CAQH CORE Releases Findings from Industry Survey on Exchanging Medical Documentation

For more than a decade the healthcare industry has been guided by the triple aim: the goal to deliver an improved patient experience, at lower costs, while improving the overall health of a population. But as providers are expected to deliver more value and take on more financial risk, a fourth aim has been added — avoiding physician burnout.

A 2019 national survey reported that over 44 percent of physicians experience some type of burnout. Of these physicians, 59 percent identified administrative tasks as the number one contributor.

The exchange of medical documentation, i.e., attachments, is an essential component to healthcare delivery; however, the administrative burden associated with these tasks causes significant provider stress and detracts from time spent caring for patients.

Last year, CAQH CORE conducted an industry survey to better understand how health plans and providers are currently exchanging attachments across four use cases: prior authorization, healthcare claims, quality measurement and value-based payment. The survey also sought to understand which service lines consistently require the highest volume of attachments and therefore most significantly contribute to administrative burden.

The results, which show wide variability in how attachments are exchanged and the prevalence of mail and fax (the most time consuming of methods), illustrate the opportunities of moving to an electronic standard which would substantially reduce the time and costs associated with attachments. Informed by the survey findings, a CAQH CORE Attachments Subgroup is currently drafting operating rules that build on the existing CAQH CORE Prior Authorization Operating Rules to support consistent business use of fully electronic methods for prior authorization attachments. The Subgroup will tackle operating rules for healthcare claims attachments in 2021.

To read “Keeping it Together,” click here.