 |
| Sample Newsletters | MarketPlace AIS Products & Services |
|
AIS's Health Business Daily
Featured Story March 1, 2010
New Jersey Pilot Program With Major Insurers Aims to Cut Provider Paperwork and Standardize Processes Reprinted from HEALTH PLAN WEEK, the industry's leading source of business, financial and regulatory news of health plans, PPOs and POS plans. By Steve Davis, Managing Editor (sdavis@aispub.com) A typical primary care physician spends about $68,000 a year on administrative tasks such as determining patient eligibility and checking claim status. The goal of a 12-month pilot project — announced Feb. 10 — is to show how that problem might be fixed.
New Jersey’s five largest health plans and five physician groups will participate in the initiative, which aims to dramatically reduce administrative costs by allowing hospitals and physicians to communicate with health plans and address administrative tasks through a single Web portal. The initiative is sponsored by America’s Health Insurance Plans (AHIP) and the Blue Cross and Blue Shield Association. Nationally, eliminating administrative inefficiencies could save hundreds of billions of dollars, according to AHIP.
During a Feb. 10 conference call, AHIP President and CEO Karen Ignagni compared the initiative to the banking industry’s worldwide ATM network, which makes it possible for people to access bank accounts from any location. Standardization throughout the banking community was needed for that network to succeed.
“That’s a similar objective here,” she told attendees. “What we’re producing is a one-stop shop, through which physicians and their offices can contact all of the health plans they deal with” through a single Web portal. The participating health plans are Aetna Inc., Independence Blue Cross subsidiary AmeriHealth New Jersey, CIGNA Corp., Horizon Blue Cross Blue Shield and UnitedHealthcare, Inc. AHIP is behind a similar program launched last October in Ohio with health plans and about 700 provider practices. Participating health plans in both states represent more than 90% of their states’ commercially insured populations.
Unlike other types of pilot projects, the Ohio and New Jersey initiatives are intended to be permanent and “won’t disappear after 12 months,” AHIP spokesperson Susan Pisano tells HPW. The first year includes an evaluation component, during which AHIP will collect feedback from participants and consider possible adjustments.
The portal is maintained by NaviNet, a health care information technology company. Several health plans that operate in New Jersey already use NaviNet. Horizon, the state’s largest health plan operator with 3.6 million members, expects to close its independent portal and move to NaviNet in March or April. During the conference call, Christy Bell, Horizon’s senior vice president of health care management, said the pilot is an opportunity for health plans and providers to move closer to standardizing administrative processes.
Aetna has been using NaviNet’s portal for several years. More than 40% of the health plan’s network providers have access, said Aetna President Mark Bertolini. Along with helping to streamline administrative processes, he said the portal also can be used to improve health outcomes. Aetna was the first health plan to use the portal to provide key clinical information to physicians at the time of care, according to Bertolini. As of the end of 2009, he added, Aetna has delivered more than 1 million care considerations electronically via NaviNet. Care Considerations alert physicians to opportunities for improved care when treatment appears to have deviated from evidence-based medical best-practice standards, according to Aetna. While individual health plan initiatives are important, Bertolini said, industry-wide collaborations will be needed.
For more information, visit www.ahip.org. |
| ||||||||
