HIPAA Benefits by Community

Benefit	Physicians	Hospitals	Health Plans	Patients	Health Care Purchasers	Govt. Orgs.	Professional Orgs.	Employers
Improve efficiency and effectiveness	Physicians' computer systems will be compatible with those of the hospitals and plans they conduct business with. Referral inquiries will be handled easily.	Administrative systems within hospitals will be compatible. Hospitals can communicate more easily with providers and plans, even when providers change affiliations. Processes like admission and registration will become more streamlined.	Transaction standards and identifiers for providers and patients means plans can provide faster, better services, such as eligibility verification. Rather than receive 1,000 acknowledge-ments for claims, one compact message will be received.	Patients seeking information on enrollment status or health care benefits, will be given more accurate, complete and easier-to-understand information. Consumer documents could be made more uniform and easier to read.	Purchasers' software will be compatible with all plans they evaluate. They will be able to obtain consistent information about all plans.	Medicare and Medicaid providers will be identified in a standard fashion. Government organizations that offer health care will be able to communicate effectively with the private sector.	Professional organizations will be able to offer a greater variety of value-added products and services to their constituents.	Employers that offer a variety of health plans to employees will have a reduced administrative burden. Inquiries by employees on the status of their health insurance can be addressed easily by the employer.
Reduce costs	Vendors will be able to supply low-cost software solutions to physicians who support standards-based EDI. Costs associated with mailing, faxing, and telephoning will decrease.	Hospitals will no longer have high costs associated with the development of customized systems solutions. Legacy systems will be replaced by systems that are less costly to operate and maintain.	Transaction costs will be lowered. Claims received without key entry and payments made without paper and check saves money. Costs related to translation will be reduced or eliminated.	Cost savings to providers and plans will translate in less costly medical care for consumers. Premiums and charges will be lowered. Patients will save postage and telephone costs incurred in claims follow-up.	Purchasers will be able to obtain the information they need about plans electronically, a less costly method than surveying.	Government organizations that provide health care or health related-services to the community will benefit from lower-cost mechanisms of data gathering and dissemination.	Systems and programs that are perceived as aiding patient care are more likely to be funded. Organizations will have less costly methods of data gathering and dissemination.	Employers will be able to provide value-added electronic services, such as automatic enrollment, which require minimal overhead costs.
Prevent fraud and abuse	Through better physician profiling mechanisms, fraudulent activities will be more easily identified and dealt with, which will lead to greater trust in the physician community.	Through standardized coding and transactions, suspicious practices can be identified and dealt with quickly and effectively.	Through standardized coding and transactions, suspicious practices can be identified and dealt with quickly and effectively.	Patients will have access to their medical record and to an audit of who viewed their record. If a patient feels that fraud or abuse has occurred, he/she will have legal recourse.	Purchasers will be able to identify more easily which plans may have had fraudulent practices.	Government programs that monitor fraud and abuse will be able to identify instances more quickly and effectively.	The lessening of fraud and abuse in the overall industry will give professional organizations more accurate and reliable data on which to base their products and services.	The danger of employee discrimination due to inappropriate use of information in their medical record will be diminished.
Protect security and privacy	Physicians will have guidelines on which to base their own confidentiality and security policies. Available software solutions will provide adequate protection for patient records.	The legislation will provide the guidance for hospitals to develop better institutional confidentiality and security policies.	Health plans will have comparable privacy protection policies with providers. Administrative transactions may be sent electronically in a secure fashion.	Patients will have the ability to see what is contained in their medical records. The infrastructure will be in place for patients to see who has accessed their medical records. Patient records will be adequately protected through organizational policies and technical security controls.	Purchasers will be able to obtain data that they need to make decisions (such as quality of health plans) in a fashion that does not compromise patient privacy.	Government organizations will have comparable privacy protections with the private sector. They will not be subject to statutes and state laws that conflict with privacy protection.	Professional organizations will be able to obtain data they need for research or reporting in a fashion that does not compromise patient privacy.	Employees will have assurances that their medical information will not be used for unauthorized purposes and that they will not be discriminated against based on their medical condition.
Reduce paperwork	All administrative tasks can be accomplished electronically. Clinicians will have more time to devote to direct care.	Departments within the hospital can easily communicate electronically. Space that was previously used to store paperwork can be put to better use as larger patient care areas.	Using electronic data interchange will reduce the amount of paperwork. Collecting premiums electronically will diminish paperwork associated with checks.	Visits to health care providers will be shorter without the burden of filling out forms. Consumer correspon-dence with insurers about problems with claims will be reduced.	Certain tasks that were performed manually, such as surveying, will now be done by electronic means due to standardized identifiers, data, and coding.	Automated Medicare enrollment could provide the benefit of paperwork reduction through a Web-based site that allows consumers to fill out forms online.	Certain tasks that were performed manually, such as surveying, will now be done electronically, due to standardized identifiers, data, and coding.	With less paperwork, personnel and human resources departments will be able to concentrate more on improving services for their organizaitons.
Advance research	Research studies will provide more meaningful comparisons and analysis. Clinicians studying diseases and outcomes will be able to track them over a period of time and across settings.	Hospital researchers will be able to perform comparable analyses at multiple sites. Research on time-sensitive issues, such as an outbreak of e-coli bacteria, can be accomplished swiftly to decide on the best course of action.	Administrative data will be more useful in helping insurers plan how to provide better services to the community. For example, a study of first-report-of-injury data for a community can aid insurers in planning the type of coverage that best suits people's needs.	The new wave of research made possible by standard datasets, identifiers, and transactions will be disseminated to patients through print and online resources resulting in a better-informed community.	Plan sponsors that purchase health care products and the patients who are trying to determine which product is best will be able to make better-informed decisions.	Data links will be facilitated between various government health care providers, and with the private sector, providing a fuller picture of the health of the nation.	Professional organizations can play a larger role in fully understanding the health status of the population and how needs differ across communities.	Employers will be able to conduct more definitive research on plans so that employees can make better-informed decisions about which products are best.
Improve quality assurance	Physicians will be able to better monitor clinical effectiveness, the application of health interventions, and their effects on health outcomes.	Rapid access to accurate data will improve quality care at delivery sites and reduce the possibility of detrimental or inaccurate outcomes.	Managed care organizations will be able to devote more time and resources to quality monitoring.	Information on the quality of providers, health plans, institutions, and other health care-related entities will be more readily available and easier to understand.	Purchasing coalitions that conduct plan evaluations will benefit from improved underlying information on the quality of plans.	Monitoring the quality of government health programs and public health programs will become easier and lead to improved health care delivery.	Studies will be more easily conducted on the access to and availability of health care. Through provider identifiers, physician profiling will be more accurate and reliable.	There is a strong connectivity between improving health care quality and improving the health and productivity of a company's work force.
Enhance patient care	Physicians will have a more complete data set of the patient they are treating, enabling better care. More efficient systems will give physicians more time to spend with patients and performing clinical work.	Emergency departments will be able to treat any patient, regardless of their affiliation or coverage. Small or rural sites will benefit through networks or telemedicine, providing them with the same level of information as larger sites to perform patient care duties.	Improved data will lead to the development of better insurance products and services. Seamless interfaces between providers and plans will help the plan play a larger role in the care of each patient.	Patients with computer access can actively participate in their own care. Providers and plans will be able to develop clear and useful information to consumers. The system will provide patients with the information they need to take better care of themselves.	Through improved data and research, purchasers will be able to better select the plans that are most suited to their constituents.	Government can make use of standardized data to facilitate systemic improvements. Government organizations can assist state policymakers, providers, insurers, and purchasers in targeting their efforts to improve delivery.	Data linkages will facilitate studies that were not before possible. Results disseminated to the health care community could lead to breakthroughs in medicine and treatment.	Employee benefits managers will be able to assist employees with inquiries and requests about their health coverage quickly and easily. Improved research means that employers are assured that they are offering the plans most suited to their staff.