What was the original inspiration for CAQH, and what was going on in healthcare that prompted the health plans to create the organization?

In 2000, the healthcare industry was experiencing significant abrasion between providers and payers. In particular, providers were communicating to patients how difficult it was to work with insurers. As a result, consumer sentiment regarding health insurers was at a low point. At the same time, health insurers were fierce competitors and appeared unable to collaborate. Because of those perceptions, two forward thinking CEOs, Len Schaeffer from then WellPoint (now Anthem) and Jay Gellert from HealthNet, decided that payers needed to find a way to work together to address common problems. Many other CEOs agreed, and the idea of CAQH was born.

In what ways has CAQH evolved over the past 20 years, and in what ways has it stayed the same?

Over the past 20 years, CAQH has become a recognized industry thought leader that can not only convene and align stakeholders on industry administrative simplification issues, but also has the ability to deploy technology solutions to address them. Additionally. CAQH CORE has become the industry authority on operating rules and automating business transactions. In fact, certain operating rules developed by the industry for the industry through CAQH CORE have been made requirements by the federal government.

Here is what hasn’t changed: our mission and commitment to improve the healthcare system through a transparent process in which diverse stakeholders come together to solve common problems.

If you could pick one CAQH initiative that has the greatest impact on healthcare, what would that be?

CAQH ProView. This solution is widely used by both providers and payers and it is what CAQH is best known for. And we are proud of the difference it has made for the industry.

The marketplace is changing rapidly today. What do you see as the greatest contribution CAQH can make to healthcare going forward?

Our greatest contribution going forward will likely be our proven ability to bring disparate stakeholders together and reach alignment on administrative simplification issues impacting providers and payers. We have been successful at this and will continue to be, in part, because of the trust we have earned from providers, health plans and vendors over the past 20 years. Here’s a perfect example: COB Smart is transforming the way coordination of benefits is conducted because health plans have enough confidence in us that they are willing to provide continuous access to their membership rosters.

This is just one example, but our reputation for integrity, transparency, collaboration and mission have put us in a unique position to convene industry stakeholders and solve common administrative problems—of which there are many.

As the SVP of Industry Relations, what initiatives are you currently working on that you are particularly excited about?

I’m particularly excited about two initiatives; first demonstrating that an entire market, Massachusetts, is adopting DirectAssure as the state standard for provider data collection, maintenance and distribution. This statewide endorsement is a model we are hopeful to see in other states and nationally, as well. 

We are also working on another very exciting initiative; CAQH is developing a relationship with the American Medical Association to collaborate on potential administrative simplification initiatives. I believe partnering with provider stakeholders is an important step in our growth.