2018 CAQH Index. Healthcare Industry Adoption of Electronic Business Transactions and Cost Savings

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1 2018 CAQH Index Healthcare Industry Adoption of Electronic Business Transactions and Cost Savings April Todd SVP, CAQH CORE and CAQH Explorations Kristine Burnaska Director, Research and Measurement, CAQH January 17, 2019

2 Logistics: How to Participate in Today s Session Today s session is being recorded. All attendees will receive a link to view the on-demand webinar. Your phones will be muted upon entry and during the webinar. Throughout the session, you may communicate a question via the web. Questions can be submitted with the Questions panel on the right side of the GoToWebinar desktop. 2

3 Welcome The 2018 CAQH Index is available now for download at Join the social conversation. - We are live tweeting this webinar. - Invite peers to download the Index by sharing the link on Twitter and LinkedIn. 3

4 Agenda 2018 CAQH Index Overview High-Level Findings Savings Opportunities Get Involved Questions? 4

5 2018 CAQH Index Overview 5

6 What Is the CAQH Index? A national benchmarking survey. Tool to track and monitor industry progress. A collaborative initiative. Measures adoption of fully electronic administrative transactions. Estimates cost and time savings opportunities. Sixth annual report. Tracks industry progress in the ongoing transition from manual to electronic administrative transactions. Monitoring progress makes it possible to identify successes and to make course corrections when necessary. The CAQH Index Advisory Council. Experts in administrative transactions, data analysis and healthcare management. Represents providers, health plans, vendors and other industry partners. 6

7 Which Transactions Are Tracked? 7

8 Index Definitions Transaction Costs - Cost and saving estimates only account for labor time required to conduct the transaction. Systems costs as well as pre-work and follow-up work are not included. Electronic Transaction - Automated transaction conducted using a HIPAA standard. Manual Transaction - Transaction requiring end-to-end human interaction, such as telephone, fax, and/or mail. Partially Electronic Transaction - Includes web portals and interactive voice response (IVR) systems. 8

9 What Did We Find? Adoption of electronic transactions continued to improve for most transactions. Dental industry experienced progress, but continues to significantly trail the medical industry. Volume of transactions increased substantially overall, with manual transactions declining for the medical industry. Savings opportunity declined for the first time in CAQH Index history. 9

10 Who Participated? Large, representative sample. Health plans: Medical health plans covering nearly half (49%) of U.S. covered lives. Dental plans covering nearly half (44%) of the covered dental population. Healthcare providers: Represent a range of specialties. Data collection facilitated by NORC at University of Chicago. Table 4: Basic Characteristics of CAQH Index Data Contributors, CAQH Index Health Plan Members (total in millions) 2014 Index Medical 2015 Index 2016 Index 2017 Index 2018 Index Proportion of Total Enrollment (%) Number of Claims Received (total in billions) Number of Transactions (total in billions) Health Plan Members (total in millions) Dental N/A Proportion of Total Enrollment (%) N/A Number of Claims Received (total in millions) N/A Number of Transactions (total in millions) N/A N/A=Not Applicable 10

11 High-Level Findings 11

12 Electronic Adoption Improved for Most Transactions in the Medical Industry 12

13 Remittance Advice Volume Increased by 39 Percent 13

14 Adoption Low as Manual Use Increased for Prior Authorization 14

15 Dental Electronic Adoption of Transactions Improved, But Continues to Lag 15

16 Volume Rose Overall, But Volume of Manual Transactions Declined in Medical Industry Medical Electronic medical industry transaction volume increased by over 18 percent. 17 percent for health plans. 19 percent for providers. Volume of manual transactions declined for the medical industry. -6 percent for health plans. -1 percent for providers. Dental Overall dental transaction volume increased at a greater rate than medical volume. Electronic and manual transaction volume increased: Similar electronic and manual volume increase for dental providers. Electronic volume increased more than manual volume for dental plans. 16

17 Savings Opportunity Decreases for Medical and Increases for Dental 17

18 Medical Industry Savings Opportunity Declined For First Time in CAQH Index History Despite the continued increase in volume, the potential savings opportunity dropped, suggesting that the industry is becoming more efficient in conducting administrative transactions. 18

19 Savings Opportunities 19

20 Transactions With the Greatest Per Transaction Cost Savings Opportunity Biggest per transaction cost savings opportunities. Claim status inquiry ($9.22). Prior authorization ($7.28). High manual cost. Table 1: Average Cost per Transaction for Manual and Electronic Transactions and Savings Opportunity, Medical, 2018 CAQH Index Transaction Eligibility & Benefit Verification Method Health Plan Cost Provider Cost Industry Cost Manual $4.00 $3.61 $7.61 Electronic $0.08 $1.01 $1.09 Health Plan Savings Opportunity Provider Savings Opportunity Industry Savings Opportunity $3.92 $2.60 $6.52 On average, each manual transaction costs the industry $4.55 more than each electronic transaction. Medical industry could save as much as $27.31 for a single patient encounter by conducting all transactions electronically. $14.64 for providers. $12.67 for plans. Prior Authorization Claim Submission Claim Status Inquiry Claim Payment Remittance Advice Manual $3.50 $6.61 $10.11 Electronic $0.03 $2.80 $2.83 Manual $0.49 $2.37 $2.86 Electronic $0.09 $1.45 $1.54 Manual $4.03 $7.12 $11.15 Electronic $0.04 $1.89 $1.93 Manual $0.50 $2.11 $2.61 Electronic $0.09 $1.87 $1.96 Manual $0.54 $2.99 $3.53 Electronic $0.06 $1.15 $1.21 $3.47 $3.81 $7.28 $0.40 $0.92 $1.32 $3.99 $5.23 $9.22 $0.41 $0.24 $0.65 $0.48 $1.84 $

21 Estimated National Cost Savings Opportunities Eligibility and benefit verification has the highest cost savings opportunity as well as volume. Represents 41 percent of industry savings. Largest savings for both providers and plans. Claim status inquiry represents 27 percent of the industry savings. Overall provider savings opportunity is more than six times greater than that of plans. Table 2: Estimated National Volume per Transaction and Savings Opportunity, Medical, 2018 CAQH Index Transaction Eligibility & Benefit Verification Prior Authorization Claim Submission Claim Status Inquiry Claim Payment Remittance Advice Six- Transaction Total Method Health Plan National Volume Provider National Volume Manual 163 1,299 Electronic 8,295 7,158 Manual Electronic Manual Electronic 3,062 3,062 Manual Electronic 1, Manual Electronic Manual 217 1,267 Electronic 2,307 1,257 Manual 785 3,365 Electronic 15,179 12,599 Health Plan National Savings Opportunity Provider National Savings Opportunity (in millions) (in millions $) Industry National Savings Opportunity $638 $3,379 $4,017 $139 $278 $417 $53 $124 $177 $328 $2,312 $2,640 $61 $36 $97 $103 $2,331 $2,434 $1,322 $8,459 $9,782 21

22 Overall Volume for Eligibility and Benefits Rose 32 Percent 22

23 Overall Claim Status Volume Declined by 20 Percent 23

24 Time Savings Opportunities On average, manual transactions require five minutes more than electronic transactions. Eligibility and Benefit Verification 7 minutes A provider practice could save 30 minutes on average for a patient requiring all six transactions by switching from manual to electronic. Prior Authorization 7 minutes Claim Status 9 minutes 24

25 Get Involved 25

26 Call to Action Focus on opportunities: - Target transactions with the greatest potential for savings. - Promote adoption by healthcare providers and the dental industry. - Accelerate updates to standards and operating rules to support evolving industry needs. - Encourage timely vendor adoption of standards and operating rules. Enhance understanding of administrative operations with the CAQH Index: - Increase and diversify sample through broad stakeholder collaboration. - Expand content. - Streamline data collection mechanisms. 26

27 Participate in the 2019 CAQH Index Promote and support participation. Health plans and healthcare providers can participate. Vendors may also participate in the Index. All participants receive benchmark reports, which provide important information specific to your organization. - How your company compares to the industry at large. - How much time and effort your staff spends on electronic and manual transactions. - Potential for efficiency gains by further transitioning to electronic transactions. Contact explorations@caqh.org. Visit 27

28 Questions? 28

29 How to Ask a Question 29

30 The 2018 CAQH Index report is available now at A recording of this webinar will also be available at this location within 24 hours. 30