Payment Modernization in Healthcare Payers


Payment Modernization in Healthcare PayersI’ve been spending a fair amount of time recently on commercial and healthcare payments, the challenges the industry is facing, and how healthcare payers and payments technology providers can work to address those obstacles.

What I’ve learned, in a nutshell, is that payment modernization efforts are critical to healthcare payers as well as providers. While payers—namely health plans and TPAs—have already made strides with regards to adopting electronic payments options, there is still ample room to grow.

Other industries like retail and consumer banking have already paved the way in expanding capabilities in a manner that customers expect. For example, real-time payments and electronic check conversion that were once in the pilot phase are now coming into full bloom and on track to becoming standard offerings.

Payers looking to implement such payment options will have to solve for the following unknowns so their aspirations can come to fruition:

  • Insufficient technology talent or missing roadmap: The most prevalent factor creating headwinds is that technology teams may lack the experience or know-how to implement newer types of payment technology—in other words, a talent gap. Healthcare payers may also not have a long-term roadmap in place that includes upgrading the payment options they make available to their provider network.
  • Disruption created by integration: Technology teams may also hesitate as they are most likely to be on the front lines and grapple with the disruption that accompanies any integration project.
  • Competing priorities: Chances are that tech teams already have multiple, and at times, competing priorities already in play based on past strategic priorities they were tasked with that consume their attention.
  • Budget constraints and senior level buy-in: Contrary to popular opinion about these two factors, they emerged as less prevalent than the other factors listed above.

When payers discuss what they are looking for in their payments roadmap, the general consensus is that any new capabilities should be intuitive and adaptable above all else. Real-time capabilities are also highly sought after. Customer-centricity is a key focus across all industries right now, and payment options should reflect what customers—in this case providers—want. Needless to say, all transactions should be secure and painless.

With the evolution and growing prevalence of payments technology across all industries, payers and their technology partners can take specific steps to keep up and respond. Organizations can start by doing the following:

  • Take cues from how other industries have implemented new payments technology.
  • Seek partnerships that can help successfully launch or integrate B2B payments platforms into their existing systems and processes.
  • Design an RFI for vendors that covers their specific challenges and wish-list items, adding any unique requirements.
  • Consider a pilot program that starts off with a select subset of providers the company works with to compare the before and after.

To learn more about how digital payments in healthcare are evolving, read Aite-Novarica Group’s recent report, Payment Harmonization Index: The Business Case for Harmonizing the Healthcare Payment Experience and U.S. Medical Claims Payments: A Second Wave in Digital Payments.

To continue the conversation, tell me about your experiences, or brief me about solutions related to payments modernization, please send me a note at [email protected] or set up some time to chat.