Benefits of an Integrated Healthcare Payments Platform to Payers

Increased digitization is coming to the payer space, and health plans with an integrated payment and communication platform will be able to reduce complexities and costs with claims management and free resources to provide a modern consumer experience to members.

According to McKinsey & Company, “the rising cost of claims and the complexity of claims management are among the most pressing challenges health insurance companies and other private payers face today.” While technology is now available to digitize part if not all of the claims life cycle, payers need to ensure that it does not lead to more siloed functions and duplicative infrastructure.

Integrated payment and communication platforms now have the ability to eliminate this fragmentation and redundancy. With legislative and regulatory changes now going into effect, health plans are feeling the crunch to achieve and maintain compliance. Getting their digital houses in order is paramount.

“Healthcare payments revolution is definitely coming,” says Eileen Dougherty, Zelis Executive Vice President of Product.

“On the one hand, there are the Transparency in Coverage Final Rule published almost two years ago and the No Surprises Act included in the Consolidated Appropriations Act of 2021. They are going to change healthcare significantly,” she continues. “The change is coming and it started with the massive shift in the payment responsibility in healthcare between the health insurance plans and the patients themselves over the last two decades, which is leading to a necessary shift to a humanization of the healthcare payments process as patients take on greater financial responsibility for their healthcare.”

Humanizing healthcare payments

What is lacking in healthcare for patients is “trust,” and the level of trust historically between health plans and patients has not been sufficient to support the relationship needed to reduce healthcare costs. Today, healthcare payers and plans are working hard to change that reality.

“If you really think about your last positive healthcare experience, it likely was a doctor or a doctor’s staff who made you feel good about something bad that happened or who was very efficient and helpful during a scary or emotional time,” Dougherty explains.

“I can almost guarantee that experience was not related to the payment part of your healthcare journey. It was not the explanation of benefits you received for $70,000 or the 12 insurance calls you had to make to try and figure out a certain line item.”

Healthcare incumbents are facing new competition in the payer space from companies working to humanize the payment aspect of healthcare. Health plans unwilling to move quickly to embrace new ways of doing business will lose ground on those providing more consumer-centric experiences.

“Many new vendors are moving into the healthcare space from tangential industries that have brought with them the concept of humanized experiences from industries like banking and finance,” Dougherty observes. “They are going to bring with them smoother payment experience, a better understanding for doctors of how to get paid better and smoother, and a way for them to create a unified experience. It’s happening now.”

Efficiency through integration

Today’s payers are facing numerous obstacles in the way of providing a streamlined experience for consumers. Recent Deloitte data indicate that half of the industry is dealing with disparate systems and businesses resulting from mergers and acquisitions and a lack of a defined vision for their digital transformation.

Modernizing healthcare payments is all about efficiency. Working with a strategic technology partner guarantees access to powerful technology.

“In my mind, the payment space is one that is made more efficient through a network effect, referring to the concept that the value of a product or service increases when the number of people who use that product or service increases,” says Dougherty. “Having a specialized vendor organization that links the most payers and providers and members possible in one system and health plans is key. Plans can leverage and integrate solutions into their own member and provider experiences to streamline efficient, simple, and secure payments to both their providers and do the same for payments between members and providers.”

What’s more, a strategic technology partner that offers an integrated payment and communication platform can help reduce the administrative complexity inherent in a highly regulated and scrutinized space such as healthcare.

“Healthcare payments are a great space because it can easily be isolated into its own solution,” Dougherty stresses. “It’s a space with numerous potential high-risk points — fraud and abuse around handling bank accounts and managing money, transfers, and unified accounts. So having a specialized organization that knows how to handle those and knows how to keep things safe and simple and secure is a great asset to a health plan that can then focus the rest of their time on their core business, which is covering patients and members and managing risk for employers.”

With improving customer experience emerging as a top priority for health plans, the latter must take a closer look at the people, processes, and technology currently hampering their ability to make the financial side of healthcare as human as the clinical one. Payers need a new platform approach to capitalize on the healthcare consumerization and personalization movement. By streamlining and driving efficiencies across the various aspects of healthcare payments and communications, they can save time and money while improving provider and member satisfaction.

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About Zelis 

Zelis harnesses data-driven insights and human expertise as scale to optimize every step of the healthcare payment cycle. We 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.