About 27,000 Michigan physicians participating in the conventional Blue Cross and Blue Shield of Michigan health plans and the Blue Care Network HMO are being invited to maintain their medical credentials online, the plans announced today.
"We expect this to be something all health plans will use within the next five years," said Thomas Simmer, M.D., senior vice president and chief medical officer for the Michigan Blues. A few national plans with what Simmer called "tiny" enrollments in Michigan have announced they also would be offering universal credentialing, but the Blues, with 45% of the Michigan market, are the first large payer in the state to embrace the new technology, he said.
Blues leaders have heard the call from physicians for consolidation in the credentialing process for some time now, but even the Michigan Blues' HMO and its other health plans used separate credentialing forms, Simmer said. So, once the Blues got past the Health Insurance Portability and Accountability Act challenge to their information infrastructure, the organization looked to rationalize the credentialing process and moved toward the Web-based solution, he said.
Meanwhile, a separate effort pressed by a national physician group practice organization is under way to explore first steps toward a coordinated approach to promoting universal credentialing -- a goal that, if reached, could eliminate an estimated $2 billion in administrative costs from the national healthcare system.
The Michigan physicians have been sent letters announcing the plan. Later this month, they will be sent enrollment packets for the Web-based service, Universal Credentialing DataSource, developed by the Council for Affordable Quality Healthcare. The not-for-profit council is a national alliance of health plans and networks whose credentialing system has been adopted by plans in 47 states and claims 92,000 physician participants, according to the Blues.
William Jessee, M.D., CEO of the Englewood, Colo.-based Medical Group Management Association, which is boosting a national initiative to develop universally accepted credential standards, called the Blues' effort in Michigan "a step in the right direction."
Jessee described the proposed Web-based approach to facilitate credentialing as a huge problem-solver for medical group leaders.
"It's one of the (problems) we get the most complaints about," said Jessee. "Not only the duplication of effort but the lack of timeliness. I've got people who have hired physicians and say they can't get them paid by health plans for months because (the plans) haven't processed their credentials."
Jessee said he's heard reports that some of the Medicare carriers are backlogged on their credential checks up to six months.
"That's a long time not to be paid."
Taking an informal survey at a state MGMA meeting in Iowa last month, Jessee said he asked attendees to put a dollar amount on the physician and staff time lost to credentialing in their practices.
"It was a small sample, only 28 people, but it averaged $1,800 per physician per year," Jessee said. "It doesn't sound like much, but when you multiply it times 600,000 physicians, it comes up to over $1 billion dollars a year."
Coupled with the costs incurred by hospitals for granting privileges for their physicians and "we estimated $2 billion was the cost for the country, and a centralized service could knock that down to $200 million."
"A billion here and a billion there and pretty soon you're talking about real money," Jessee said. "It's a no brainer. I can't see why we haven't done this a long time ago."
Jessee asked the Commonwealth Fund, a New York City foundation, for help addressing the problem, according to Stephen Schoenbaum, M.D., a senior vice president with the fund, which made a $25,000 grant to AcademyHealth, a Washington, D.C. think tank, to dig into the problem.
"Bill approached us last year sometime because he was looking for a neutral party to convene a conference or a meeting to work through issues around administrative simplification," Schoenbaum said.
On May 19, Academy Health rounded up about 20 representatives from a core group of stakeholders in the credentialing issue, including health plans, hospitals, academic medical centers, CMS and MGMA, for a meeting in Washington to strategize.
"We all left this meeting with the notion that the next step is not the kind of bigger meeting that Bill had originally anticipated, but rather, to try to start understanding what some of the problems are and where people are doing some things that are innovative," Schoenbaum said. "AcademyHealth is due to come back to us in the next month or so or maybe two months and give us some idea what they think are the next feasible steps."
In Michigan, where one of those steps is being taken, the Blues plans will pay an annual fee to access the Web-based credentialing system, which is free to physicians.
Physicians can go to the Web and update and check the accuracy of their credentials, which are in a form acceptable to the plans. The data will be made available only to health care organizations that have been authorized by each physician to receive it.
Initially, the Blues won't be able to directly input credentialing information from the Web-based service into the Blues own computer systems, so the full financial return to the plan won't be realized until then, said Simmer, the Blues' senior VP and CMO. Hospitals also will need to add forms for procedures in their credentialing processes, but the system should provide a solid basis for both future activities, Simmer said.