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.
Happy New Year! I sincerely hope you had a wonderful holiday season – I think we all needed a moment to pause and reflect on what really matters!
Our team is looking at a few major trends for the industry in 2022, building on the big events of 2021.
Firstly, the new No Surprises Act (NSA) and the Transparency in Coverage (TiC) Rule regulations. Compliance has been our priority, and we have quickly responded across the industry. Still, the benefits to be gained through increased transparency and member empowerment and the processing of costly out-of-network claims are extraordinary. These are the most impactful pieces of legislation in the healthcare industry in the last decade. It’s a big deal and one that we are very excited about to address rising healthcare costs in our country.
Secondly, the payments industry is evolving at record speed, with over 50% of US consumers now using mobile wallets like Apple Pay to make payments. Electronic payments create efficiencies and cost savings in every industry. Healthcare has typically been behind, but we believe that we will continue to help change that this year, for consumers but also payers and providers.
And thirdly, COVID-19 has driven all of us – as healthcare businesses and as healthcare consumers – to think much harder about how we can use technology. There are so many examples of innovations in technology in the last two years. New and enhanced consumer purchase and payment capabilities are set to seriously change the way we operate.
These trends are challenging us to think about what is possible given the unprecedented amount of data and information that we will have in the future. So, here’s my take on how Zelis is thinking about 2022.
On readiness for the impacts of NSA and TiC, the Zelis team has been busy for the past several months making sure our clients were ready for January 1 compliance. Protecting patients from surprise medical bills and the costs of out-of-network care has been an important step for the industry overall. TiC will ensure that prospective patients (members) have better insights into the cost of services before obtaining care and getting billed in the future.
The new requirements are adding some complexity to claim processing and administration. Still, the benefits to be gained through increased transparency and member empowerment, and in the processing of costly out-of-network claims, are extraordinary.
We are fortunate to have a team of legislative experts to help understand the implications and guide our clients and partners to manage these changes. We’re working on multiple solutions, including machine-readable files, ID cards, enhanced member communications, provider directories, pricing negotiation tools and deeper, more meaningful analytics.
When I think about payments, I am genuinely excited about the innovation taking place in the broader payments industry. There is so much happening in payments, and it’s crucial we see these improvements integrated into the healthcare journey and help drive the right infrastructure and platform to help this highly dynamic and complex process. Electronic, contactless payments and straight-through processing make such impacts on our daily lives – and that is a process we can and should aspire to: for healthcare ‘shopping’ and ‘transacting’ to be a smoother financial experience for all those involved in the transaction.
I have often thought about why the healthcare payments process has become so complicated and wondered how things have become such a pain. I tend to compare it with the other purchases I make and find myself shaking my head that the system is like it is.
The time has come to give the power back to the consumer, like in most day-to-day purchases – think about that recent online purchase early in the morning or late at night – and yes! the healthcare payments process can absolutely get to that level of ease.
And this leads nicely into how we at Zelis are thinking about agency and empowering the member (otherwise known as the patient or consumer). We have a new business unit dedicated to this. Their entire purpose is to put the consumer in the driver’s seat with a full understanding and capability to navigate the healthcare financial system.
By building (or buying) differentiated technology, we can provide connected solutions to deliver a seamless, end-to-end healthcare payments experience.
Leveraging new technologies against the backdrop of new NSA and TiC legislation, we believe there has never been a more appropriate time for healthcare consumers to be back in control of their healthcare journey.
In November last year, Zelis completed the acquisition of Sapphire Digital, an incredible company, with a comprehensive, integrated healthcare consumer shopping and navigation platform – along with a team of industry experts and pioneering technologists.
Both Zelis and Sapphire have been tackling some of healthcare’s greatest challenges, and this is the first step in a vision that brings together technologies that are out there to help members make more informed decisions on their care.
We know healthcare consumers are frustrated. We seek to remove the burden on them to understand, navigate, and address the 35% of out-of-pocket medical expenses not covered by their benefits. Empowered members are more engaged in their healthcare journey – an informed and supported member who is aware of their options is more confident they will achieve positive outcomes.
The Wrap Up
We know there is a better way. New regulations, advances in payments and technologies with the end goal of empowering the consumer are important parts of how we work together to transform the way our country pays for care. We call this Member Empowerment – more on that next time I write.
Thanks for taking the time to read my first blog of the new year – I wish good health and happiness to you and yours in 2022!