New report measures harmony of healthcare payment processes among payers, providers, and members.
As healthcare payers and third-party administrators (TPAs) seek alternative ways to optimize financial performance while maintaining positive provider relationships, they are advancing business-to-business (B2B) disbursement methods, payment integrity, network management, and member engagement to help optimize the healthcare payments process. But when the three main participants in healthcare – payers, providers, and members are not aligned– the healthcare payment process becomes a frustrating experience for all.
In Payment Harmonization Index: The Business Case for Harmonizing The Healthcare Payment Experience—a new Impact Report sponsored by Zelis, a healthcare payments company — research and advisory firm Aite-Novarica Group introduces a payment harmonization index: a weighted scorecard for payers that measures factors like the current forms of payments available to providers, the appetite for expanding electronic payment methods, as well as the interdependence among payer, provider, and member processes.
- Workflow automation is lagging in healthcare payments. Although payment integrity executives identified automating claims adjudication (90%) as an important aspect of their practice, less than a third of the components that make up claims adjudication take place automatically.
- Continued inaction in conversion to e-payments, despite importance. Forty-three percent of payments executives remain inactive or reactive in converting providers into electronic forms and ACH/EFT, which is at odds with the level of priority they place on the topic.
- Health plans are prioritizing building out a personalized member experience. While many factors determine the magic mix, providing information to decide on medical care has emerged in importance. Provider quality scores and reviews, price comparison, and shopping tools are also key ingredients.
“Payers are making valuable strides in harmonizing and modernizing their payment functions, but there is room for improvement,” said Inci Kaya, Strategic Advisor at Aite-Novarica Group and author of the new report. “While many factors determine the magic mix personalizing member experience, providing information to decide on medical care has emerged in importance. Provider quality scores and reviews, price comparison, and shopping tools are also key ingredients.”
“The healthcare payment system operates with disfunction wherein the member is left with a poor financial experience, which is just as impactful as their clinical one,” said Amanda Eisel, CEO of Zelis. “Aite-Novarica Group’s Payment Harmonization Index can help guide payers towards a more harmonious and optimal path forward for all.”
About Aite-Novarica Group:
Aite-Novarica Group is an advisory firm providing mission-critical insights on technology, regulations, strategy, and operations to hundreds of banks, insurers, payments providers, and investment firms—as well as the technology and service providers that support them. Comprising former senior technology, strategy, and operations executives as well as experienced researchers and consultants, our experts provide actionable advice to our client base, leveraging deep insights developed via our extensive network of clients and other industry contacts. Visit us on the web and connect with us on Twitter and LinkedIn.