Over the last two decades, the digitization of healthcare payments has created growing pains for numerous payers in the form of overly complex infrastructure.<\/p>\n\n\n\n
Today, health plans and third-party administrators face the unintended consequences of adopting point solutions or integrating existing and new technologies due to mergers and acquisitions, all of which threaten their ability to compete and protect their bottom lines.<\/p>\n\n\n\n
With the average organization managing\u00a0more than ten vendor relationships for a single initiative, payers struggle to maintain their IT infrastructure, let alone future-proof their technology stack, due to the technical debt they carry.<\/p>\n\n\n\n
\u201cThe number of systems, software, and vendors becomes significant,\u201d says Zelis Vice President of Business Solutions Leah Silver. \u201cThe tools and resources once used for efficiency and productivity are now seen as operational burdens that create inefficiencies. The wrong combination of people, process, and technology means staff must support obsolete processes, work around multiple vendor dependencies, and manage their impact on interactions with providers and consumers.\u201d<\/p>\n\n\n\n
The unintended consequences span four major categories which present unique risks to payer business operations:<\/p>\n\n\n\n
Technology bloat:<\/strong> Complex payment infrastructure leads to high maintenance costs, difficulty managing multiple systems, and limited visibility into operations that are not sustainable over the long run. Mergers and acquisitions often add new systems to the technology stack, which often already includes support for legacy solutions and protecting against negative impact from shadow IT.<\/p>\n\n\n\n Regulatory compliance:<\/strong> Systems not designed for compliance with evolving regulations mean organizations are at risk of fines and penalties due to their inability to audit their operations and mitigate issues promptly. Customizations and workarounds make unwieldy infrastructure function but undermine efforts to comply with federal and state rules and policies.<\/p>\n\n\n\n Interoperability:<\/strong> Inadequate data sharing can easily strain relationships with providers and diminish the member experience, on top of increasing the likelihood of data loss and preventing data-driven decision-making across the enterprise. A lack of system interoperability has the potential not only to drive up operating expenses but also to give rise to errors that damage a payer\u2019s reputation.<\/p>\n\n\n\n Security: <\/strong>The greater the number and age of systems, the greater the likelihood that missed patches or updates could render a payer\u2019s infrastructure vulnerable to a system breach or improper handling of sensitive health data and financial information. Security breaches have financial implications in the form of fines and can damage a payer\u2019s reputation beyond repair.<\/p>\n\n\n\n \u201cThese unintended consequences not only lead to operational inefficiencies but also create risks,\u201d Silver explains. \u201cThe more cooks in the kitchen, the higher the risk becomes.\u201d<\/p>\n\n\n\n The urgency of consolidation<\/strong><\/p>\n\n\n\n The healthcare industry has long been a target for\u00a0fraud, waste, and abuse, drawing the interest and ire of federal authorities. Recently, the healthcare sector has become a target for bad actors to exploit the vulnerabilities of the industry\u2019s critical infrastructure. Healthcare has quickly become the\u00a0preferred target of ransomware attacks. What\u2019s more, breaches of health and healthcare-related information and systems cost organizations, on average,\u00a0more than $10 million to mitigate.<\/p>\n\n\n\n \u201cTechnology bloat, regulatory compliance, interoperability, and security are urgent issues that require mitigation,\u201d Silver emphasizes. \u201cAs payers find that they have more systems and processes in place that they have to work with, that also opens them up to more opportunities for risk, security breaches, and fraud.\u201d<\/p>\n\n\n\n However, payers managing complex payment infrastructure are not well-positioned to mitigate the sources of risk efficiently. \u201cThe more health plans and TPAs are focused on their point solutions, the less they can address bridging the gap between their business processes and their desired outputs,\u201d adds Silver.<\/p>\n\n\n\n According to Silver, the time is ripe for payers to streamline their digital ecosystems for payments and reap the benefits of a consolidated platform.<\/p>\n\n\n\n \u201cThe smartest and clearest path forward is through consolidation, a single platform where the entire healthcare financial experience can be managed securely. The organization has access to more modernized tools and gains the ability to scale for future growth under one umbrella,\u201d she advises.<\/p>\n\n\n\n \u201cStreamlined processes ultimately help with a reduction of not just operational costs but also mitigating risk. A holistic solution helps prevent that and adds another layer of prevention for fraud and security and the means for swiftly and easily resolving issues. In the end, consolidation ensures the payer\u2019s bottom line is not greatly impacted by avoidable risk.\u201d<\/p>\n\n\n\n By replacing a complex payment infrastructure with a consolidated platform, payers can achieve new levels of efficiency and be in a position to adjust quickly.<\/p>\n\n\n\nSource: HealthPayer Intelligence<\/a><\/span>\n\n\n\n <\/p>\n\n\n\n <\/p>\n","protected":false},"excerpt":{"rendered":"