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.
In my last blog, I talked about what we at Zelis see as the big three trends for 2022: the impact of new regulations now in force, innovation in payments, and the way new technologies can help put healthcare consumers back in control of their healthcare journey.
I also talked about how we truly believe there is a better way for people to manage their healthcare journey, and how the industry can come together to transform the way our country pays for care. By putting the healthcare consumer – or member – at the center of their healthcare journey it can help remove the pain points that exist in the system today.
We call this Member Empowerment.
For this blog, I asked Michael Axt, Chief Member Empowerment Officer, three questions about Member Empowerment and how he sees the future for healthcare consumers.
Before I share Michael’s input let’s put this into perspective:
The persona of the member in healthcare and their role as the consumer is rapidly changing. All the actors in the healthcare marketplace are frustrated.
Two Key Trends:
- Increasing Health Care Costs: The share of the U.S. economy dedicated to healthcare spending hit a record 19.7% in 2020, up from 17.6% the year before.
- Increasing Patient Responsibility: Revenues paid by patients accounted for 35% of total provider revenue in 2017, compared to just 5% in 2005. Rise in HDHP (High-Deductible Health Plan): 46% of all insured adults are on a HDHP today.
Two Significant Opportunities:
- Increasing Digital Shopping: In 2020, 30% of patients found their primary care physician (PCP) through independent research, while 22% rely on their own research to find a specialist.
- Increasing Innovation in Payments: Electronic, contactless payments are fast becoming the norm in our daily lives – and that is a process we can and should aspire to for healthcare ‘shopping’ and a smoother financial experience.
The trends indicate that big problems are brewing (and have been for some time); they need to be fixed. The opportunities in the broader industry, when viewed through the lens of the member, provide us with the opportunity to put the pieces of this puzzle together.
Let’s get to the interview:
Michael, what’s the reason for using the term Member Empowerment rather than say, Member Experience?
We were intentional about selecting ‘empowerment‘ because this is about empowering the member across their healthcare journey. The goal is to empower every member, so they are more informed and able to execute on that information as they navigate their healthcare.
We aim to do this by fundamentally enhancing the information they receive – how much, and when – and with that information they can make better decisions. This is about the complete education from decision to transaction – that’s more than the experience – that’s empowering them and putting them in control of their healthcare decisions.
Why is Zelis the right company to solve member empowerment?
I love this question! There are so many details but there are two big things. The first one is capabilities. Zelis is embedded in the healthcare ecosystem and in the thick of the infrastructure. That helps us to execute on all the transactional components of Member Empowerment, as we already have the parts, and we’re already in there doing the work. Now, with the added capability of Sapphire – an extraordinary company with a comprehensive, integrated healthcare consumer shopping and navigation platform, along with a team of industry experts and pioneering technologists – we can engage with the member and facilitate the beginnings of that shift.
The other reason that Zelis is the right company to advance Member Empowerment is the Zelis spirit and DNA – we grew up with entrepreneurs building this business. We recognize it’s a big vision and we have a real dedication to innovation, making a difference, and driving change across our business and the industry. Our company was founded on the belief that there is a better way to determine the cost of a healthcare claim, manage payment-related data, and make the payment – that one holistic approach is needed to transform a pain into a payment.
I’m so excited by this as there isn’t another company out there that can do this as well as we can.
What can we do today and in the near-term for our clients’ members?
Lots! This is the very essence of our vision and mission when it comes to delivering for members. By meeting the member at each stage of their journey, providing a venue for them to navigate their benefits, healthcare choices, financial responsibilities, and payments, we will create meaningful relationships between payers, members and providers that will be the catalyst to reduce pain points and deliver cost savings.
We have four pillars in our solution:
- Navigation, Transparency, and Access: that is search, shop, and schedule
- Member Communications: enroll, estimate, and explain
- Member Advocacy: negotiate and pay, verify, validate, and save
- Member Payments and Financing: pay and assist
Healthcare is personal and emotional for all of us – we are working to remove the excessive costs and increase member satisfaction and engagement. For the member we would like to help remove the uncertainty and restore trust. We know that care avoidance due to high costs and complicated processes is a reality for many people. This shouldn’t be the case for anyone in a modern society. This is one of the reasons I personally feel so strongly about Member Empowerment. We want to change the way this country pays for care.
The Wrap Up
I really like talking with Michael about Member Empowerment because of his passion for the topic; he energizes me and the team. I know all of us at Zelis work for the company because we believe in a better future, and each of us wants to be part of that future.
To hear more about Michael’s perspective, listen to this recent podcast with HIMSS Media.
The addition of the Sapphire team was a real highlight for us last year and we’re delighted to have the team onboard as we can now complete the entire cycle. This is a serious game-changer and one you’ll hear more about as this is a critical part of our 2022 focus. This is a big moment for us and our friends across the industry.
Until next time, stay well and thanks for reading the blog today!
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