Claims clearinghouse and revenue cycle management vendor Emdeon Inc. on March 31 will publish its first annual progress report on the adoption status of electronic financial and administrative transactions in the health care industry.

The report will be based on the U.S. Healthcare Efficiency Index, an industry consortium that Emdeon founded in 2008 to measure industry progress in adopting electronic financial and administrative transactions.

To a degree, the initiative seeks to restart and greatly expand the annual research on electronic data interchange growth that Health Data Management did in the 1990s through its Health Data Directory. The forthcoming report will be called the National Progress Report on Healthcare Efficiency.

Through an extensive search of literature, Emdeon employees estimated the current rate of adoption during 2008 for electronic medical claims and related transactions.

Based on their research, Emdeon employees in 2008 estimated 75 percent of claims were electronically submitted, as were 40 percent of eligibility and claim status transactions. Only 10 percent of claim payments were electronic, as were 26 percent of claim remittance advice transactions. Emdeon estimated use of EDI for these five transactions presently saved $23.6 billion annually. But $53.3 billion could be saved each year if all of these transactions were electronic.

Last fall, a second phase began as Emdeon started to get hard numbers from 150 insurers about five transactions, says Miriam Paramore, senior vice president at Emdeon. She spoke with Health Data Management at the HIMSS 2010 Conference in Atlanta.

Now, the U.S. Healthcare Efficiency Index consortium is talking with the HIMSS Medical Banking Project to start a third phase and bring banks to the table. The goal, says Paramore, is to assess the adoption of electronic funds transfer and electronic remittance advice transactions, and how to get to an environment where these transactions are fully automated and automatically posted to patient accounts.

The consortium also is looking to expand its work into the pharmacy market, with a twist. Rather than just count transactions in a market where those numbers are pretty well known, the goal is to get data from pharmacy information systems to determine medication adherence rates. The data, for instance, can show how often prescriptions are picked up and refills ordered. Further study then can determine if there is a correlation between adherence and outcomes.

More information is available at ushealthcareindex.com.

--Joseph Goedert

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