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Lessons in claims processing from Pawnee's finest


Last week marked the end of Parks and Recreation, the only scripted show on television I genuinely enjoyed. (I don't like dramas, as real life is dramatic enough, and I have a very particular sense of humor.)

I loved the show primarily for its quirky cast of characters--many of them, like me, offbeat but nonetheless lovable--but also for its lighthearted yet consistent digs at mundane government processes. Every form needed several signatures. Every change, no matter how minute, required a hearing. Employees faced red tape at every turn. A single gadfly or uninformed vote could derailed years of well-intended hard work.

Replace "government" with "healthcare" in the previous paragraph and every point still rings true. That may change, though, as the industry continues its push to improve claims processing.

When it comes to healthcare innovation, claims processing admittedly isn't sexy. It's easy to get excited about smartphone dongles that can take biometric readings, analyze blood samples or even test water for deadly bacteria. Filing claims? That's a job only Gary (AKA Jerry/Larry/Terry/Garry) Gergich could love.

That could change, though. Payers are starting to speed up the claims process, mostly by aggregating and normalizing data but also by gently nudging providers, who can take up to a month to tell insurers that a customer came to the emergency room.

Payers are also inviting patients into claims processing, in an effort to reduce fraud and reduce unnecessary charges. Independence Blue Cross and startup TrueClaim are discussing a pilot that recognizes that patients know better than anyone else whether a claim with their name on it happens to be correct. Chris Traeger would say it's literally the greatest idea he's ever heard. That may be a stretch, but it's definitely a sign of progress.

And progress we need. The healthcare payment system is broken. With so many stakeholders--payers, providers, government agencies and, above all, patients--it's no surprise that bills aren't paid until every last detail has been scrutinized and every avenue for getting someone else to pay the bill has been exhausted.

As anyone who has ever received a bill for health services can tell you, the problem stems in large part from a system that still relies on paper documents. Information must be collected several times, in several places, by several people, not all of whom will do so correctly. Patients must tote binders of information to get a full picture of their health. Few have the scrapbooking skills of Leslie Knope.

The biggest benefit of the digitization of healthcare, in theory, is the notion of the single version of the truth: One patient record, one claim, one bill. In practice, this has proven quite difficult, especially when it comes to patients who see several specialists with separate electronic health record systems and different levels of tech-savviness. Normalizing that data--for claims processing as well as population health management and numerous other purposes--presents quite a challenge.

Part of the brilliance of the last season of Parks and Recreation is that it skipped two-plus years into the future. This let Pawnee, Indiana, evolve seemingly overnight, with holographic messages replacing paper forms at city hall and all municipal business occurring on smartphones.

Healthcare, obviously, cannot skip ahead. It must progress one day at a time. It also suffers from a lack of celebrity cameos, witty repartee and conflicts easily resolved in 30 minutes with little more than a hug or a plate of waffles.

To achieve the happy ending that every Parks and Recreation storyline enjoyed, the healthcare industry, like the show's ragtag characters, must band together, set aside their differences and work for the greater good.

Streamlined, digitized claims processing, like a single repaired swing or stray raccoon captured, won't fix everything. But it will show a commitment to getting the job done. Brian (@Brian_Eastwood and @HealthPayer)

Related Articles:
How payers can speed up the claims process
Startup brings patients into claims processing
Healthcare innovation won't come to those who wait
Health insurance will go digital, eventually