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June UHCC Meeting: Administrative Simplification Round 3: Health Insurance Plans vs. the Rest of Us

At its June meeting, the Universal Health Care Commission again tackled the topic of Administrative Simplification, this time hearing from a panel of 3 providers and 1 insurance executive.  The presentations reinforced what members of the public have been telling the Commission for years in their public comments.

All panelists agreed that simplifying administrative requirements was essential to lower the costs of care and improve patient access.  

Priorities for what to tackle first varied across specialties:  

  • Physicians: prior authorizations, licensure delays, and clinic/pharmacy communication.
  • Behavioral health: claims processing, timely payments from insurers, and ER follow-ups.  
  • Insurance executive: too many interoperability standards across their “lines of business” and getting provider buy-in to the new standards.

Commissioners identified these priorities for simplifying administrative requirements:

  • Better communication between pharmacies and medical clinics 
  • Address the stigma of substance abuse, mental health and cost in lives lost, especially at the Federal level. Given Federal laws, what can we do at the state level?
  • Lack of uniformity in pharmaceutical formularies, possibly caused by insurers chasing rebates.
  • How does administrative simplification affect different provider types? 
  • What are the unintended consequences for Medicaid patients? 
  • Analyze savings from simplicity, as improvements may not give significant savings
  • Help connecting the dots:  where would a universal health care system help on all of these good ideas?

There needs to be a set process or systemization for how legislative changes are implemented.  

For example, in 2019 an exception process for pharma to avoid prior authorizations was passed into law, but it is not well known. 

Staff will review these priorities and advise for the 2024 Report. 

This was a rich meeting with many details and is well worth viewing. The Panel presentations begin at 1:26:06 with Jeb Shepard.

The next UHCC meeting is August 8 @ 2-5 pm. Find the meeting materials and Zoom link here.

Meanwhile, please join us as we track the  FTAC meeting on July 11 @ 2-4:30 pm

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