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The #HCBiz Show!


It may seem cliché to say payers need to be more like Amazon, but the analogy provides fundamental, and surprisingly actionable insights for the health insurance industry. Think about your experience with Amazon (or Google or Zappos, or any other organization that provides a phenomenal customer experience). Whether they’re helping you find the right product, or streamlining the purchase, or dealing with a delivery problem, or a return, these organizations have made the transactions feel easy… frictionless… natural.

If you’re a payer: Ask yourself, does your front-end member experience, or back-end provider experience even remotely resemble this? If you’re a member or provider: Does your experience with health insurance companies even remotely resemble this? If we’re being honest, approximately 100% of you are shaking your heads “No”.

The reason that Amazon can provide an awesome consumer experience is because, through telemetry and analytics, they know exactly what’s happening in their business in real-time. They know how much each decision costs them, and they know it on the spot. That enables automation. And that enables the end-user experience we’re trying to emulate.

How is this relevant to payers?

Well… that’s what this interview is all about. Steve Krupa, HealthEdge CEO, explains that the adequacy and data sharing capability of a payer’s underlying transaction systems will be the rate-limiting factor when it comes to improving the member and provider experience.

And what could that experience look like?

First-pass payment accuracy that reduces the need for “claw-backs”, saving health plans money and reducing a key source of provider abrasion. Point-of-Service Payments that provide members with transparent out-of-pockets costs and improve provider cashflows. Automatic claims adjudication that works as-well-as, or better than the current workflow, and does it in real-time. Additionally, Krupa very elegantly explains the transition of health insurance companies from underwriters of risk to managers of risk, and now increasingly, to participants in the delivery of care itself. We’re always looking to expand our fundamental understanding of the business of healthcare. This section created some new and powerful connections for me, and I suspect it will for you too.