Healthcare data workflows are notoriously disconnected and inefficient, injecting cost, time, and anxiety into already complicated medical situations. It is ready for disruption and surprisingly, it is still behind the digital transformation curve that is reinventing other aspects of our lives.
Some FinTechs are embracing the disjointed nature of healthcare payments with platforms and application programming interface (API) integrations that make sense of the maelstrom of medical billing and payments, and can be quite blunt in addressing how much modernization is needed across the board. this area.
Taking it from the angle of what embedded payments offer to clear up the confusion, Lynx co-founder and chief information officer ken abel told Karen Webster of PYMNTS that on the transformation front, “health care is probably lagging behind in that change,” as the greatest responsibility rests with the patient-consumer who wants to know why health care payments Health care couldn’t be more like PayPal.
“What’s really driving it all is that people are starting to expect more from these experiences, aligned with what they’re getting from Venmo, what they’re getting from Cash App in terms of real-time and transparency,” Abel said. “The traditional players in health care have been a bit behind on that, but that’s part of the services that Lynx is introducing to really help bridge the gap.”
An ideal example of the simulation of confusion in health care is the dreaded explanation of benefits (EOB) that often contains the words “you may have to,” which is a red flag for consumers.
Lynx wants to eradicate “maybe you should” from the health care lexicon, Abel said.
“The way you do it is that the institutions that support those claims processes, if you give them programmatic APIs that they can integrate within those workflows, they’ll have access to that payment cycle and they’ll be able to update those transactions and provide further guidance. fluid. and a more seamless experience for the individual,” he explained.
The warning? “Those that don’t offer those solutions, whether online or by card, are going to find themselves behind the eight ball when it comes to attracting employees and attracting retail customers for their health services,” she said.
The problem with traditional
Despite massive disruptions to the health care system and a pandemic-era expansion in how and where services can be delivered, the sector still lags behind when it comes to how data is used — or not. in billing and payments, as well as basics like moving one. pay attention to another system.
Given the fact that health care benefits are not transferable if a person leaves their employer, for example, Abel called it “an ongoing challenge in terms of creating a seamless experience that the individual can take advantage of as they move from one employer to another.” to another. What we can say is that if Lynx supports both the old organization and the new organization, we’ll figure it out. But we know that we are only a small slice of the cake.”
As an industry, he added, “Honestly, we’re not quite there yet.”
To get there from here, he said, real-time transparency is a missing link that needs to be filled in, adding “we’re not there yet in health care.” That is becoming more noticeable as the consumer-patient has a new set of expectations that confounds the traditional players in the space.
“All the components are there,” he said, referring to patient data and payment lineage.
The trick is to have systems for digesting information and creating workflows that allow people to “easily understand where they sit, what has been paid for, what hasn’t, what offers are available to them, and then leverage that engagement for better results by go ahead”. incentive programs and other things” that are available to people but are often not used.
The FinTech opportunity is leveraging financial commitments to healthcare financing solutions like HSAs to provide valuable information to patient payers to improve the relationship.
“The problem you have right now is that those experiences are unconnected,” he said.
When billing and payments are siled, sending payers to different systems, “what you’re effectively doing as an employer and as a health plan is losing that commitment to another system, where if you were to integrate that into your own solution, you could close that cycle, be able to reap the benefits of those additional incentive programs, better results and lower costs.”
The next level of connection
As much as consumers want health care to start behaving like Venmo, it’s overkill given strict HIPAA regulations and information confidentiality. But things can and are moving in more connected directions, including improvements to the incentive aspect.
While incentive programs may have traditionally meant a one-time gift card for completing a health challenge, Abel said it’s an easy solution that can increase engagement and improve results.
“We’re saying you can be more intentional than that,” he continued. “You can offer a card that is reloadable, that allows you to really build a long-term relationship with the person while leveraging these incentives up front to drive these activities.”
That reloadable card becomes a new access point to patient metrics that feed into better experiences “and next best actions, which is a key issue within healthcare,” he said.
This starts with traditional players filling these gaps with the help of innovative FinTechs that have solved important pieces of the billing and payment puzzle for providers.
“They’re somewhat entrenched in those payment streams, talking about insurers and ultimately employers looking at health plans,” Abel said. “It’s really ensuring that those players take advantage of the innovations that have come over the last 10 or 15 years in payments. You would think that that would be something inherent, but the truth is that it is not something that is happening.
Major players like Big Tech companies certainly see the opportunity, explaining why each of them is vying for a seat at the healthcare table, encompassing everything from wearable devices to walk-in clinics.
“Look at someone like an Amazon, the big giant, they’re looking out into space,” he said. “They understand how much cash flow is happening here. I think the traditional players are aware of that and looking to make those investments in payment solutions and better experiences to try and compete with the tech companies that they know are coming.”
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