Internet program speeds eligibility check

Nearly half of the population of Washington state — up to 3 million people — is expected to enjoy faster and more hassle-free health care thanks to an Internet-based program being implemented by a group of several of the state’s largest health care organizations.

The new program, created by members of the Washington Health Care Forum, allows physicians and hospitals across the state to devote more of their resources to patient care and less to unneeded administrative processing.

"The first of the four health plans has put patient eligibility on the system," says Tom Curry, executive director/CEO of the Washington State Medical Association and a Forum member.

"Now a question about who is eligible for service can be answered over a secure Web connection in just four seconds. That’s four seconds — instead of making a phone call, getting a voice mail, making alternative command selections, being placed on hold, and other hit-and-miss procedures that often consume a lot of valuable time. The new system works just great and protects patient confidentiality," adds Mr. Curry.

All four participating health plans should be up and running on the eligibility portion before the end of the year, adds Leo Greenawalt, president of the Washington State Hospital Association in Seattle. "The potential savings in time, money, and hassle are enormous. The patient benefits by getting better health service and lower costs. And this is just the first step."

As soon as eligibility verification is on-line at all four participating health plans, the next step is to create secure Web connections for authorizing referrals of patients to specialists and to assure prompt payment of claims to minimize patient frustration. Forum CEOs have assigned staff to simplify other administrative processes that now add time and take money away from patient care.

The Washington Health Care Forum is a group of leaders from health care provider organizations and health plans, including the Washington State Hospital Association, the Washington State Medical Association, First Choice Health Network, Group Health Cooperative of Puget Sound, Premera Blue Cross, and Regence Blue Shield. Work on developing the Web-based eligibility verification system began late last year, with the overall goal to make the health care system simpler and more efficient to navigate for consumers, physicians, and hospitals.

Representatives of the member organizations first met in early 1999 to set goals and develop a work plan, Mr. Greenawalt says. "All of us in health care need to remember that our fundamental goal is to provide good service to consumers with as little administrative hassle and as much care and compassion as we possibly can. Those of us who are members of the Washington Health Care Forum are taking action to make sure we deliver on that goal."