As healthcare volumes ramp up post-pandemic, legacy payment processes create friction for providers and patients – and they are looking to payers to modernize these platforms.
Claims can easily become a focal point for consumer frustration and erosion of trust.1 Even if an interaction has otherwise gone well, a bad payment or claims experience can cause members to view their provider in a negative light. As a result, providers see outdated processes as a threat to their practice in an increasingly competitive market, creating challenges for payers that haven’t upgraded to modernized payment systems.1
Health plans committed to improving provider satisfaction and consumer experiences are moving to next-generation payments platforms that:
- Support digital transformation
- Reduce resource use and employee burnout
- Allow providers to spend less time on claims and more time on care.
Reducing provider burnout is urgent as industry-wide labor shortages continue and workloads increase. Following the pandemic, the industry saw a 28% increase in medical care volume and a 9% rise in dental care volume.2
This increase in demand, coupled with the shortage, led providers to hire less-experienced employees at higher salaries and to a 15% increase in direct administrative tasks among providers.2
Last year, about $60 billion was spent on nine common administrative healthcare tasks, up from $18 billion in 2021, a report from the Council for Affordable Quality Healthcare found.2 These tasks include eligibility and benefits, prior authorization, claim submission, attachments, acknowledgements, coordination of benefits, claim status inquiries, claim payment and remittance advice.
As a result of these inefficiencies, 70% of providers are seeking payment and claims management solutions that reduce administrative burden and increase transparency.1 Although the industry has increasingly embraced automation over the past 10 years and has realized savings of $187 billion annually, it can go even further. Moving to fully electronic transactions would save almost $25 billion, CAQH estimates.2
Patient and provider experience
Electronic, streamlined and transparent payment processes, with omnichannel communications, are also key to providing the type of experience both patients and providers have grown accustomed to in other industries.1
Fifty-two percent of providers recently surveyed by Forrester said a poor overall patient experience has a negative effect on both care and retention. Meanwhile 47% and 44% said financial process errors and workforce shortages, respectively, hurt their ability to deliver high quality care.
A modern payment process should aggregate claims, health plan and payment data to build comprehensive member profiles that help providers and patients understand their responsibilities. It should allow members to freely access information on the healthcare financial process. This will also free up time for providers struggling with staffing shortages.
Finally, payers should ensure their platforms proactively flag and evaluate billing and banking errors to reduce overpayments, fraud and provider abrasion down the line.
Optimizing the payment process
Despite clear examples of positive customer experience from other industries, more than half of providers in the Forrester survey said claims and payment processing delays are having a negative impact on their business. Half said claims reviews lead to reduced payment with little explanation.
Health plans can do better.
By implementing a next-generation payment platform, payers can manage payments and communications in an integrated portal, reducing both costs and provider workload. Streamlining payments, claims and remittances processes will make digital adoption an easier ask for providers and will in turn improve provider satisfaction with the health plan.
Meanwhile, patients – who now choose providers based on experiences in addition to care quality – will experience a smoother, more transparent payment process, similar to what they see in other industries.
As competitive pressures increase and healthcare utilization continues to grow, it is urgent for payers to take the next step toward more efficient, more effective payment processes.
Zelis brings payers closer to this goal with the Zelis Advanced Payments Platform (ZAPP). ZAPP helps improve provider relationships, streamlines operations, keeps information secure and positions organizations to be a model for the modern healthcare experience. Learn more about ZAPP here.
- Phelps, N., Stutzman, E. The Importance Of Reducing Friction In Healthcare Providers’ Financial Journeys. Forrester. May 2023. https://www.zelis.com/white-papers/the-importance-of-reducing-friction-in-healthcare-provider-financial-journeys/
- 2022 CAQH INDEX® A Decade of Progress. CAQH. 2023. 2022-caqh-index-report.pdf