Chicago Business Journal Cites Alliance Waste Report in Who’s Watching the Money?

The Chicago Business Journal article, “Who’s Watching the Money?”, extends the fiduciary obligations businesses have under the Employee Retirement Income Security Act (ERISA) to its health care benefits plans and the requirement to manage them “with the care, skill, and diligence of a prudent person.” That responsibility includes reducing waste, and cites its prevalence using results published in the Washington Health Alliance’s First, Do No Harm report. To fulfill their fiduciary obligations, the article recommends that:

  • there be procedures in place to review and evaluate whether health care claim payments are being handled appropriately;
  • claims be monitored regularly and advanced inferential analytic methods be used to analyze them;
  • avoid conflicts of interest and use different organizations to process claims and conduct reviews, and
  • there be a process to address errors quickly to avoid fraud.

Handling benefits as a fiduciary responsibility benefits the employer by making sure the money is “not wasted unnecessarily on billing errors, abusive use of the emergency department, testing for medically unlikely scenarios, or on intentional fraud.”

Read the article here.

Published: February 4, 2022

About Washington Health Alliance

The Washington Health Alliance is a place where stakeholders work collaboratively to transform Washington state’s health care system for the better. The Alliance brings together organizations that share a commitment to drive change in our health care system by offering a forum for critical conversation and aligned efforts by stakeholders: purchasers, providers, health plans, consumers and other health care partners. The Alliance believes strongly in transparency and offers trusted and credible reporting of progress on measures of health care quality and value. The Alliance is a nonpartisan 501(c)(3) nonprofit with more than 185 member organizations. A cornerstone of the Alliance's work is the Community Checkup, a report to the public comparing the performance of medical groups, hospitals and health plans and offering a community-level view on important measures of health care quality (www.wacommunitycheckup.org).

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