Title: The Future of Precision in Healthcare is Just Around the Corner
Amanda Eisel serves as the Chief Executive Officer at Zelis. Expecting precision in healthcare, especially when it comes to test results or treatment protocols, is understandable. However, the financial side of healthcare, including pricing, billing, and payments, often faces unnecessary friction and an excessive administrative burden, making accuracy harder to achieve at scale.
Modern healthcare experience extends beyond clinical care. The financial aspect is proving to be crucial in how individuals engage with, perceive, and react to healthcare. Pain points related to the financial side of healthcare can be addressed by modernizing outdated systems and processes.
The complexity of the business side of healthcare is overwhelming. The journey from pre-care to post-care involves a multitude of touchpoints and constituents: both humans and technology working together to deliver, price, bill, and communicate about care. Unfortunately, the components were not initially designed to work seamlessly, leading to complications with accuracy and confusion in the typical care journey.
Legislation like the No Surprises Act or Transparency in Coverage rules necessitates adjustments within an already intricate system in the healthcare industry. The evolving regulatory landscape poses significant challenges in keeping current with billing, coding, and payment requirements. As a result, inaccurate billing shortchanges both the healthcare system and consumers, generating risks and challenges.
To achieve the best possible outcomes in the healthcare industry, a collaborative and solution-focused approach is needed. Following are some key areas that can be modernized to improve the healthcare financial experience:
Empowering Members with Informed Decisions
Nearly 9 out of 10 U.S. adults who make healthcare decisions for themselves or a family member struggle with health literacy. Meanwhile, 75% of American adults have not taken advantage of lower-cost care options, unaware that alternatives are available.
Platforms that analyze a member's care options and provide personalized, transparent pricing data are vital to enable easier care access and selection at scale.
Consistent Compliance and Excellent Ratings
Accurate information contributes significantly to member experience and satisfaction, a crucial factor in Medicare Star Ratings. Therefore, investments in data accuracy will play an increasingly critical role in Medicare Star Rating evaluations, making them indispensable.
Empowering consumers with real-time, accurate provider data can significantly impact member engagement.
Streamlined Payments and Communications
Payers struggle with the intricate patchwork of incompatible systems that often result in delayed payments and balance bills.
Modernizing payments means sending funds digitally and offering dynamic payment options to meet the preferences of payees. Providers can benefit from a unified payments platform, allowing them to manage multiple payers efficiently, streamline the enrollment process, and simplify account management.
Accurate Provider Directories
Almost 81% of provider directories' entries include inaccuracies, particularly regarding network status and location, prohibiting access to care. Updating the information requires real-time updates and extensive research, which most administrative staff may not have the resources for. The time and cost investment associated with updating provider directory information for health plans total around $2.76 billion annually.
Consider whether the time investment justifies the risks of surprise billing and care barriers. Partnering with industry experts can alleviate administrative burdens and improve directory accuracy, helping members to trust and engage in preventive care services.
By embracing modernization and technology, the healthcare industry can make substantial improvements in financial accuracy.
Strong partnerships allow stakeholders to focus on their core strengths and responsibilities, ensuring that quality care is provided and that payment processes function well. With well-functioning financial experiences, providers can treat patients without undue bottlenecks, payers can engage members in selecting high-quality care at a transparent cost, and patients can focus on their well-being without worrying about financial uncertainty.
Collaboration is essential to challenge the status quo and work towards improved financial accuracy. Healthcare leaders can drive remarkable change in the ease of financial processes, accelerating the progress towards a seamlessly functioning healthcare system.
Amanda Eisel, as the CEO of Zelis, is leading efforts to address the financial challenges in healthcare. Modifying outdated systems and processes under Amanda's leadership could significantly reduce pain points related to healthcare financing.
