How a Consolidated Payments Platform Positively Impacts Payers

Healthcare payers and third-party administrators are facing increasing challenges with complex and outdated technology infrastructures while keeping pace in a competitive marketplace.

Technology bloat, difficulty maintaining compliance, security risks, and a lack of interoperability are the unintended consequences of adopting point solutions or integrating existing and new technologies due to mergers and acquisitions. These factors threaten a payer’s bottom line due to high maintenance costs and the need for manual intervention to resolve breakdowns in people, processes, and technologies.

“Point solutions and the piecemealing of systems, vendors, and things of that nature ultimately lead to inefficiencies,” says Zelis Vice President of Business Solutions Leah Silver. “The more a payer is focused on those point solutions, the less it is focused on bridging the gap between its business process and desired outputs. As payers find they have more systems and processes in place that they have to work with, it opens them up to increased opportunities for risk, security breaches, and fraud.”

By streamlining their digital ecosystems for payments through a consolidated platform, health plans and TPAs can achieve new levels of efficiency and put their organizations in an advantageous position to succeed moving forward while at the same time preventing fraud and mitigating security risks.

“The way to create efficiencies is through consolidation, moving to a comprehensive platform where the entire healthcare financial experience can be managed securely,” Silver continues. “Payers gain access to more modernized tools and ultimately have the ability to take advantage of more streamlined processes and scale for future growth under one platform.”

Modern tools are critical in light of changes in the marketplace and expectations among providers, members, and other stakeholders.

“At the end of the day, a consolidated end-to-end ecosystem for all healthcare payments and communications is necessary to help meet the needs of today’s market,” Silver maintains. “Understanding information in a concise way and staying ahead of the technology curve are all responsibilities of the payers. A robust platform allows them access to a centralized hub where they can scale their business and meet the needs of today’s consumers.”

But the right consolidated platform should be able to do more than address the here and now. It should likewise put payers in a position for future success.

“Some payers are in a state where they’re solutioning for the now, but what does that look like in the future?” Silver inquires. “How are they making those advancements? What sort of aspirations are they working toward as they build out the technology to be able to support the needs of not only today’s but tomorrow’s healthcare consumer as well?”

According to Silver, the choice of a strategic payments technology partner has the potential to make a significant impact on payer operations.

“A strategic partner with a comprehensive platform can shift the dynamics of a payer’s business to drive efficiencies and lower costs,” she emphasizes. “A streamlined payment platform reduces operational inefficiencies and management costs associated with supporting multiple systems. It helps to adapt to the ever-changing rules and regulations of the industry and lower error rates. Working with a strategic partner puts some ownership on external parties to handle the day-to-day upkeep and allows a payer’s resources to be dedicated to more high-value tasks and their core competencies.”

Silver suggests that health plans and TPAs scrutinize a strategic partner based on the latter’s capabilities to improve operations as well as communications.

“When a payer is looking for a neutral party to provide a solution on these types of capabilities, it has to assess the value of that vendor and its ability to improve relationships with providers and members — a partner that can help meet the needs of all the stakeholders involved in the financial healthcare payment journey,” she notes.

What’s more, a strategic partner must have the credentials necessary to work in a highly regulated space such as healthcare. “It’s important to ensure that that vendor is a credible source, that they have all of the tools and certifications to back up their work and the long-term growth plans to execute on the complexities of the ever-evolving landscape that is healthcare,” says Silver.

Replacing complex payment infrastructure with a consolidated platform will put a payer in the best position to succeed in the marketplace while mitigating risks to business continuity. Working with a strategic partner will help health plans and TPAs not only assess their healthcare payment infrastructure for inefficiency, fragmentation, and risk but also implement a solution that brings together people, processes, and technologies to improve productivity, reduce waste, and prepare payers to adjust to future change with agility and confidence.

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Zelis harnesses data-driven insights and human expertise as scale to optimize every step of the healthcare payment cycle. They partner with more than 700 payers, including the top-5 national health plans, Blues plans, regional health plans, TPAs and self-insured employers, 1.5 million providers and millions of members, enabling the healthcare industry to pay for care, with care.