The Healthcare Industry Keeps Automating Business Processes But Has A Ways To Go

Last June, a healthcare industry group known as CAQH shared the results of a study looking at process automation in medical and dental practices. According to the group, which tracks health plan and healthcare provider adoption of electronically-based transactions, dental and medical offices are leaving $11.1 billion in potential savings on the table annually.

Last month, CAQH released its 2018 Index, data from which concludes that medical and dental practices are continuing to make progress towards full automation — and saving money along the way.

The CAQH Index draws data from medical and dental plans covering roughly half of the insured consumers in the United States and providers representing multiple specialties. The data collected for medical plans represented 160 million lives, with data submissions for medical plans representing nearly 1.6 billion claims and over 7.8 billion total transactions. Data from dental plans represented by 106 million lives representing over 730 million transactions.

While medical and dental practices are automating more business processes, there’s a lot of work still to be done. The group projects that these industries can still save an additional $12.4 billion annually if they adopt electronic administrative transactions fully.

On the other hand, CAQH notes that this is the first time they’ve seen the savings opportunity narrow over the six years it has published the Index, with the total having fallen by $700 million.

In fact, the research found that electronic adoption and transaction volume have continued to grow, with several common transaction types reaching 80% electronic adoption across the healthcare industry sector. This includes increases of up to 6% in the adoption of electronic transactions by the medical industry 4% by the dental industry.

The most commonly automated transaction type was claims submission, performed electronically by 96% of practices, followed by eligibility and benefit verification (85%), coordination of benefits/crossover claims (80%), claim status inquiry (71%), claim payment (63%) and remittance advice (48%). Prior authorization transactions represented only 12% of electronic transactions in these practices last year.

Along the way, CAQH calculated that the industry could save $27.31 for a single patient encounter if all six of the transactions tracked in the report used a fully electronic workflow. Practices could also see quick benefits by automating the highest-cost transactions, which include claim status inquiry ($9.22 per transaction), prior authorization ($7.28) and eligibility and benefits verification ($6.52).

Meanwhile, the Index shined the light on a substantial rise in overall transaction volume among these practices, which researchers say has expanded in parallel with the need to connect administrative and clinical data elements in value-based payment models. Researchers note that it would move things along if the healthcare industry implemented updated standards, operating rules, infrastructure, and functionality.

Though the report doesn’t highlight this specifically, it’s worth pointing out that medical and dental practices have been slow to new transaction types over the six years studied, with automation of claim status inquiries falling from 28% to 9% between 2016 and 2018. This is one of several trends the group identifies which deserves further study.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.