Industry Collaboration to Simplify Office Administration
Blue Cross Blue Shield of Massachusetts
A 2003 survey conducted by Blue Cross Blue Shield of Massachusetts (BCBSMA) revealed that 54 percent of physicians reported seeing a larger number of patients than the previous year, and 64 percent reported working longer hours. Administrative tasks required by government programs and health insurers, typically handled by a larger staff, were in some cases being handled by the physicians themselves. Though these tasks are critical to modern-day healthcare delivery, they limited physicians' availability to see patients.
Program Elements
- Average physician offices in Massachusetts deal with at least 15 managed care organizations, each with its own referral and claims processes . This greatly increases the time office staff and physicians are required to spend on time-consuming administrative tasks. Simplifying and standardizing some of these procedures would require tremendous collaboration and cooperation between insurers, physician groups and other stakeholders.
- In 2002, BCBSMA founded the Massachusetts Roundtable, along with the Massachusetts Medical Society, the Massachusetts Hospital Association, the Massachusetts Hospital Association of Health Plans and several key physician groups.
Program Results
- BCBSMA suggested that this group form smaller Professional Administrative Simplification Workgroups to tackle inefficiencies. Each of the criteria were identified as areas where competing health plans could collaborate to develop smooth, efficient and cost-effective administrative procedures across insurers.
- Credentialing and re-credentialing physicians – developing a uniform application for Massachusetts providers.
- Office administration – providing online resources to physicians and patients for "e-visits" and online claims administration.
- Filing limits – working to set uniform deadlines for claims and appeals across health plans in Massachusetts.
- Prior authorizations – standardizing and streamlining information required by plans.
- Referrals – simplifying the process and in some cases eliminating the need for referrals altogether.
Contact
Vincent Plourde, VP, 617-246-7632, vincent.plourde@bcbsma.com
