Payers setting own rules for sharing health information

Right now, payers and providers that want to share information between them have some big problems on their hands. One of the toughest is that payers and providers may not have compatible networks or computer systems, which can make data sharing difficult or even impossible.

However, a group of 100-odd payers, trade associations and government payers (CMS and the VA) hopes to solve that problem. The group--the Council for Affordable Quality Healthcare (CAQH)--is setting standards for sharing electronic health data that it hopes will save time, effort and money. In fact, a study by the group has predicted that if health plans and providers adopt its rules, it could save $3 billion over three years.

At yesterday's session of the World Health Care Innovation and Technology Congress, which is taking place in Alexandria, Va., two health plans stepped up to share their experiences with CAQH standards. The execs--with Aetna and Harvard Pilgrim Health Care--both said that they've made meaningful progress in using the group's CORE rules.

Harvard Pilgrim put its money where its mouth is, having achieved CORE certification in April. Executives made the move to promote new processes, not just to save money on claims processing costs.

Not only does the new approach save time and money, it fosters the kind of behavior Harvard Pilgrim would like to see among its 28,000 providers, says John Kelly, director of IT operations for the plan. "If you think about when ATM came out, they said 'hey, I can save myself a 5-minute teller visit.' But how often do you go to the bank now?" Kelly said. "It's all about changing the dynamic, not just about dollars and cents."

Aetna, which processes over 230 million claims per year, has demanded that partners participate too. "One of the things we've done is to have all trading partners CORE certified and keep that certification up," said Jay Eisenstock, manager of eSolutions with Aetna. "We feel very strongly that unless information is adequately transferred from provider to point of care, then the chain is broken."

To learn more about these initiatives:
- visit the CAQH website

Post a comment