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 Brian Zimmerman with Becker’s Hospital Review to discuss how to strengthen payer provider relationships in a way that supports more timely payment, the benefits of a multi-directional payment solution, and more.

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

Understanding current relationships

To gain a holistic understanding of the current state of payer provider relationships, it’s important, for payers especially, to understand the level of imbalances within the system.

Take, for instance, a doctor who manages their own practice. We’ll call this practice ABC Primary Care.

ABC Primary Care interacts with over 50 different payers, has no IT department, manages their own phones, and handles patient care.

As you can imagine, what ABC needs is going to look a whole lot different than a provider of much larger size.

Payers need to understand the provider-specific hoops ABC jumps through in order to get their payment in a way that works for their particular accounting systems and billing processes.

It’s for that very reason that payers should make a move toward investing in solutions that solve for both the payer and the provider. That one small step will, over time, lead to more efficient and complete payments and cost savings for everyone across the industry.

Multi-directional payment solutions

In healthcare, we often have a tendency to look at just one connection point and solve for the actor that’s involved in creating that solution.

A payer will solve for the challenges they have surrounding the cost of provider payments. Or they may solve for their reimbursement process friction points.

But that’s just not working.

The key is to find a way to tie all the different payer, member, and provider points together in a multi-directional platform.

In a healthcare organization where a fully integrated multi-directional payment solution is available, a patient could have access to one healthcare financial account where they could see:

  • Provider payments
  • Health plan payments
  • Paid incentives
  • Accumulators
  • Co-pays
  • Health plan enrollments
  • And their overall financial picture

The wrap up

The biggest challenge facing the healthcare industry today is patient engagement. But the solution is relatively straightforward: take away the confusion surrounding financial status. (Which, we know, is easier said than done.)

Several pieces of the member engagement puzzle have been executed successfully, but until each healthcare organization takes the time to really “pull it all together” for the member, current challenges will only increase.

If you’re interested in discovering how Zelis can support your organization’s shift towards a multi-directional payment solution, contact us here.