By Amanda Eisel
Amanda Eisel has focused the last 20 years of her career at the intersection of healthcare and technology. She has been deeply involved creating and scaling multiple growth technology companies including Waystar, Applied Systems and Viewpoint. Amanda has been a member of the Zelis team since 2019, playing a leadership role across Zelis’ growth, operational and talent strategies. Amanda started her career at McKinsey & Company, where she spent nearly a decade advising consumer companies. Prior to Zelis, Amanda was an Operating Partner at Bain Capital focused on technology and healthcare IT companies.
Organizations cannot be complacent (or worse, cynical) about how consumerism will continue to drive disruption via governmental and market pressure. The waves are building. Be sure your boat is ready to surf them.
There’s a video that circulated social media recently showing a modern journey across the Drake Passage to Antarctica. It’s intense: waves crashing against the window of the boat, the vessel getting tossed sea to sky. The person with the camera is safe, and the destination is known, but the trip is unrelenting.
What a fitting metaphor for what our industry has been like in the past year.
We are seeing the most healthcare regulation we’ve seen since the Affordable Care Act in 2015. If the industry has learned anything in the last two years, it’s that we need to stay nimble in the face of the perfect storm of societal pushes, regulatory changes, technological advances, and economic pressure. But here’s another thing that I learned about the Drake Passage trip that also applies here: it’s not always rough seas. Sometimes, the ocean is calm, the sailing smooth. Preparation for the worst, however, is essential.
Here’s my warning call: Organizations cannot be complacent (or worse, cynical) about how consumerism will continue to drive disruption via governmental and market pressure. The waves are building. Be sure your boat is ready to surf them.
Sea Change is Inevitable
Americans are increasingly interested in healthcare price comparison as high-deductible health plans (HDHPs) continue to put more financial responsibility in their hands. Indeed, with 28% of the employed population on a HDHPs of which 61% are carrying significant medical debt, the high tide of price sensitivity is coming. As a result, we’ve seen governmental interference through the No Surprises Act and Transparency in Coverage Rule and prescription pricing changes included in the Inflation Reduction Act fundamentally change out-of-network markets. Ultimately, pricing will continue to be a hot trend as consumers seek more value across the continuum with inflation making wallets tight.
We’re also seeing an increase in market competition for healthcare providers amid labor shortages, increasing investments by payers in member experience tools, and more demand for transparency from consumer-members — and it’s all moving at a speedy clip.
It’s no surprise to see that the title of this September 2022 McKinsey report on healthcare is titled, “The gathering storm: The transformative impact of inflation on the healthcare sector.” (One I urge you to read). Their latest analysis puts the annual U.S. national health expenditure is likely to be $370 billion higher by 2027 due to the impact of inflation compared with pre-pandemic projections.
Our post-quarantine world has brought changes that will not disappear. Consumers want to be digitally engaged and captaining the ship of their healthcare experience. Regardless of what naysayers point to — a tech generation gap, pricing difficulties or historically disengaged patients — we will not return to what the industry has looked like for the past decades. Insurers will need to evolve in the ways they direct members to high-value care, while providers need to think about how to proactively attract consumers.
Additionally, increased attention on the importance of mental health and an increased awareness of Social Determinants of Health (SDOH) brings pricing parity into view. A federal initiative for equitable healthcare as well as payers’ interest in leveraging patient data to drive personalized guidance calls for organizations to be even more thoughtful about how to apply data in ways that will drive better outcomes. Organizations that can’t publish data, won’t upgrade technology or expect consumers to come to them for answers will fall behind.
Integration Weathers the Storm
But I don’t want to be all doom and gloom here. The greatest storms are also the biggest opportunities for companies to prove their mettle.
The answer to avoiding business disruption during all this change is to maintain a focus on speed-accelerating productivity improvements, reshaping portfolios, innovating new business models to refashion care and reallocating constrained resources. Players who consider value-driven integration and consolidation of platforms aimed at reducing friction could set themselves up for success in the coming years.
For Zelis, this means very thoughtful and thorough integration of the new capabilities we’ve acquired in 2022, from solution offerings to client success processes to talent. It was a big year for us in terms of bringing some “best-of” solutions into our portfolio, most recently from Payspan and Payer Compass. Next year needs to be even bigger, launching solutions focused on: empowering plan members through personalized pre-service guidance, rewards-based incentives through advanced benefit communications, and post-service advocacy aimed at helping the roughly 55% of Americans facing significant medical debt despite having insurance.
It also means considering both our technology investments and data strategies. On the former, we are expanding the use of artificial intelligence within our claim integrity operations and advancing the development of the Zelis Advanced Payment PlatformSM which brings together member enrollment and communications, an expansive provider network for e-payments, seamless payments from payers to providers and members to both payers and providers.
On the latter, this past year we embarked on a journey to drive more value for the healthcare system with the scale and robustness of data. We have designed and plan to launch a new set of distinctive analytic solutions to increase price transparency and network optimization for payers, which further enables them to support members in choosing the best care.
I like to view Zelis as the platform that positions our clients to stay ahead of the waves of continuous and impending change, to surf them successfully. We accomplish that by efforts like those I have mentioned (and many more to come!), and I’m so proud of the progress we have made to modernize the business of healthcare in the short time that I’ve been at the helm.
I am excited Zelis is a part of this journey with you. Best wishes in the new year.