Did you know that administrative complexity adds more than $250 billion annually in unnecessary costs to the U.S. healthcare system? While the quantity may be surprising, we at Zelis believe the qualitative impact is an opportunity for improvement.

How to Make Progress in Healthcare Finance

Behind every delayed claim, incorrect bill and unclear statement is a deeper problem: disconnected data. Solving these challenges is not just an operational need — it’s a financial imperative for healthcare organizations. As I reflect on all that has occurred in healthcare over the past year, I keep coming back to the same conclusion: There is a shared desire for a system that works.

Our industry is fueled by hardworking individuals who want to improve care. But they are dealing with data scattered across disparate systems, legacy and modern tools, and non-interoperable platforms. Payers need access to centralized, meaningful data to simplify their jobs and better serve members. Payers and providers both need a partner who creates healthcare financial solutions that benefit them and the healthcare consumers they serve.

They need a technology partner who can turn the fragmented financial experience into one integrated system. By focusing on collaboration and thoughtful solutions that address more than one problem at a time, we can ultimately address the needs of healthcare consumers.

The good news is that progress is not just possible — it’s happening. When we think about progress in healthcare, we generally imagine clinical advancements. But here’s the thing — not every breakthrough in healthcare is clinical. There are innovations, ideas and collaborations happening every day that are moving the needle toward a modernized, seamless healthcare financial experience.

We have a clear choice in front of us. Do we stand still, or do we move forward?

Defining “Forward” in Healthcare Finance

“Forward,” for us at Zelis, means making tangible progress in improving the healthcare financial experience for all. We believe problems need to be solved at their root, ensuring every new solution addresses the core issue — and doesn’t create new problems.

We believe the only way forward is to do things differently.

For Zelis, forward looks like:

Healthcare transparency data that works

Forward means believing in the vision behind price transparency; we are committed to making it real. We’re intelligently and responsibly using data to inform directories, improve accuracy, lower costs and prepare clients for the current administration’s focus on price transparency. With our acquisition of the assets of Medxoom, we’ll give health plans and TPAs the option to deliver a mobile-first solution that leverages existing price transparency data and provide more effective member experiences that comply with evolving healthcare regulations.

Transforming provider workflows and payments

Forward means integrating provider directory and price transparency data into provider workflows. This will enable providers to make recommendations that best benefit patients and lower costs.

And on the payments side, our expanding ACH+ payments network will increase electronic payments through a platform providers value—meaning less inefficiencies and better relationships between payers and providers.

Responsibly using GenAI in healthcare pricing

Forward means using AI-driven insights to revolutionize healthcare pricing by using large language models (LLMs) trained in policy information. It’ll improve efficiency by automatically detecting changes in plan designs and regulatory rules — a process previously managed manually. This frees people to focus on tasks that require human expertise.

Building a member-first financial experience

Forward also means accelerating pricing solutions that help members. Last year, we introduced Zelis Health Bill Assist for out-of-network medical bill assistance, a solution that helps members understand and navigate balance bills.

A Call to Action: Moving Healthcare Forward

We’re all aware of the complex healthcare system we inherited, and the reality is that it’s not going to change overnight. But, to quote the ever-inspiring Robin Arzón, “forward” is a pace — a pace we can set together.”

You’ve probably heard the mantra “one percent better each day.” The idea is: if you push your pace one percent more each day, you’ll be 10 percent stronger after 10 days, 50 percent stronger after 50 days, and so on.

I encourage everyone in the industry to identify what “one percent better each day” looks like for you and your business. Where can you get started on your own, and where might you need a partner’s help?

Together, we can create a healthcare industry where financial systems support care — instead of hinder it — and where every innovation serves the people who depend on us the most.

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We love a challenge – and welcome collaboration. Bring us your biggest healthcare financial frustration or learn how to optimize what’s already working. Contact Us.