Transparency in health care (both the delivery and financing of same) has been a recurrent theme here at IB. One of the problems, of course, is getting providers and carriers on the same page regarding what kinds of information should be available, and how to decide what information is useful. And although I've had my issues with AHIP, it seems that they may be able to deliver on at least one piece of the transparency puzzle:
"Eight of Ohio's major health insurance companies, which provide coverage to 91 percent of the state's residents, announced Monday that they have created a Web site that gives doctors one place to find patients' benefit information."
The insurers, working with AHIP and the Ohio State Medical Association (OSMA), have apparently developed a way to put coverage and claims information on-line, available to both the provider and the insured. There are a number of benefits to this idea; for one thing, it should help cut down on claims denials due to policy exclusions. That is, if an expense isn't covered, that information is available (almost) immediately to both parties. On the other hand, insureds with covered expenses can know from the outset how much their carrier will pay towards a given procedure, and the provider will benefit from knowing what their reimbursement rate will be. This could lead to more consumer-driven interaction, focusing on cost-effectiveness and medical necessity.
The provider benefits in a number of ways from this, as well: according to OSMA, medical office staffs spend over 3,000 hours a year just connecting with insurers. And the doctors themselves spend, on average, some three and a half hours every week "calling insurance companies and checking various Web sites to track billing claims and coverage." This new program promises to significantly reduce both those numbers. This benefits pretty much everyone: less time dealing with claims should translate to more time with patients or reading the latest journals.
I do have a few questions about how this program evolved, and how it's to be implemented, so I've emailed all three parties to see about getting some background. Hopefully, we'll have a follow-up post with more details.
[Hat Tip: Bob Vineyard, CLU]
"Eight of Ohio's major health insurance companies, which provide coverage to 91 percent of the state's residents, announced Monday that they have created a Web site that gives doctors one place to find patients' benefit information."
The insurers, working with AHIP and the Ohio State Medical Association (OSMA), have apparently developed a way to put coverage and claims information on-line, available to both the provider and the insured. There are a number of benefits to this idea; for one thing, it should help cut down on claims denials due to policy exclusions. That is, if an expense isn't covered, that information is available (almost) immediately to both parties. On the other hand, insureds with covered expenses can know from the outset how much their carrier will pay towards a given procedure, and the provider will benefit from knowing what their reimbursement rate will be. This could lead to more consumer-driven interaction, focusing on cost-effectiveness and medical necessity.
The provider benefits in a number of ways from this, as well: according to OSMA, medical office staffs spend over 3,000 hours a year just connecting with insurers. And the doctors themselves spend, on average, some three and a half hours every week "calling insurance companies and checking various Web sites to track billing claims and coverage." This new program promises to significantly reduce both those numbers. This benefits pretty much everyone: less time dealing with claims should translate to more time with patients or reading the latest journals.
I do have a few questions about how this program evolved, and how it's to be implemented, so I've emailed all three parties to see about getting some background. Hopefully, we'll have a follow-up post with more details.
[Hat Tip: Bob Vineyard, CLU]
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