Albert Wright Jr., PharmD, president and CEO of West Virginia University Health System in Morgantown, has set out on a path to reduce the cost of administrative burdens. The latest part of that effort: processing insurance claims in Epic.
Dr. Wright's focus on reducing the cost of administrative burdens began as he continued to see numbers on healthcare spending in the U.S. He specifically referenced a study published in 2018 in the Journal of the American Medical Association, which found that in 2016, the U.S. spent nearly twice as much as 10 high-income countries on medical care and performed lower on many population health outcomes. The study's authors cited prices of labor and goods, including pharmaceuticals and devices, and administrative costs as the apparent main drivers of the differences in spending.
"They did a great job in that study of showing how much more administrative burden and non-care costs we have in the U.S. healthcare system that is a result of having a lot of different healthcare system entities in our country, plus all of the insurance companies," Dr. Wright told Becker's.
To address the issue, Peak Health, a Morgantown-based health insurer and health insurance services company owned by WVU Health System, Marshall Health, Mountain Health Network and Valley Health, is now processing claims for health system employees, using a platform that is familiar to many of them.
"We're actually processing claims in Epic," he said.
"We use Epic as our electronic medical record for all of our clinical enterprise, all of our clinics, hospitals, inpatient, outpatient. And by processing claims in Epic, it gives us real time interoperable information between the provision of healthcare and the payment of healthcare. And I think we're going to use that to really simplify and revolutionize prior authorization processes or try to eliminate some copays and just all of the little back and forth that happens today between healthcare systems and the payment of healthcare."
By decreasing that administrative burden, WVU Health System aims to reduce waste and improve caregiver information and relationships.
Dr. Wright said Peak Health will start offering Medicare Advantage products in 2024 in most of the state of West Virginia.
"Hopefully, as we move toward that Medicare Advantage product, it will allow us to create some alternative payment models where we capitate ourselves. And we're really creating an incentive in the healthcare system for our healthcare system to keep our patients as healthy as possible. And be in the lowest-cost setting as possible, which theoretically, should be good for the patient and should be good for us financially to remain a viable entity," Dr. Wright said.
The health system's goal is to reduce costs by 4 percent to 5 percent through decreasing administrative burden.