Kaitlin Howard

By Kaitlin Howard

Kaitlin Howard is a researcher and writer producing insightful content across the healthcare revenue cycle. She has written and produced content for Zelis, Waystar, and Recondo Technology, as well as agencies. With a B.A. in English and Writing from University of Denver, Kaitlin stays current on market updates on claims management and healthcare payments, publishing a regular educational blog series on industry trends and Zelis offerings.

Zelis Executive Vice President of Solutions Eileen Dougherty joins Laura Deruta with Becker’s Healthcare to discuss how the shift toward consumerization affects payers, how health plan leaders can best position their organizations amid these changes, and more.

As always, we’ll discuss the highlights below, but you can listen to the full podcast here:

Payer effects

Patient responsibility has increased by more than 30% since 2015, a trend that is blamed primarily on the rise of High Deductible Health Plans, which now account for more than 50% of all employer-based health plan coverage.

That’s not the only thing rocking the boat.

Higher pocket maximums have also escalated the member’s financial burden.

But that might not necessarily be a bad thing.

Costs have increased for healthcare in general (no secret there). As such, payers and employers now need members to make decisions that will drive down the cost of care.

Enter: a new need for consumer-facing solutions.

Meaning: Payers must make a major shift towards innovative, consumer-facing infrastructure. Which could be a big win for the healthcare industry as a whole.

Positioning for success

By looking for expertise on consumerization in other industries and bringing those subject matter experts and best practices into their own organizations, payers can gain a more holistic understanding of what works, what doesn’t, and next best steps.

But payers need to take it one step further.

They need to start thinking about how members think, what they need, how busy their lives are. Simply put, payers need to put themselves in the member’s shoes.

How often do you use your phone? On average, how many tasks must you do each day outside of work? What grabs your attention? Do you have a great memory or do you need a few little reminders here and there?

Health plan leaders should also look for vendor partners specializing in the consumer space that offer a specialized solution with a unified network that allows members to have even more information throughout their healthcare journey.

Preventing inefficiencies

Let’s take a minute.

Pause to think about how much you have going on in your life.

Think about your family, your living expenses, your daily existence, that to-do list that never seems to get done. Now, add in a healthcare visit.

It starts to get a bit overwhelming, doesn’t it?

In order to add enough value that a member truly wants to engage with solutions, payers need to offer a more universal and transparent view of healthcare.

Encourage more cost effective choices for care. Lay out costs before service. Build manageable payment plans for post-care. One-to-one solutions aren’t going to solve for the consumerization shift.

Patients are tired. Integrated payment and communication platforms across the payments ecosystem and healthcare journey are the only way forward.

Your vendor partner’s solutions should be cross-payer and cross-provider to drive transparency and efficiency.

The Wrap Up

Bottom line? Dismantling and updating the infrastructure that the US healthcare system has built over the last few decades won’t be easy. But there’s a light at the end of the tunnel.

The shift to a consumerization has been slow, but great leaps have already been made, and there’s only more to come.

If you’re interested in seeing how Zelis can support and streamline your organization’s consumer-facing innovation efforts, contact us here.