opportunity for U.S. Healthcare With Adoption of Electronic Business Transactions | Healthcare and Technology news | Scoop.it

U.S. healthcare could save $8 billion annually by transitioning six routine business transactions from manual to electronic, according to the newly published 2014 CAQH Index™. The CAQH Index tracks progress from manual (e.g., via phone, fax or mail) to industry standardized (HIPAA) electronic administrative transactions between health plans and healthcare providers. This annual report, the second from CAQH, details adoption rates and potential savings.

“Hospitals should be focusing on patients, not paperwork. By expanding automated electronic communications between providers and health plans, we can reduce health care costs, ease administrative burdens, and ensure that key stakeholders in our health care system communicate with each other more effectively,” says Joel Perlman, Executive Vice President, Finance, and Chief Financial Officer, Montefiore Medical Center.

Based on data from 2013, the 2014 CAQH Index represents a collaboration between healthcare providers and health plans. Data submitted includes administrative transactions and cost estimates for analysis. The report reflects data from participating health plans representing 112 million enrollees – almost 45 percent of the privately insured U.S. population – on more than four billion transactions. In addition, a range of healthcare facilities and provider practices participated in a data collection process conducted on behalf of CAQH by Milliman, Inc.

Both this and the prior year’s CAQH Index studied six transactions — claim submission, eligibility and benefit verification, prior authorization, claim status inquiries, claim payment, and remittance advice transactions. This enabled year-over-year comparisons between health plans providing data counts for both reports. CAQH also measured two transactions for the first time: claims attachments and prior authorization attachments.

While overall adoption rates of fully electronic transactions (those automated for both health plans and healthcare providers) rose only slightly during this period, the volume of fully electronic transactions grew by double-digit rates for eligibility and benefit verifications, claim status inquiries and claim payments.

Average adoption rates of fully electronic transactions varied widely, from a high of 92 percent for claim submission to a low of 7 percent for prior authorization. About half of all claim payments and remittance advice transactions remain manual. Health plans continued to process about 1 billion transactions manually, and healthcare providers handled over 2.4 billion.

The potential for significant cost savings is due to the large volume of transactions, as well as the dramatic cost difference between manual and electronic transactions. For health plans, costs for each manual transaction averaged $2 for the six transactions studied, while electronic transaction costs ranged from only 5 to 10 cents. Healthcare providers’ estimated costs averaged more than $5 for manual versus $1.60 per electronic transaction.

“The CAQH Index shows that additional progress to realize the full potential of electronic transactions requires an ongoing commitment by all healthcare stakeholders, including health plans, providers, vendors and government,” says Robin Thomashauer, Executive Director, CAQH. “Findings can inform industry initiatives such as CAQH CORE and CAQH Solutions that support the move towards greater use of electronic transactions.”

Health plans and providers can estimate their potential cost savings by using an interactive savings calculator available at www.caqh.org. The complete 2014 CAQH Index report and highlights are also available for download.

The 2015 CAQH Index is underway, and is seeking additional participants. Health plans and providers that participate will receive a confidential, independent assessment of how they compare to their industry peers.

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Smarter healthcare through business intelligence

Smarter healthcare through business intelligence | Healthcare and Technology news | Scoop.it

In case you missed my posts on our Microsoft in Health Facebook page, I recently went on a road trip across Europe to talk with our healthcare industry clients about how they're using Microsoft business intelligence (BI) tools and analytics to improve health services for their customers.

Tools like Power BI for Office 365 and Microsoft Azure offer a variety of benefits for healthcare organizations and providers. Power BI for Office 365 provides a self-service business-intelligence infrastructure for all of their information, enabling them to visualize data, share discoveries, and collaborate in intuitive new ways. With Microsoft Azure, organizations can stream massive amounts of data, perform real-time analytics, and gain key insights to make faster and more reliable decisions about critical issues.

During my 16-day journey, I visited Norway, Sweden, Croatia, Belgium, France, and England. At each stop I was amazed to see the many ways healthcare organizations are using business intelligence and analytics enabled by Microsoft products to increase healthcare efficiency and improve patient care.

Helse Vest, for example, is a regional health authority that operates 50 healthcare facilities throughout Norway. To meet the requirements for a government-sponsored national patient safety program, Helse Vest needed to create analytical reports based on surgery trends and other medical data, and to do so much more quickly. Using Power BI for Office 365, Helse Vest employees can now visualize combined data from multiple facilities and create dynamic analytical reports in less than one day—a 93 percent improvement over the 14 days it previously took to build a report.

In Sweden, I had the opportunity to meet with representatives from Aerocrine, a company that makes medical devices used by physicians and clinics worldwide to monitor, diagnose, and treat asthma. Nearly 10 percent of the world’s population suffers from asthma—a potentially deadly disease that has no cure. Medications and inhalers offer relief that help asthma patients live healthy lives, but only if they routinely monitor their condition and follow their prescribed treatments.

Using a Microsoft Azure solution, Aerocrine can collect near-real-time telemetry data from all of its devices worldwide. With that data, the company can monitor the equipment remotely, keeping track of where devices are located, how they’re performing, and which ones need to be replaced before dangerous downtime occurs and leaves patients unmonitored for days at a time. The Aerocrine devices precisely measure airway inflammation, for example, but the machines are very sensitive and easily disrupted by environmental factors such as dry weather or humidity. With the analytics that Microsoft Azure provides, Aerocrine can check remotely to see whether a device has a humidity level that is too high or too low. Microsoft Azure also enables Aerocrine to see when devices are nearing the end of their allotted number of tests and then deploy new resources proactively.

These are just two examples of the innovative ways in which healthcare organizations worldwide are putting Microsoft BI tools and analytics to work to provide more efficient services and better patient care. In the end, it all adds up to smarter healthcare.


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