COLUMBUS, Ohio, Oct. 5 /PRNewswire-USNewswire/ -- 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.

For more information on the multi-payer portal project in Ohio, please visit: http://www.americanhealthsolution.org/assets/Uploads/Blog/Backgrounder-Ohio.pdf.

America's Health Insurance Plans (AHIP) is the national association representing nearly 1,300 member companies providing health insurance coverage to more than 200 million Americans.

The Blue Cross and Blue Shield Association is a national federation of 39 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for more than 100 million members - one-in-three Americans. For more information on the Blue Cross and Blue Shield Association and its member companies, please visit www.BCBS.com.

Quotes from Project Participants and Supporters

• "Aetna is committed to making it easier for doctors, hospitals and other health care professionals to do business with us and the industry. Initiatives like this that help increase utilization of electronic capabilities are key to reducing administrative expenses for health care professionals and increasing quality for patients," says Ronald A. Williams, Aetna chairman and CEO, and chair of AHIP's Administrative Simplification Taskforce.
• "This initiative is a reflection of our efforts to help reform America's health care system. Improving and streamlining the administrative side of health care is an important part of our effort to help build a sustainable health care system," said Brad Fluegel, executive vice president and chief strategy and external affairs officer for Anthem Blue Cross and Blue Shield's parent company. "Every penny saved on forms, claims and administrative expenses is money that can be invested in innovative products and services that improve the health of our members and their communities."
• "Availity empowers providers to improve the quality of health care delivery by allowing them to focus on patients, not paperwork. Real-time access to health care claims information will drive efficiency and generate cost savings system-wide, which directly benefits Ohio's citizens, providers and other healthcare stakeholders," says Julie Klapstein, CEO of Availity.
• "CIGNA is pleased to participate in this technology initiative and to work with physicians to make administrative functions less complex and more efficient," said Dr. Jeff Kang, chief medical officer for CIGNA. "This work, combined with other recent efforts like our CIGNA Cost of Care Estimator and new, simpler explanation of benefits, will help people get straightforward information about the cost of care and their financial responsibility more quickly and help reduce patient bad debt for physicians."
• "This project, and the cooperation among so many elements of the health care system, are exactly what our country needs if we're to rein in health care costs," said Tim Cappel, president, Humana of Ohio. "Availity streamlines an unnecessarily complex system, eliminates duplication and waste, and most importantly allows our health care providers to spend more time caring for patients and less time pushing papers. It's tremendously encouraging to see this level of coordination from so many organizations."
• "Kaiser Permanente Ohio is pleased to join with other Ohio health plans to support greater ease and transparency in billing for providers and their patients. The work that led to today's announcement represents the same kind of cooperation needed in Washington to make true health care reform a reality this year," says Patricia Kennedy-Scott, Kaiser Permanente Ohio President.
• "Medical Mutual of Ohio supports industry efforts to bring payers and providers together to achieve administrative efficiency and accuracy," said Joe Gibbons, Medical Mutual of Ohio's vice president of Government Relations. "Such efforts can improve the health care delivery system and deliver more value for consumers of health care and for doctors, hospitals and payers."
  

"Physicians have been urging the insurance industry for many years to eliminate duplication and simplify transactions for physicians and patients. Since it's time-consuming and frustrating for physician offices to deal individually with multiple payers who offer a wide variety of plans with different coverage benefits, this online portal will allow offices to quickly determine patient eligibility, obtain benefit information, expedite pre-authorization for services, and submit insurance claims by going to a single internet site. We are pleased that America's Health Insurance Plans and the Blue Cross Blue Shield Association are working together to improve patient service and help reduce administrative costs for physicians. We hope this project will prove successful and eventually involve all health care plans in Ohio," says Jon F. Wills, Executive Director, Ohio Osteopathic Association.

• "Ohio Academy of Family Physicians (OAFP) support the efforts of AHIP and BCBSA in its Web portal pilot project. Our hope is that this initiative will help to streamline and minimize some of the administrative burden plaguing physician practice teams thus allowing physicians more time to focus on providing high quality care and addressing the individual needs of their patients," says Ann Spicer, executive vice president, OAFP.
• "Working collaboratively to find ways to simplify administrative processes for providers and patients is a priority for the member companies of the Ohio Association of Health Plans," (OAHP) said Kelly McGivern, President and CEO of OAHP. "This innovative project will help streamline and accelerate insurance eligibility and payment processes, saving time for both providers and patients. We are pleased that Ohio was chosen for this innovative project and hope the results can advance programs in other states."
• "The Ohio State Medical Association is pleased to participate in the launch of the Availity project in Ohio. This new tool will allow Ohio physician practices to check patient insurance eligibility, benefit coverage and claim status all from one source," said Mark Jarvis, Senior Director of Practice Economics at the Ohio State Medical Association. "This project will also help practices simplify the 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."
• "The bureaucracy of health care has increased to become a prime contributor to costs. Many practices have had to create entire departments to deal with this one-time-non-existent workload. The Ohio Medical Group Management Association is pleased to support this effort by AHIP and BCBSA to reduce health care costs through efficiencies in operations and processes," says Todd M. Fowler, Chief Administrative Officer, OMGMA.
• "UnitedHealthcare strongly supports consistent national standards that simplify administrative interactions between insurers and care providers," said Timothy Kaja, senior vice president of UnitedHealthcare's physician and hospital relations. "We are pleased to be a participant in the multi-payer portal project with AHIP and have high expectations that this industry partnership will save time and expense by streamlining administrative processes for medical practices in Ohio. This project aligns with the innovative work UnitedHealth Group has done in partnership with WEDI and others this year on industry standard health care identification cards."
  

SOURCE America's Health Insurance Plans

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