“Digital Health” is often centered on EHRs and Meaningful Use to the detriment of many other technologies that can help improve patient satisfaction. To help make sure that we don’t forget how useful modern technologies are to actually getting paid for medical services, I invited Jay Fulkerson, president and CEO of Health Payment Systems (HPS), to take us through the most important issues surrounding claims and payment tech. Prior to his role at HPS, Fulkerson served as chief executive officer of Touchpoint Health Plan (which was acquired by United Healthcare) so he knows the payment space pretty well. Here’s what Jay had to say about the power of health claims technology:
Technology has driven many important changes in healthcare delivery over the years, and now it’s tackling healthcare billing. The current processes are often messy, confusing and wasteful, but like EMR revolutionized medical records, claims technology has the potential to revolutionize payment. Today’s technology can streamline the payment process, close existing gaps or delays, and better connect its components. Here are some tips for harnessing these emerging technologies:
What claims technology can do
- Technology can now combine all medical bills into one monthly statement for the entire family. It includes the family’s medical claims, from multiple healthcare providers, and helps patients review their monthly out-of-pocket healthcare expenses in one, easy-to-understand format, similar to a monthly credit card statement.
- Today’s claims technology allows quality leaders to gather de-identified claims data into a centralized data warehouse that can drive further improvements in benefit delivery and care delivery. It overlaps with other technology efforts related to EMR, health informatics and clinical business intelligence.
- Advances in healthcare technology now let patients track how individual hospitals and doctors rate on cost, quality, and by procedure. This kind of transparency is what people expect when they shop for big-ticket items in any other industry. They compare prices at multiple places to make sure they’re getting the best deal. Technology now gives them that option in healthcare payment too.
- Care is increasingly delivered through an Accountable Care Organization (ACO) or other large in-network affiliated provider group. As coordinated as those organizations are when it comes to delivery, it often isn’t reflected in their billing processes. So, patients are left with a confusing assortment of bills from facilities and providers they may not even remember visiting. Technology synthesizes those claims—one bill for the patient, one claim number for internal billing offices and HR managers.
- More and more patients are paying claims through online portals, tracking their claim information with smartphone and tablet apps, and proactively comparing expected costs from individual providers. What are you doing to give them those options?
How you can use it
- Consider technologies that can “overlay” current business office systems without requiring a specific software change.
- Look for software that allows the provider and third-party administrator (TPA) to connect electronically, simplifying the adjudication of a claim and resulting in a single electronic payment of both payer and patient portions of a claim. This improvement drastically reduces a provider’s risk of bad debt.
- Explore the uses of Competitive Electronic Marketplaces. Instead of a provider-centric system based on paying billed charges calculated after-the-fact, Competitive Electronic Marketplaces (CEM™) bring buyers and sellers together through an interactive, transparent online auction process, similar to the eBay model. For medication benefits, for example, patients can select the option that best fits their pharmacy needs from a price list of competing providers after inputting the necessary prescription information from their physician. It puts the consumer in control by allowing them to choose the brand name and cost, while safely tying results to doctors’ prescriptions.
- When determining where to invest in payment technology, ask yourself two key questions: Does this simplify our patients’ lives? Can it save our patients (and us) money? The best solutions can answer yes to both.
Why it’s so important
- In one test case, an average family of four received more than 120 separate bill-related pieces of mail within 5 months. Claims technology streamlined that to 1 per month.
- Much of healthcare IT focuses on the patient’s stay or visit, but studies also show that patient satisfaction drops about 10% after receiving a bill because of the waste and confusion involved. Applying user-friendly payment technologies can help change that.
- The right technology fosters knowledge and engagement among patients, which creates greater understanding and control and, in turn, leads to smarter healthcare consumers.
- Payment technologies also help support the “Population Health” approach toward which the healthcare industry is moving. The latest claims tools and reporting metrics—like consolidated billing and Competitive Electronic Marketplaces—help provide an accurate, thorough picture of a patient population’s overall health claims and can further be customized to that population’s particular needs.
- Younger patients, who are used to operating in a high-technology world, expect to be able to use technology to access information. They expect mobile capabilities. In a traditional healthcare payment environment, those patients must bring in paper to HR, try to pull together a number of sheets, determine in what order they were processed, etc. Technology saves time and headaches by making it much easier to access all the information in one place.
- Because technology is putting more power in the hands of healthcare consumers, it’s opening the doors to larger discussions about payment improvements in the healthcare industry.
While many technology professionals focus on the daily ins and outs of maintaining and advancing their systems, there comes a time when an entire industry must heed a call for large-scale change. We’ve reached that point in healthcare payment, and technology is leading the way toward valuable solutions for patients, employers, providers and payers alike.