A new Council for Affordable Quality Healthcare (CAQH CORE) report states that Medicaid could save more than $4.8 billion annually if they moved to fully electronic transactions. The California-based nonprofit also said more than half of Medicaid enrollees are in plans without electronic prior authorization.
Only 44 percent of Medicaid recipients are in plans with automated claims processes. State agencies and health plans covering these enrollees have achieved some level of CORE Certification compared to 78 percent for commercial health plans and 75 percent for Medicare Advantage plans.
Through a collaboration of more than 130 public and private entities across the healthcare industry, CORE has developed rules that support electronic sharing of administrative data quickly, cost-effectively and securely. Currently, there are four phases of operating rules, each covering a different set of administrative transactions.
By adopting all four phases of operating rules for electronic transactions, Medicaid payers can reduce overhead expenses and direct more state and federal tax dollars toward patient care.
For example, Medicaid payers in New York could save $571 million, Illinois could save $294 million and those in California could save $655 million annually, or so the estimates suggest. Even in much smaller states, Arkansas is estimated to potentially save $98 million and Connecticut $93 million.
Specific amounts from specific locations is staggering, as a chart from CAQH CORE shows.
"Medicaid payers confront the challenges of administrative costs, productivity and information security through CORE Certification," said Robin J. Thomashauer, president of CAQH, in a statement. "The benefits to enrollees, taxpayers and government programs from efficient operational processes and electronic transactions are significant."
George Conklin, CAQH CORE board member and CIO of CHRISTUS Health in Irving, Texas, said in a statement that CHRISTUS has found working with CORE-certified Medicaid plans to be "more efficient and predictable."
Payers are increasingly turning to electronic transactions, such as prior authorizations. Manual prior authorizations can create administrative issues, lost productivity and result in delayed or avoided care. CAQH estimates that electronic transactions can save $6.84 per transaction.
The American Medical Association found earlier this year found that 92 percent of physicians said prior authorizations hurt patient clinical outcomes, and one-third of reporting doctors said they had waited at least three business days during a week for a payer to give the okay on patient care, which can delay patient care.
Stakeholders including the AMA, American Hospital Association and America's Health Insurance Plans, recently wrote a consensus statement highlighting their shared commitment to industrywide improvements to prior authorization and patient-centered care.
A case study by Aurora Health Care suggests that use of a prior authorization system allowed patients to receive their drugs more quickly with less administrative work for providers.
