The Value & Impact of Collaboration: CAQH Presentation at AHIP Institute 2015

“Collaborating to Take Costs Out of the Business of Healthcare”

August 2015

Collaborative projects are advancing operational efficiencies, improving health plan and provider relations and reducing millions in costs for the healthcare system at large, according to examples recently provided by senior executives from three national health plans at AHIP Institute 2015.

The presentation by CAQH explored the advantages of using industry-wide collaboration to improve routine business processes. In the session, titled “Collaborating to Take Costs Out of the Business of Healthcare,” panelists explained how this approach helps ease the burden on individual health plans and provider organizations, while reducing unnecessary administrative costs.

Collaboration among health plans - as a means to streamline the business of healthcare - leverages industry expertise, enables resources to be allocated more efficiently and can help improve provider relationships. Rather than individual proprietary solutions that require extensive resources to conceptualize, build and implement, collaboration brings together stakeholders sharing like-minded objectives for cost-effective solutions that deliver real results.

Panelists Jay Eisenstock, Senior Director, Provider eSolutions, Aetna; Kelly Toman, Staff Vice President, Clinical Quality Compliance and Credentialing, Anthem; and Sean Killeen, Executive Director, Claims Payment Integrity & Cost Containment, Kaiser Permanente and Kaiser Foundation Health Plan, Inc. discussed how their organizational efforts to improve business processes led them to participate in collaborative solutions. CAQH Executive Director, Robin Thomashauer, moderated the session.

Aetna presented its experience with EnrollHub, the CAQH Solution providers use to sign up for electronic funds transfer (EFT) and electronic remittance advice (ERA) from multiple health plans. Before working with CAQH, Aetna spent millions of dollars annually producing checks and explanations of benefits. The process of delivering paper checks cost as much as $70 per payment. In January 2014, Aetna required all contracted providers to be paid electronically. While high volume providers were quick to adopt electronic payments, EnrollHub offered a compelling model to encourage enrollment by all providers. Today, Aetna pays 90 percent of its claims electronically, with 76 percent of Aetna providers no longer receiving any paper.

Anthem worked with CAQH to simplify provider credentialing using CAQH ProView. Anthem found the self-reported professional and demographic provider information in the collaborative solution contained data elements useful not only for credentialing, but also provider directory maintenance and claims administration. Prior to the creation of a single source of credentialing data, keeping provider information up-to-date required multiple inquiries to providers. Now automated system alerts prompt providers to make updates and electronically re-attest, helping to ensure provider information stays current. Nearly 99% of Anthem's providers use CAQH ProView, with Anthem processing 115,000 credentialing applications last year.

Kaiser Permanente discussed how COB Smart addresses difficulties associated with the coordination of benefits process. From manual processes to prolonged and error-prone payment cycles, the healthcare system is cumbersome when addressing claims for patients with multiple sources of insurance coverage. By collaborating with other plans through COB Smart, Kaiser Permanente is able to correctly identify which members have benefits that should be coordinated in order for corresponding claims to be processed correctly the first time. The cost for Kaiser to collect other coverage information has been reduced by more than 90%. This enables the organization to process claims in a way that is scalable, automated, non-invasive, and efficient.

To learn additional insights from these industry leaders, view the presentation Collaborating to Take Costs Out of the Business of Healthcare.

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