CAQH 2018 Index: Healthcare Industry Continues Progress Automating Business Processes Amid Increase in Transaction Volume

About CAQH Explorations

CAQH Explorations measures the impact and opportunity associated with streamlining healthcare business processes through various research initiatives, including the CAQH Index. The CAQH Index helps the industry optimize operations by tracking trends in adoption rates and cost savings associated with the shift from manual to electronic transactions.

Opportunity for $12.4 billion in additional savings exists through further automation

WASHINGTON, DC - 01/16/2019

CAQH released the 2018 Index today, which reveals that the healthcare industry continues to make progress automating business processes. Electronic adoption and transaction volume increased, with several common transactions reaching 80 percent electronic adoption across the sector. This progress resulted in a narrowing of the cost savings opportunity for the first time in CAQH Index history.

“The results highlighted in the 2018 Index are encouraging,” said Kristine Burnaska, Director of Research and Measurement at CAQH. “Both providers and health plans are saving time and reducing administrative costs, but more effort is needed to significantly reduce the volume of expensive, time consuming manual processing.” 

The CAQH Index is the industry resource for tracking the adoption of HIPAA-mandated and other electronic administrative transactions between healthcare providers and health plans in the medical and dental industries. Data was submitted by medical and dental plans that cover roughly half of the insured population in the United States and providers representing a range of specialties.

Despite the progress that has been made, the Index estimates that the medical and dental industries could save an additional $12.4 billion annually with full adoption of electronic administrative transactions, particularly through greater automation by providers.

The Index also highlights a substantial rise in overall transaction volume, growing in parallel with industry complexity. As these trends persist, the Index finds that the industry would benefit from updated standards, operating rules, infrastructure and functionality that can accommodate the increase in volume and growing complexity associated with the need to connect administrative and clinical data elements in value-based payment models.

“The industry is making progress,” said April Todd, Senior Vice President, CORE and Explorations at CAQH. “But, we are at an inflection point where processes and technology must adapt to a healthcare system that is transitioning to value-based payment and becoming increasingly complex.”

Download the 2018 CAQH Index here. A webinar discussing these findings will be held January 17, 2019 at 12:30PM ET. Register here.