Mitigating Waste in Healthcare & Provider Information Exchanges

Blog Posts  |  20 November 2018

Even in today’s data driven environment, many interchanges between health care providers (HCPs) and the healthcare industry remain manual. These manual processes are inefficient adding both cost and complexity to the healthcare system. One study found an estimated $248 billion dollars in wasted U.S. healthcare spending attributed solely to administrative complexity in a single year.1

Solutions are available to both health plans and HCPs that can automate processes and help manage cost. Interchanges such as medical chart exchanges, gap in care communications and electronic prescription prior authorization management can be readily automated to cut waste from the healthcare system.

Medical chart exchanges

More than 100 million medical record requests are made to HCPs annually, 90% of those are exchanged via manual methods such as traditional paper or analog fax.2 As value-based reimbursement models become more commonplace, the need for health plan audits of medical records will increase. Thus leading to a growing demand for more efficiency in conducting chart audits among both health plans and HCPs.

Automated chart retrieval solutions, such as Veradigm eChart Courier™, make the chart audit process simple and efficient by:

  • Electronically delivering medical records, saving time and HCP resources
  • Providing data in an easy to use format for health plan analysis
  • Ensuring security and HIPAA compliance, since the data is sent in an encrypted format
  • Providing complete historical patient data to support in-depth analysis

By using automated solutions, health plans can not only make their own processes more efficient, but they can improve efficiency for their network providers. This leads to improved provider relationships and reduced waste in the healthcare system, allowing HCPs to focus on patient management.

Gap in care communications

Care gaps are estimated to have caused between $25 billion and $45 billion in wasteful spending in one year because of avoidable complications and unnecessary hospital readmissions.ɫ Closing these gaps in care is critical for member/patients to obtain the best health possible and is important to assessing quality measures such as HEDIS and 5-Star Quality ratings.

To be effective, health plan communication concerning gaps in care require timely attention by the HCP. However, manual communication processes such as fax, email or snail mail require HCP office staff to read, sort and manually flag patient records. This is not only a drain on HCP resources, but also leads to a significant lag time between when the Health Plan identifies the gap in care and when the HCP is able to act upon the information.

HCP messaging tools that are integrated into the workflow of the electronic health record (EHR) decrease the need for manual options, improve communication and can positively impact quality of care. By providing alerts to the HCP, that appear within their EHR during the patient visit, these tools deliver information at the right place, at the right time, encouraging the HCP to act and close any gaps in care. Since communication is automatically integrated into each patient’s record, these tools eliminate the need for costly manual entry by HCP staff. Thereby reducing waste in the system while improving health plan to HCP communication and potentially the quality of care delivered.

Prescription prior authorization

Manual prior authorizations (PA) place a heavy burden on HCPs, health plans and patients. 69% of manual PA’s require several days to resolve, often with many iterations between the prescriber and health plan.ǂ These can lead to treatment delays and member dissatisfaction.

Electronic prior-authorization tools, such as Veradigm eAuth, automate the process. They enable health plans to interact with prescribers to flag the need for prior authorization, ask questions and approve the medications during the patient visit. This can help to drive improved medication adherence and patient satisfaction by dramatically reducing the time and cost associated with prior authorization management.

In summary

There is significant opportunity to reduce waste in the healthcare ecosystem by automating manual processes with savings opportunities for both payers and HCPs. Automating manual processes also improve payer-provider relationships and enhances member satisfaction.

Veradigm is committed to improving the value, efficiency, and quality of healthcare delivery through providing actionable insights and innovative tools, such as eChart Courier, Point-of-Care Messaging and eAuth. Visit for more information or contact us.

1 Donald M. Berwick and Andrew D. Hackbarth, “Eliminating Waste in USHealthCare,” JAMA 307, no. 14 (April 11, 2012) 1513-6. Copyright ©2012 American Medical Association. All rights reserved.

2DataFile Technologies, Allscripts Milestone Points to Industry Shift to Streamlined Records Processing, April 28, 2017

ɫ, Can Technology Really Save $2340B?, September 1, 2013

ǂ Santesys Solutions, The Pain, Confusion and Costs of Prior Authorization (PA), May 27, 2016