Credit: Liubomyr Vorona/Liubomir/Adobe Stock
Big health insurers might be starting to compete based on promises about how much they have and will reduce administrative friction for health care providers.
UnitedHealth's UnitedHealthcare business sent providers a notice Monday talking about a new effort to pay many commercial health plan claims in real-time.
David Joyner, the chief executive officer of CVS Health, Aetna's parent, talked today during a conference call CVS held with securities analysts about how much Aetna has and will reduce pressure for physicians to seek prior authorization for proposed courses of treatment.
UnitedHealthcare's real-time payment program: UnitedHealthcare said the new "real-time" payment program will involve paying many claims the same day the claims are filed, without the 3-day or 5-day waiting period typically associated with payments sent through the standard Automated Clearing House network.
"There's nothing you need to do to initiate real-time payments for eligible commercial claims," UnitedHealthcare said in the notice about the change.
But the insurer said providers may need to talk to their banks and patient record services providers about how information about the real-time payments will show up in cash-management and patient record systems.
Providers can handle the new real-time payments the same way they would any other electronic payments, and "the only difference is the same-day speed at which they're credited to your account," the insurer said.
Aetna's prior authorization strategy: CVS held the analyst call to go over earnings for the first quarter, which ended March 31.
One key priority for CVS and Aetna is "reducing unnecessary friction for providers and patients, particularly in the prior authorization process," Joyner said.
"Our leadership is clear here," Joyner said. "Aetna has the fewest medical services subject to prior authorization in the industry."
Aetna uses widely accepted standards for 88% of the procedures that are still subject to prior authorization, and it approves 95% of the requests for authorization for eligible procedures within 24 hours, he said.
Aetna is also supporting efforts to help other insurers and the America's Health Insurance Plans trade group standardize prior authorizations for the most commonly reviewed procedures by the end of the year, he said.
"The next critical step is ensuring other stakeholders within the healthcare system open up their own systems, so these standards can be fully adopted and the benefits of this work can be realized at scale," Joyner said.
Steve Nelson, the president of Aetna, said the company hopes to further reduce friction by providing more advocacy services for patients and creating more provider-payer partnerships.
What it means: Health insurance executives have noticed public anger about health insurance and are trying to do something about that.
The changes could reduce care access problems for participants in employer-sponsored health plans, but one concern for employers and benefits advisors may be what efforts to reduce friction will end up doing to the use of care and the cost of claims.
© Touchpoint Markets, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to TMSalesOperations@arc-network.com. For more information visit Asset & Logo Licensing.