State of Simplification in the State of Washington

Simplification of healthcare requires grassroots efforts in addition to national initiatives. As health care is primarily regulated at the state level, state initiatives are essential to move simplification forward. Stakeholders in the state of Washington have answered this call.

The Washington Healthcare Forum has been at it since 1999, developing very specific incremental solutions regarding daily administrative issues and transactions between patients, providers, plans and employers. The Forum is a coalition of health plans, physicians, hospitals, and purchasers. Their stated mission is to (1) Streamline and simplify healthcare financing and delivery across the state; and (2) Advance a public dialogue on sustainable solutions to the challenges facing the health care system.

You can check out their very detailed administrative simplification activities at: http://wahealthcareforum.org/AdminSimp/index.htm . You can also register at the web site for e-mail updates.

The Washington Healthcare Forum formed an Administrative Simplification Steering Committee that included the Washington State Hospital Association, the Washington State Medical Association, First Choice Health Plan, Group Health Cooperative, Premera Blue Cross, and Regence Blue Shield.

The steering committee identified specific projects that met the following criteria:

• Reduce staff costs to refer, authorize, bill, and process claims
• Decrease turnaround time between claims submissions and payment
• Improve the patient experience

Their guiding principles for adopting projects included:

• Win-win: Impacts multiple providers and plans
• Quick win: Can be implemented within three to six months without information system changes
• Significant relief: Represents a high cost, high volume and/or high frequency headache
• Affordable: Can be implemented at a reasonable cost
• Enduring: Will have lasting impact
• Widely available: Accessible to a large segment of health care community
• Local impact: Local health plans can make a difference on the issue

They have over the past seven years developed very detailed and specific standards, policies and simplified guidelines in the areas of (1) Claims Processing; (2) Practitioner Credentialing; and (3) Referral & Prospective Review

Check them out, and let us know what you think.