By NextBestFitStandardize across many payers
Require all insurers to use identical forms, codes, prior-auth rules, and credentialing.
Interim standardization across today's insurers.
Review ledgerHow this path connects
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Require identical forms, codes, prior-auth rules, and credentialing across payers
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
- About $1 trillion a year in administrative cost
Identical insurer forms, codes, prior authorization rules, and credentialing reduce provider paperwork while retaining multiple payers. Savings are smaller than with a single payer.
- Clinician burnout from paperwork and EHR work
Requiring insurers to use identical forms, codes, prior authorization rules, and credentialing reduces provider paperwork.
- Losing the choice of health plan and insurer competition
Standardizing insurer rules retains multiple payers rather than replacing them with a single payer.
- Faces political, industry, or legal opposition
Insurers may resist requirements to give up their own forms, codes, and rules.
Who's affected
- Doctors, nurses, and other clinicians
- About $1 trillion a year in administrative cost: Time goes to billing and insurer rules instead of patients.
- Clinician burnout from paperwork and EHR work: Documentation and insurer paperwork drive burnout and early retirement.
- People with employer coverage
- About $1 trillion a year in administrative cost: Premiums pay for the administration.
- Losing the choice of health plan and insurer competition: They can't keep or pick a plan they like, or switch if service is poor.
- Taxpayers and public budgets
- About $1 trillion a year in administrative cost: Public programs pay for it too.
- Hospitals, clinics, and care organizations
- About $1 trillion a year in administrative cost: Identical insurer forms, codes, prior authorization rules, and credentialing reduce provider paperwork while retaining multiple payers. Savings are smaller than with a single payer.
- People with ongoing or specialist care needs
- Clinician burnout from paperwork and EHR work: Paperwork leaves less face time with clinicians.
- Health insurers, brokers, and their shareholders
- About $1 trillion a year in administrative cost: Insurers, billing firms, and clearinghouses earn from the complexity.
- Insurance and billing workers
- About $1 trillion a year in administrative cost: Their jobs exist because of the complexity.
- Health administration and software vendors
- Clinician burnout from paperwork and EHR work: They supply the record and billing systems used for administrative work.
Where it has been tried
- Germany, Switzerland: Standardized claims across insurers.
- Netherlands: In 2012, the Netherlands reduced standardized hospital billing categories from 30,000 to 4,400 to reduce administrative complexity.Sources: Commonwealth Fund (2020)