Roads? Where we’re going we don’t need roads!
Unless you’ve been living under a rock for the last five years, we’re sure you’ve noticed that the healthcare landscape is changing. Dramatically. Sparked by the pandemic and fueled by trends like value-based care, data analytics, telehealth, and artificial intelligence (AI), healthcare is experiencing innovation like never before.
Here are just a few of the current trends to watch:
Act I: Back to the Future
A transition to value-based care
The goal of value-based care is to improve patient outcomes and quality of care while controlling costs. This is a large shift away from the traditional fee-for-service approach.
In a traditional fee-for-service model, healthcare providers are paid based on the number of services they deliver, regardless of patient outcomes. And while we always like to think the best in people, this model could incentivize providers to offer more treatments, tests, and procedures to increase their revenue.
Value-based care, on the other hand, rewards healthcare providers based on the quality of care they deliver. This transition encourages healthcare organizations to prioritize preventive care, patient satisfaction, and better health outcomes.
Data analytics and predictive modeling
Data analytics involves using advanced software and algorithms to analyze large volumes of healthcare data. And, you guessed it, it’s rapidly becoming a critical tool in adjudication as it helps insurers and providers identify patterns, anomalies, and trends in claims data. Think: flagging unusual billing patterns that might indicate fraud.
Predictive modeling, a subset of data analytics, uses historical data to forecast future events. In healthcare adjudication, it can be used to predict which claims are more likely to be legitimate and which ones might require closer scrutiny. Think: identifying over billing or unnecessary medical tests.
Blockchain and data security
Simply put, blockchain technology is a decentralized and highly secure digital ledger that can record and protect sensitive healthcare data. As such, it is being explored to enhance data security in healthcare adjudication to ensure patient data remains private and unaltered.
But blockchain’s immutable nature also makes it challenging for unauthorized parties to access or tamper with healthcare data. This reduces the risk of data breaches, leading to greater trust among patients, providers, and insurers.
Advanced technology and automation
Technology-powered systems and trained algorithms can quickly analyze claims, check them for accuracy, and make decisions based on predefined rules. This streamlines the adjudication process and reduces the need for manual intervention. AI can also assist in fraud detection by flagging suspicious claims for further investigation.
Act II: Brace for Impact
Sometimes there’s no way to prepare, all you can do is brace for impact. Luckily, that’s not the case here.
While the trends mentioned above are certainly about to shake things up, you’re already on the right path to ensure your organization stays ahead of the curve. And, newsflash, there are about to be a whole lot of opportunities for you, so get excited.
Here’s the lowdown on the revolution:
Less hassle, lower costs
Automation and efficiency are the new buzzwords. Less paperwork, fewer errors, and reduced administrative costs mean savings for both payers and providers.
A better member experience
Efficiency isn’t just about speed; it’s about providing a smoother journey for everyone involved, especially members. When claims are handled swiftly and accurately, members can focus on their well-being, not paperwork. Enter: a more member-friendly system.
Spotting mistakes and fraud
Thanks to data analytics and predictive modeling, healthcare organizations are getting really good at catching mistakes and fraud. That means members only pay for the stuff they should, and payers won’t get tricked into covering things they shouldn’t.
Act III: The Power of Partnerships
At Zelis, we have a bold vision: to revolutionize the healthcare landscape by creating a simple, intelligent platform that bridges the gaps in the healthcare financial system and aligns interests across payers, providers, and healthcare consumers.
But how does it all work?
Streamlining Claim Workflows
Our partnerships and integrations are a big deal for making claims work better. Here’s why:
- No more “oops”: We’ve automated key processes to kick human error to the curb. Meaning: smoother, error-free operations and fewer bumps in the road.
- Consistency is king: Our system is designed to be so smooth that there’s no need for manual workflows.
- Scaling up, no sweat: Our platform can handle a massive amount of claims without you lifting a finger.
- Reconciliation made easy: We’ve built reconciliation right into our interfaces. Your monthly billing activity reports are just a click away, helping you stay on top of your financial game.
- Flexible and low maintenance: Say goodbye to the days of dredging through custom code, and hello to more free time.
- Your way, your workflow: We give you the freedom to customize during implementations. That means your unique needs and workflows are seamlessly integrated.
- Expert support: Our team is a bunch of pros. They’ve got your back, so you don’t have to sweat the maintenance stuff.
In fact, in a recently released report by KLAS, Payment Accuracy & Integrity Solutions 2023, Customers gave Zelis the highest overall score, specifically noting our “affordable, easy-to-use interface”, “integration with core claims systems”, and outcomes such as “cost savings, fewer billing errors, and explanations of edits.”
Act IV: That’s a Wrap
Efficiency, accuracy, cost reductions, and putting patients first – that’s what’s on the horizon. But here’s the deal: to ride this wave, you’ve got to stay in the know. The healthcare game is evolving fast, and you don’t want to be left behind.
The main takeaway? Stay in the loop!
Keep your finger on the pulse of industry news, and think about how these trends might shake things up in your corner of healthcare adjudication. Whether you’re a claims pro, a healthcare provider, or a patient, these trends are making healthcare smoother and smarter.
Want to see how Zelis is keeping up with healthcare adjudication trends? Connect with us.