Talk To Your Health IT Clients About Payments — They'll Thank You For It

By Megan Williams, contributing writer

The work “leakage” haunts the dreams of many of your clients, and most commonly this is attributed to billing issues.

That thinking isn’t incorrect, but as this InstaMed report on payments, and our talk with Trusted Health Plan CEO, Thomas Duncan reveal, the true answer to cutting leakage is much deeper than cleaning up billing and aligns cleanly with your clients’ initiatives to center patients in their care processes.

Losses Due To Billing

According to InstaMed, of the $5 trillion that is expected to flow into healthcare by 2022, over 30 percent is expected to be wasted due to inefficiencies and a disjointed payment process, along with costs around paper-based billing and administration.

Unless the industry actively recognizes the role that consumer choice plays, along with the impact of the digital economy (data security and best practices primarily), costs will continue to increase. The report focuses on four specific points in trends around healthcare payments:

• A shift to consumer-centric care
• A demand for multiple payment channels
• The need to manage risk and data security
• Adoption of ERA/EFT (Electronic Remittance Advice/Electronic Funds Transfer)

A New Role For The Consumer

As payer payments drop, payment load is shifted to that of consumers in the form of co-payments, co-insurance, deductibles, and balance billing — consumer payments jumped a full 193 percent between the years of 2011 and 2014 in the InstaMed network. This means that providers will need to focus more resources on collecting payments from patients.

Payment Channels Diversifying

Providers will be met with increasing pressure to mimic payment structures that consumers are familiar with. This means moving away from the check via mail, and offering convenient options including credit card and automated and mobile payment technologies — much of which will need to be integrated with online portals.

ERA And EFT Adoption

The ACA has required since January of last year that all payers support EFT and ERA according to the act’s specifications. Payers are increasingly using these options and smart providers are accepting these types of transactions. The rate of use in the InstaMed network has jumped 169 percent between 2011 and 2014.

Increasing Security Challenges

As the industry responds with more flexible payment options, the already endemic data breach will likely become even more common, and providers and payers alike will have to work to prevent fraud and shield both their organizations and consumers from threat.

Challenges That Cannot Be Met Alone

While your clients might be overwhelmed by tackling such apparently disjointed goals, they can likely begin to address them by working with other stakeholders in streamlining the patient experience.

Duncan emphasized Trusted Health’s patient-centered approach — his organization devotes half its staff to positions that aid patients in navigating the increasingly complex health system. This includes a mix of nurses, doctors and care coordinators. He says that this is not enough though, and that all stakeholders should coordinate their efforts. “Working together is essential in avoiding two major and negative factors that come about when both providers and payors are addressing patient involvement — harassment and confusion.” Organizations have to “focus on managed care, not just managing the dollars” and go beyond doing so in a vacuum.

Duncan believes that once true industry coordination is achieved, a decrease in waste is an inevitable by-product.