Healthcare Update

In This Issue

• Focus on Relationships Between Insurance Companies, Physicians
• Guest Essay: UnitedHealthcare is working to improve the healthcare system through the processes, services and relationships that payers have with their networked hospitals and healthcare professionals.
• This Issue’s Announcements: Learn more about the Quality Institute for Healthcare focus areas and the upcoming lean Six Sigma Black Belt course.
• Quality News: Current news stories about quality tools and trends in the healthcare field, as well as issues facing the healthcare industry.

Focus On…

Saving Billions of Dollars—and Physicians’ Time—by Streamlining Billing Practices

The U.S. system of healthcare billing is complex, expensive and inefficient. Excessive administrative complexity costs physicians nearly 12% of their net patient service revenue, according to a Commonwealth Fund—supported study. Streamlining administrative processes associated with medical providers’ billing and payment could save $7 billion annually and save four hours per week of physicians’ time and five hours of support staff. More

Prescription for a Healthier Practice: Physician Claims Process Checkup
This check list for physicians provides the opportunity for them to evaluate their practice’s capability to submit claims efficiently and accurately, and analyze health insurer payments for accuracy. More

What Does It Cost Physician Practices to Interact With Health Insurance Plans?
A national study of nearly 900 U.S. physicians and medical group administrators found that physicians spent on average 142 hours annually interacting with health plans, at an estimated annual cost to physician practices of $31 billion, or $68,274 on average per physician, per year. More

Standardization of the Claims Process: Administrative Simplification White Paper
This paper expands on the American Medical Association’s recommendations to eliminate significant administrative waste from the healthcare system by simplifying and standardizing the current healthcare billing, payment and claims reconciliation process.
More

Finding Knowledge Lost In Data: Data Quality In Physician Report Cards and Pay For Performance Programs
This presentation from a recent ASQ World Conference on Quality and Improvement provides an overview of various pay-for-performance programs and report cards initiatives that are used to quantify quality of care in healthcare organizations, including an investigation into data choices and data quality and policy implications associated with these reporting systems. More

Insurers, Physicians Must Work Together
This Managed Care Magazine article describes how health reform law can make collaboration between groups that are sometimes at odds not only easier, but also necessary, as the cooperation between groups is no longer just an enlightened approach to healthcare. More

Taking Hold of Opportunity
According to this Greater Lansing Monthly article, some hospital and medical executives have risen above the controversy surrounding President Obama’s healthcare reform and are focusing on the opportunities the changes provide. Physicians Health Plan officials is working to take advantage of it as a company for its customers. More

Featured Book

Guest Essay

Working Together to Simplify Healthcare
A critical component to improving the healthcare system is through the processes, services and relationships payers have with their networked hospitals and healthcare professionals. Here, UnitedHealthcare representatives share what their organization is doing for these efforts. More

Guest Essay is an ongoing Healthcare Update feature in which authors from the healthcare field explore the role quality tools and methods play in delivering better care and driving down costs.

If you would like to submit a Guest Essay for consideration, send an e-mail to Healthcare Update editor Nicole Adrian.

This Issue’s Announcements

There’s Still Time to Register: Lean Six Sigma Black Belt Course
ASQ’s lean Six Sigma Black Belt course combines interactive and on-demand web-based learning with instructor-led classes. The course, which begins Nov. 9, allows students to save on travel time and expense while getting hands-on advice for their project work.

The course’s objectives include learning how to:

• Deliver significant, bottom-line cost savings and significant business results.
• Develop skills to collect, analyze and quantify data to enable process improvements.
• Apply statistical and problem-solving tools to an improvement project brought to class on the first day.
• Execute Six Sigma.
• Plan and implement process control.

Learn more about the course.  

Mark Your Calendars: QIHC Set for May

The 2011 Quality Institute for Healthcare (QIHC) is set for May 16–18 in Pittsburgh. The event will follow the theme, “First Do No Harm, Then Make No Waste: Proven Methods and Tools for Safe and Efficient Global Healthcare.”

The conference will follow six focus areas:

• Efficiency.
• Quality basics: customer satisfaction.
• Patient safety.
• Technology and quality improvement.
• Quality systems and organizational excellence.
• Building and sustaining a quality culture.

Continue to check the QIHC website for more details or follow QIHC on Twitter.

Quality News

Little Bang for Healthcare Buck

While the saying “you get what you pay for” makes sense in many fields, a new industry report said it doesn’t apply as neatly to healthcare, according to this Quality News Today article. Health plans that allow for many tests, doctor visits and hospital stays don’t necessarily deliver the best quality of care for the cost, the report states. More

Health Insurer Repeats Atop Service List

According to this Quality News Today article, Independent Health Association has been named the top-ranked health plan in the nation for customer service for the second straight year by a national rating organization. The National Committee for Quality Assurance put the Amherst, NY-based insurer at the top of its Quality Compass 2010 list for health maintenance organizations and point-of-service health plans. More