$342B wasted each year due to government healthcare benefits data integration challenges

Health and human services agencies take more than three weeks to confirm benefit eligibility, according to MeriTalk's The Economics of Eligibility: The Cost of Eligibility and Verification Challenges for Government Healthcare Benefits report.

The report surveyed 155 IT executives and program managers working with healthcare and other social service benefits.

The respondents report data integration as the top challenge to delivering healthcare benefits. They estimate $342 billion is wasted each year due to improper payments from benefit eligibility and verification. Nearly half of respondents (47 percent) believe improved data integration across agencies could stem financial losses.

Survey respondents listed accuracy as the second challenge. They estimate 11 percent of people enrolled to receive government healthcare benefits are not actually eligible.

The majority of survey respondents have a positive outlook. More than half of respondents (59 percent) believe a user-friendly IT system that integrates necessary beneficiary data from all departments and sources is at least three years away. According to the respondents such a system would provide:

•    Better overall quality of service: 64 percent
•    Faster eligibility determination: 63 percent
•    Faster verification: 57 percent
•    Increased accuracy: 55 percent
•    Improved employee productivity: 54 percent
•    Fraud reduction: 53 percent
•    Overpayments reduction: 47 percent
•    Underpayments reduction: 41 percent

The survey recommends an audit of current systems and processes, prioritization of data integration and improved collaboration to address the financial loss and challenges associated with benefit eligibility and verification.

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