Claims clearinghouse and revenue cycle management vendor Emdeon Inc. has published its first annual progress report on the adoption status of electronic financial and administrative transactions in the U.S. health care industry. The report shows electronic claims and remittance advice have been adopted at a higher rate than previously believed.

Nashville, Tenn.-based Emdeon in 2008 founded the U.S. Healthcare Efficiency Index, an industry consortium to collect hard data on the extent to which providers and payers use electronic transactions. Through an extensive search of literature and other research, Emdeon employees conducted a Phase I study in 2008 and estimated the current rate of adoption for electronic claims and related transactions. They estimated in 2008 that 75 percent of claims were electronically submitted, as were 40 percent of eligibility and claims status transactions. Only 10 percent of claim payments were electronic, as were 26 percent of remittance advice transactions. The Phase I study estimated that $30 billion could be saved annually if all these transactions were done electronically.

A Phase II study began in 2009 with data gathered from an initial sample of 113 insurers, primarily medium and small regional payers with two unidentified large national commercial payers. In the new USHEI National Progress Report on Healthcare Efficiency, the consortium reports 85% of medical claims are being transmitted electronically, along with 46% of remittance advice transactions.

These findings form a new baseline for tracking progress and validation of the data collection methodology, according to Emdeon. Phase II also gathered hard data on eligibility, claim status and claim payment transactions. That data is still being analyzed and Emdeon will release these transaction figures during 2010 as they are made available.

Phase III of the U.S. Healthcare Efficiency Index will expand data collection and analysis into the pharmacy market. Rather than counting transactions in a market where the numbers are well known, the goal of Phase III is to get data from pharmacy information systems to determine medication adherence rates. The data, for instance, could show how often prescriptions are picked up and refills ordered. The Phase III report is expected in 2011.

The new report is available at no cost at ushealthcareindex.com.

--Joseph Goedert

 

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