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.

The healthcare industry is moving towards a patient-first strategy, but in order to provide a more unified member experience, healthcare organizations must rethink the provider payment journey across the continuum of care.

Zelis Director of Business Solutions Leah Silver joins Brian Zimmerman with Becker’s Hospital Review to kick off a series surrounding the provider payment experience. In this episode, Leah details the typical provider payment experience as it stands today, as well as how (and why) it’s changed in recent years.

We’ll discuss the highlights below, but you can also listen to the full podcast here:

Let’s get started.

Providers are looking for innovation. Traditionally, the healthcare experience, as it relates to payments, is a bit antiquated.

Payers typically pay through two modalities: automated clearing houses (ACH) and paper checks. In fact, as recently as February 2022, healthcare providers were still receiving paper checks for 68% of their payments. This often occurs regardless of whether said providers are also utilizing ACH methods.

The result? An increase in administrative burden and corresponding manual-based work.

Our end-goal as an industry should be patient care. That’s why it’s so important to ensure organizational workflows are as streamlined and digitized as possible, especially when it comes to payments.

Recent data from the National Automated Clearing House Association (NACHA), which manages the development, administration, and governance of the ACH Network, shows nearly 37.4M healthcare claim payments were made to providers by ACH in March 2021, the most ever in a single month. The value of those payments, more than $171.3B, is up 13% from a year earlier.

But those payments traditionally go out to the more high volume, in-network providers, leaving the “mom and pop shops” to default to checks. Which means smaller providers must look for alternative solutions in order to actually receive payment.

And those alternative solutions can be pricey. Each manual payment costs providers approximately $2 more than an electronic payment.

What’s driving the push for digitization?

The mass migration towards a digitization of payments is directly due to the search for innovation. Health systems consider digital capabilities a path to fundamentally transform their relationship with consumers.

Over the last two decades, many healthcare organizations have adopted digital technologies across various functional areas. But the COVID-19 pandemic significantly accelerated these efforts. Virtual health and care delivered in the home became not only a necessity but a preference. The pandemic also hastened several other trends, including shifting consumer preferences, rapidly evolving technologies, newer talent models, and clinical innovation.

What are some benefits and challenges?

Payers traditionally think about payments in two categories: the traditional bank ACH and the check. Meaning: plans will have an in-house ACH offering, ACH vendor partnership, traditional direct deposit methods, or paper-based check solutions.

The challenge? Many have hit a plateau as it relates to electronic adoption. Providers with less payment volume are typically left out of the mix when considering electronic payments, negatively impacting payers, as well as smaller providers.

When payers make the transition to a partner with additive value solutions, they get an increase in provider satisfaction. Why? When you institute a multimodal solution, your organization is able to allow providers to pick and choose what option best meets their needs. And if you’re offering more options, providers are going to have better (and more frequent) payment timelines, as well as less balance billing.

The bottom line? Once you implement digital solutions, you’re providing more value for your memberships.

The Wrap Up

Healthcare can be a pricey industry. That’s why it’s so important to take advantage of, as well as spearhead, industry shifts to drive down cost as much as possible for healthcare constituents across the provider payment experience.

If you’re interested in finding out how Zelis can help you digitally empower your members, click here.