Of all the health-care collaborations highlighted in The Arizona Republic recently, a new and entirely entrepreneurial alliance — designed by a group of health-care companies that compete with one another in a highly regulated environment — is working to relieve the administrative burdens on Arizona’s medical providers.
The Arizona Association of Health Plans, made up of the companies that contract with the Arizona Health Care Cost Containment System to provide for the health-care needs of Arizona’s most vulnerable citizens, has launched an alliance to credential and recredential all of the Medicaid providers in the state. AzAHP’s Credentialing Alliance serves about 35,000 doctors and other licensed health-care professionals and continues to grow.
Arizona’s Medicaid providers have seen their reimbursement rates cut 15 percent in the past four years. And while it’s up to AHCCCS and the Legislature to set the rates, the objective of the new alliance is to make it easier for health-care professionals to do business with the health plans.
Government regulations require that before a health plan or hospital can add a health-care provider to its network, it must essentially run a background check to verify the provider’s credentials and then recheck them every three years to ensure their licenses are current. If you are a doctor in Maricopa County, you might see AHCCCS patients from six different health plans, each one obligated to do its own complete verification of credentials.
Until the creation of our alliance, each health plan may well have had a different application and process and used a different set of criteria, with recredentialing dates that varied from plan to plan. In any doctor’s office, the administrative burden of credentialing is a significant and ongoing activity.
From the individual health-plan perspective, credentialing is an equally labor-intensive process that consumes considerable internal resources.
After nearly a year of operation, our overhaul of the credentialing process allows doctors to use just one form that’s accepted by all of the health plans. We contract with one company to verify a provider’s credentials, constantly monitoring for sanctions, and set a single date to recredential that provider, which is good for all the plans he or she contracts with. More than 80 percent of our providers are in at least two health-plan networks, so the overlap is significant.
Beyond eliminating duplicated work and slashing the administrative burden for plans and providers alike, we expect that the alliance will ultimately result in cost savings.
The feedback we’ve had from our providers has been incredibly positive, and AHCCCS liked the idea so much that it made participation in the alliance a requirement of the new contracts that started in October.
Although it was designed by and for the Medicaid plans, nearly all of our member companies run other lines of business through the alliance. We have just started the process of adding the state’s behavioral-health plans to our alliance and look forward to recruiting Arizona’s commercial insurance carriers to join us.
Deb Gullett, executive director of the Arizona Association of Health Plans, is a government relations specialist with the law firm of Gallagher & Kennedy.
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