Steps Toward Streamlined Credentialing

1
Steps Toward Streamlined Credentialing

• Synopsis of Findings and Recommendations
• Educational Forums
• March-April 2002

2
Commonly Used Acronyms . . .

• CAQH -- Coalition for Affordable Quality
  Healthcare
• WCSG -- Washington Credentialing Standardization
  
• Group
• WHFS -- Washington Healthcare Forum Services
• WPA -- Washington Practitioner Application
• WSHA -- Washington State Hospital Association
• WSMA -- Washington State Medical Association

3
Our findings and recommendations are based on . .
.

• Discussions with members of the Washington
  Credentialing Standards Group (WCSG) to
  understand work that has been completed and what
  is underway.
• Evaluations of credentialing initiatives in
  Washington State, the Northwest and other areas
  of the country to understand how others are
  tackling the issue.
• Interviews with Practitioner Staff to get their
  perspective of the Credentialing/Recredentialing
  problems and possible solutions.
• Work with Hospital and Health Plan
  representatives to understand the similarities
  and differences in their Credentialing/
  Recredentialing requirements and processes.
• Meetings with the OIC and Governors Office staff
  to share our mutual perspectives of the problem.

4
Credentialing practitioners is worthwhile and
necessary to help ensure quality care for
patients.

• Patients and employer groups expect effective,
  efficient and quality care for their premium
  dollars.
• Health plans and hospitals evaluate practitioners
  so that patients can count on a high standard of
  patient care and safety.
• Accreditation requirements and federal/state
  regulations reinforce the importance of
  credentialing activities by health plans and
  hospitals.

5
Our opportunity is to
continuously improve a complex process.
Important insights include...

• Recredentialing is the recurring headache. ?
• A critical mass of healthplans and hospitals
• must adopt standard forms and cycles. ?

Estimated Effort
45000
40000
35000
30000
25000
20000
15000
10000
5000
0
Credentialing
Recredentialing
Hospitals x 20 Credential _at_100 Recredential _at_
600
Healthplans x 4 Credential _at_ 2000 Recredential
_at_ 7600

• Any solution cant add complexity to the
  practitioners. We need to understand their
  perspective and get their buy-in to any proposed
  solution and transition implications.
• We need to keep our eye out for comprehensive
  solutions that are viable, affordable and that
  fit our needs.

6
Key conclusions from the analysis . . .There are
no easy solutions.

• From the practitioner perspective, there are two
  major problems to solve
• Problem 1 Practitioner staff do redundant work
  to keep up with multiple recredentialing forms
  and cycles. This work, which feels bothersome and
  frustrating, averages about 17 hours per
  practitioner every two years with 14
  credentialing organizations. A best case
  scenario might save up to 12 hours.
• Problem 2 The credentialing process sometimes
  takes too long. Process includes application
  completion, verification of sources, assembly of
  the file, peer review and assessment and
  committee approval. Information can expire while
  waiting for a once a month credentialing
  committee process. Our impact opportunity is
  unclear.
• Three types of solutions are on the horizon --
  automated forms (on-line forms and electronic
  exchange), a central practitioner data repository
  and a central credentialing organization.
• The success of any comprehensive solution will
  require broad adoption by hospitals, local health
  plans and national health plans. Developing
  consensus will take time.
• WHFS can take steps that will provide near term
  relief.

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Recommendations for moving forward . . .
WHFS Near-Term Action Steps

• Endorse the WPA and encourage WSHA, WSMA and
  others to do so.
• Work with WCSG to propose and adopt
  Credentialing process guidelines for health
  plans, hospitals and practitioners.
• With WSMA, encourage practitioners to maintain
  their credentialing information on their
  computers.
• Endorse WCSGs effort to standardize the
  attestation document for recredentialing.

• Long Term
• Continue to monitor centralized credentialing
  efforts, specifically the Universal Credentialing
  Solution offered by Coalition for Affordable
  Quality Healthcare (CAQH).

8
Detailed Findings

• Practitioner Staff Perspective
• Solutions Analysis
• Review of CAQH Solution (Coalition for Affordable
  Quality Healthcare)

9
Practitioner staff say credentialing takes far
too long and recredentialing creates busy work.
Practitioner Staff Perspective . . .

• Problem 1 Recredentialing -- repeating the same
  work over and over again.
• Practitioner staff must complete different forms
  at different times, e.g. about 14 forms every 2
  years per practitioner.
• Practitioner must attest to and sign every single
  one. (Information must be current within 180
  days of the time it is approved by the
  credentialing organization.)
• Recredentialing with health plans is a bigger
  problem than with hospitals because of the shear
  volume of health plans with which a practitioner
  contracts.
• Problem 2 Credentialing -- Too many forms and
  too long to wait.
• The WPA, developed by WCSG, is well loved and
  provides some relief. Practitioners want
  everyone to use it.
• Some practitioners have requested more frequent
  meetings of credentialing committees.
• Opportunity -- one set of information that can be
  easily updated.
• Standardized credentialing/recredentialing
  information and format
• Ease of update, signature and distribution
• Evaluate more frequent credentialing committee
  meetings

10
Practitioner Staff Perspective . . .
Standards will provide relief, if widely adopted
and implemented appropriately.

• Standards can make the process easier . . .
• The WPA has begun to streamline the credentialing
  process for practitioner staff.
• We need a similar standard for recredentialing.
• Additional benefits can be achieved by
  documenting and communicating credentialing
  process guidelines.
• Practitioners - Outline best practices for
  completing the credentialing processes
• Credentialing Organizations - Define reasonable
  expectations for credentialing steps, completion
  timeframes and committee meeting frequency
• . . . As long as there is broad compliance.
• Broad based communication and education is
  necessary to gain adoption and usage. It may
  also clear up misperceptions about who accepts
  what form.

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Practitioner Staff Perspective . . .
IF we could get to a standard recredentialing
cycle and forms, we may save about 4
hrs/practitioner every 2 yrs.

• Practitioner staff interviews indicate that it
  takes between 30-180 minutes to complete the
  appropriate forms and attest to them. A standard
  cycle promises some relief, if . . .
• 50 of a practitioners hospitals and health
  plans participate, and
• practitioners receive the recredentialing packets
  at the same time.
• A standard cycle may help save 4 hours per
  practitioner in two years.
• At 75 minutes per practitioner, with 50 of
  credentialing organizations participating in
  standard cycles, it would be a possible savings
  of about 4 hours per practitioner in 2 years
  based on 14 health plans and hospitals.
• A 3-year cycle would provide time savings to
  practitioners, health plans and hospitals.
  Health plans and hospitals would also have a cost
  reduction in mailing and queries.
• A standard recredentialing cycle does not add
  value to delegated groups.

12
Other types of solutions are beginning to emerge.
Their success will depend upon critical mass
adoption.
Solutions Analysis . . .

• The solution must make it easy for practitioners
  to supply credentialing organizations with
  information that will still be up-to-date within
  2-3 months after being submitted to the
  credentialing organization. (180 day
  requirement).
• Three types of possible solutions are on the
  horizon
• Automated forms -
• On-line Forms - Practitioners
  maintain/update their WPA information on
  an electronic form in their office, e.g Microsoft
  Word.
• Electronic Exchange - Practitioners can
  exchange forms with credentialing
  organizations, e.g. email attachments or eforms.
• Central Practitioner Data Repository (e.g. CAQH,
  Phase I) -- Practitioners maintain their
  credentialing application information on a
  centralized database that is accessed by
  credentialing organizations.
• Centralized Verification Organization (CVO) -
  Practitioners supply a single organization with
  updated information on a specified cycle.
  Organization also does Primary Source
  Verification for all health plans and hospitals.

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There is no silver bullet. Heres how each
solution meets our objectives and challenges us.
Solutions Analysis . . .
Barely Easy
Adequately Moderate
Meets Objective Level of Challenge
Strongly Difficult
Forms
Stnd. Cycle
Legend
Central Repository
CVO
O.
E.
Reduces the practitioners redundant work.
Object ive
Automatic update reminder system
Quick exchange of credentialing information (i.e.
electronic)
Single accessible storage point for credentialing
info
Enables future opportunities for shared/central
P.S.Verification
Likely participation by national health plans
(CAQH specifically)
Chal lenge
Need policy/operations/process changes by
credentialing orgs
Red Flag
Red Flag
Need secure way to exchange information grant
access
Need electronic signature or way to process paper
signatures
Need training/help for practitioners
Need way to register and uniquely identify all
practitioners
14
Long term, a central practitioner data
repository appears to be the best alternative.
Solutions Analysis . . .
Considerations

• Health plans and hospitals will weigh the costs
  of this solution, which represents new,
  additional costs of doing business. These costs
  may not be offset by any savings to their
  organization.
• Like any of the solutions, success will depend
  upon breadth of participation.
• Electronic forms may have interim value for
  practitioners, and long term value if central
  practitioner repository does not prove feasible.

Recommendations

• Do a quick assessment of the cost and benefit
  of automated forms.
• Continue to monitor CAQH and other database
  solutions that emerge.
• Consider how to address security, signature and
  access issues related to electronic exchange of
  forms and central practitioner repository.

15
Review of Coalition for Affordable Quality
Healthcare (CAQH) Solution . . .
CAQH, a collaborative effort of 26 national
health plans, is developing a universal
credentialing solution.
Roll-out in 2002
Health Plans Local National
CAQH Database
Phase I
Physician Staff
Central Physician Data Repository

• Plans Notified of Updates
• Plans Retrieve Physician Data when and as needed
• (electronic)

Update Credentialing information
(electronic)
Signed Attestation
Fax/Mail Supporting Documents
Future

Primary Source Verification
Other Practitioners
Hospitals
16
The CAQH offering has the potential to address
our needs.
Review of CAQH Solution . . .

• Central practitioner data repository supported by
  national health plans
• Technology solution and business model under
  development
• Initially targeted only at health plans and
  physicians

Status

• Phase I
• Designed to address the credentialing
  applications process
• Phase II
• Scope is to address the credentials verification
  process and reduce redundancies for primary
  source verifications

Phases

• Two rollout sites scheduled to be complete by
  mid-May 2002
• National roll-out scheduled to begin June 2002
• Contacting Washington State physicians in July
  2002 for October availability of their
  information in central practitioner data
  repository
• Primary source verification in late 2002 or
  early 2003
• National roll-out expected to be complete May
  2003

Schedule
17
However, the CAQH offering is still unproven.
Review of CAQH Solution . . .

• Concept appears sound
• Supported by national health plans
• Database pricing seems reasonable _at_ 4.50 per
  physician/year
• Willing to work with WHFS, using WPA
• Adds additional costs to our healthcare system
• Health plans must support dual credentialing/recre
  dentialing processes -- CAQH for physicians and
  current process for other practitioners
• Has not been fully reviewed by NCQA, JCAHO, URAC,
  AMA, AHA
• Process for updating information needs more
  review
• Price is based on total physicians, not annual
  recredentials
• Non-Member hospital of 400 physicians - 4,800
  per year
• Non-Member health plan of 10,000 physicians -
  48,000 per year

Pros
Analysis
Cons
Scenario

• Solution has potential but is still in
  development
• Monitor progress and fully review again after
  roll-out experience
• Determine participation level that can be
  achieved in Washington

Conclusions
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Heres what the Work Group will be doing . . .
Impact on Problem
WHFS Near-Term Action Steps
2. Long Cred Wait
1. Redundant ReCred Work

• Endorse the WPA and encourage WSHA, WSMA and
  others to do so.
• Work with WCSG to propose and adopt
  Credentialing process guidelines for health
  plans, hospitals and practitioners.
• With WSMA, encourage practitioners to maintain
  their credentialing information on their
  computers.
• Endorse WCSGs effort to standardize the
  attestation document for recredentialing.

We are also continuing to monitor the CAQH
initiative.