Yusuf Qasim, President of Payments Optimization at Zelis.
Talk of “operational efficiency” and “compliance” can wear healthcare leaders down. But while industry buzzwords might be numbing your psyche, the benefits of enhancing healthcare payment workflows are a continuous conversation for good reason: They go beyond tech upgrades. It’s a strategic shift, driving broader organizational goals and boosting treasury management—and it could just be the upgrade you need to focus on the most.
With a background in technology, finance and healthcare, I firmly believe that modernizing healthcare business is crucial to meet the needs of patients and consumers. I’ve been an entrepreneur for more than two decades, and I started my first business building mobile apps more than 20 years ago. I co-founded the business that evolved into my current company’s payments division. I now lead payments optimization for a healthcare financial technology company that provides a payment platform for healthcare payers, providers and consumers.
I’ve been a strong advocate for digital payments innovation, and I see a tremendous opportunity to make healthcare more efficient, cost-effective and satisfying for everyone involved. Through strategic steps like consolidating payments, aligning with consumer demands, leveraging AI and data analytics and prioritizing smart compliance management, the aim is to help all players in the healthcare space not only address today’s financial challenges but also set themselves up for long-term success.
Embracing Technological Advancements
The first step in revolutionizing healthcare payment processes is to embrace change and innovation. Payers understand the need for improvements, but they also realize it’s an extreme undertaking to implement an entirely new payment system. New payment processes, enterprise information across multiple adjudication systems, shifting entire check files and training staff is an extremely daunting endeavor.
But hanging on to unwieldy systems can position an organization at a disadvantage, not just for today but for the next few decades. At the forefront of challenges is the increasing instances of cyberattacks on healthcare every year; risk management becomes more complex when relying on older systems or software that haven’t been updated. Not only that, but also the longer a healthcare organization waits to make system upgrades, the further into “tech debt” it can get.
With the right technologies in place, the future looks brighter. For example, advancements like multiple bank flexibility and payment tracking for the management of funds across various accounts can prepare payer organizations for future modernization phases. As healthcare evolves, staying ahead with new technology can enable payers to adapt more quickly to future changes, whether they involve regulatory shifts, market dynamics or new business models.
It’s about working smarter, not harder.
Why Modernizing Matters
1. Improved provider relationships: Streamlined payment workflows can support timely and secure payments and enhance provider satisfaction, which can lead to more favorable reviews and recommendations in the long term. Happy providers are more likely to stay with a network, which can potentially reduce turnover and build a stable provider base.
2. Lower operational costs and reduced environmental impact: One of the most compelling arguments for adopting advanced payment workflows is the potential for reducing operating expenses. I’ve seen this in action with my own company when helping payers digitize payments. An additional bonus of decreasing reliance on printed checks is that payers can also reduce their environmental footprint—a step that often aligns with broader corporate sustainability goals as well as consumer expectations.
3. Enhanced security: The security of transactions is paramount to long-term success. Systems that detect suspicious activity in real time can help protect resources and build trust with providers, which is a crucial element in any business relationship.
Getting Started
Here are four considerations organizations can keep in mind when modernizing their payment platforms and workflows:
1. Create a unified payment platform. Bring all your payment systems together into one central hub. This can help things run smoother, reduce administrative tasks and speed up claims processing. If you choose to invest in this type of platform, ask about its capabilities, such as whether it supports electronic funds transfer and traditional ACH payment functionalities; next-generation provider payments and member disbursements; a digital channel for members to make instant premium payments; check payments to providers; full-scale member-provider communications; pre- and post-care communications and physical and digital member IDs.
2. Invest in digital for better experiences. In my experience, providers want easy, digital payment options. Think about what tech would best solve your organization’s pain points. For example, could you benefit from automating multiple processes or speeding up virtual card payments?
3. Consider using AI and data analytics. AI can help understand provider needs better and catch errors before they happen. While AI doesn’t replace the need for human expertise, it can make certain things work more efficiently. Ask solution providers whether their platform can analyze data points such as payment modalities, frequency, volume and location. For instance, these types of capabilities can support payers in helping providers along their EFT journey by quickly identifying those most likely to benefit. This means better provider relationships and ultimately better member experiences.
4. Choose platforms and partners that can adapt to regulatory changes. Regulatory rules change all the time, so you need to ensure partners and the platforms you’re using keep up. Ask providers if and how they adapt their solution to ensure regulatory compliance. Non-compliance can lead to hefty fines and a damaged reputation.
The Bottom Line
It’s not just payers who could see positive changes from modernized payments. For healthcare leaders, administrators and providers—who are often working with wafer-thin margins, time-strapped and want to improve operations for their employees—modernizing a payment system can be viewed as an investment in an organization’s future.
All players in the healthcare space have the power to lead the charge in setting a standard for efficiency and innovation in healthcare. By reducing administrative burdens, cutting costs, minimizing risks and improving relationships, modernizing payments can equip the industry to meet today’s challenges and anticipate tomorrow’s opportunities. After all, in a field as critical as ours, staying ahead isn’t just a benefit; it’s a necessity.
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