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.
“If you want to go fast, go alone. If you want to go far, go together.” — Steve Jobs
If you’ve been reading our news lately, you’ll know that we’ve been busy accelerating our purpose to modernize the healthcare financial experience for all by way of acquisition (in addition to our investment in optimizing and expanding core capabilities, of course).
This is crucial work, as healthcare costs continue to rise while the financial system continues to lag. In fact, the US Centers for Medicare and Medicaid Services projects spending to increase about 5.4 percent per year to reach $6.2 trillion by 2028, with hospital expenditures growing faster in 2019 (6.2 percent) versus 2018 (4.2 percent). But for all those increases in cost, 1 in 3 healthcare consumers report dissatisfaction with patient billing processes.
Today, I’d like to unpack our acquisition strategy a bit. I’ll say it outright — Zelis is not interested in merely being acquisitive for market share. We’re deliberate about our investments because we’re uncompromisingly committed to transforming the business of healthcare.
I couldn’t be more excited that we’ve recently welcomed three companies who are all equally as committed. Each brings something special to our connected platform, and in this blog, I’ll explain how, with our powers combined, we’re delivering more value for our clients and the healthcare system more broadly.
First, a little history lesson. Zelis has a legacy in claims cost management, having been founded back in 1995 as Stratose where we initially focused on wrap network services and later added out-of-network services, claims editing, bill review, and audit services in the early 2000s when we acquired phx. Over the next twenty years, we continued to add to our network capabilities both organically and by acquiring Strenuus and Truven Health Analytics in the 2010s.
Simultaneously, the healthcare payments market was evolving, and we saw an opportunity to deliver efficiencies on both the claims integrity aspect of a claim and the actual delivery of the payment. When RedCard became part of Zelis in 2019, we achieved the goal of delivering value on both sides of the claim equation — to the tune of billions of dollars in savings since our founding.
Many companies would stop there. With these solutions, we’re already helping roughly 80% of the payer achieve efficiencies and cost savings.
But Zelis is different. Every single one of us, from our amazing investors to our incredible staff, wakes up thinking about a better way. It’s our job as industry leaders to bring purpose-built capabilities together to make that better way a reality.
Recently, our illustrious Chief Revenue Officer, Patrick O’Keefe likened this strategy to the iPhone.
“In the ‘90s, people were all walking around with point solutions in various pockets and bags, from pagers to those boxy mobile phones and wrist watches, until the iPhone put all those capabilities together into a single platform.” — Patrick O’Keefe, Zelis Chief Revenue Officer
Through these recent acquisitions and our existing roadmap, I like to see Zelis as the iPhone for the healthcare financial system.
Recent acquisitions
Sapphire Digital
In 2021, we announced the acquisition of Sapphire Digital, a leader in member access, navigation, and care selection.
When we came across Sapphire Digital and realized its goal of “making it easier to find, understand, and access quality healthcare,” we knew we had met a company that could help us empower our payer clients to help direct their members to quality care at an affordable cost.
They’ve saved clients and their members tens of millions since inception.
Sapphire Digital’s platform uniquely engages members through dynamic incentives where members receive pre-approved discounts and rebates for selecting in-network care services. It’s a model where everyone wins, which is entirely aligned with Zelis’ mission. A match made in heaven.
This partnership perfectly aligns us to better support our clients’ compliance with legislative requirements, like the No Surprises Act and Transparency in Coverage rule as well as an empowered member experience with savings for all stakeholders.
We’re zealously considering ways our solution offerings can come together to help members throughout their care journey from initial care selection all the way through post-service advisement through an advanced EOB and member advocacy.
Payer Compass
Just last quarter, we officially welcomed Payer Compass to the Zelis team.
Dedicated to restoring rationality to the cost of care, Payer Compass was another company that “just fits” into the Zelis family. Payer Compass is one of the healthcare industry’s leading providers of reimbursement and claims pricing, administration, and processing solutions.
But don’t just take my word for it. One client recently shared, “What attracted us to Payer Compass was the fact that they price your claims themselves, in-house, and their non-adversarial approach to balance bills.” Through reference-based pricing, patient advocacy, balance billing, appeals services, value-based payments, care management, predictive modeling and analytics, and tools for provider search and price transparency, Payer Compass is able to cut through the complexity of healthcare pricing so their customers can experience quality, accessible care, and more cost-efficient care.
Quite the mouthful, but the gist is that they have complementary capabilities to our claims cost management solutions AND some effective software to boot.
The average in-network claims denial rate reported by HealthCare.gov was 14% in 2018, 17.4% in 2019, and 18.3% in 2020. That’s why we’re so excited about our continued journey to achieve next-generation payment integrity capabilities to manage rising healthcare costs.
Payspan
This one’s hot off the presses. Last week, we introduced Payspan as the newest member of the group of innovative companies we’re adding to the team.
Payspan is a pioneer of healthcare electronic payment and reimbursement automation services. They leverage their large healthcare payment network and flexible payment modalities to drive value-based care reimbursement, improve the patient experience, and reduce costs for health plans and providers.
In fact, based on a recent case study, Payspan has helped Kern Health Systems achieve more than a 99% adoption rate in 2016, 2017 and 2018 and increased the number of providers registered to receive e-payments from 965 in 2015 to more than 4,800 currently.
Like us, Payspan has been a key player in healthcare payments for decades. So, you can imagine, we’re very excited to work more closely together on a more seamless and expansive payment and communications experience for payers, providers, and members.
This partnership extends Zelis’ network of health plans, provider payees, and consumers, perfectly positioning us to generate even more savings for our clients, while driving additional value across the entire financial experience. Notably, it also doubles the payment processing volume of our combined organization, enabling providers to consolidate to their optimal payment modality across more payers.
Together, we will provide an omni-channel offering through the Zelis Advanced Payment PlatformSM that reduce costs, accelerates cash flow, and improves satisfaction across the board.
The Wrap Up
There are a lot of innovative, forward-thinking companies out there. But it boils down to one question, “Can the dog hunt?”
Many companies talk the talk, or, in other words, have “bark”. But very few companies continuously make large investments that demonstrate their dedication to a movement that transcends their organization, or, in other words, “hunt”.
Zelis does both. Where others see complexity, we see opportunity.
Acquiring companies is easy. Choosing those that best fulfill a big strategic vision, and then integrating them in a purposeful way takes grit. It takes foresight, a collaborative spirit, and deep dedication, the kind that all Zelots — including our newest members — have in their DNA.
Personally, I couldn’t be more positive about the way our strategy for the next chapter of Zelis is shaping up, or more grateful to the teams coming together so harmoniously to drive true transformation in this complex industry.
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Until next time, stay well!
