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Improve Transactions, Enhance Member and Provider Relationships

Every day, the limitations of legacy systems cause health plans to waste money and time fixing improper payments, leading to strained budgets and relationships with providers and members.

According to a recent survey of more than 220 health plan executives, when asked what has the greatest negative impact on satisfaction, it comes down to underpayment/overpayment/delays in payment and need for access to real-time data for providers and surprise billing/difficult transactions for customers.

It’s clear that health plans want to create better experiences for their core constituents. The survey also revealed that increasing member satisfaction and improving provider relationships are the top two organizational goals for payers.

In fact, increasing member satisfaction has remained the top organizational goal since 2018. While executives remain focused on finding ways to gain approval from their members, we’ve seen more emphasis over the past year on improving engagement strategies as part of this focus.

However, for members, the transactions with health insurers do not feel natural—it’s completely different than any other transaction consumers engage with every day.

As HealthEdge CEO Steve Krupa said on the #HCBiz Show! Podcast:

The analogy that I often go to is Amazon. When we think about Amazon and its capabilities today, we see an awesome consumer front-end experience and a great supplier backend experience where suppliers can adopt the Amazon platform and use it as a place where they can do business. Those experiences are fundamentally enabled by an autonomous transaction engine. Amazon invested in [developing] the capability to manage transactions as close to real-time as possible … and the transaction engine produces data, information, and insights that have led to a very intuitive and efficient marketplace for customers and suppliers. 

More streamlined transactions are happening across every single industry. Consumers expect their interaction with the health system to resemble the customer service they’re used to, if not better.

If health plans want to create a similar experience for their members and providers, they need a next-generation core administrative platform with data-sharing capabilities that enables them to innovate their business models and push toward a better transaction process.

To improve provider and member satisfaction, health plans must invest in forward-thinking, next-generation technology solutions that offer a better experience with efficient and accurate payments – the first time.