InstaMed Blog

In 2008, we released the second white paper focused on the issue of payment assurance in healthcare. The first outlined the challenges and opportunities for providers, but this new white paper articulates what most in the industry still aren’t talking about – payers play a critical role in payment assurance for providers even as consumer payment responsibility increases. Ten years later, we have re-released the Healthcare Payments White Paper for Payers because the ability for payers to deliver payment assurance to providers is more relevant than ever. Keep reading for highlights from the white paper and then be sure to download it for the full story.

 

New Dynamics of the Payer-Provider Relationship
Most providers are dependent on income from their payer relationships, which payers leverage into deep discount arrangements. Payers consistently pressure providers with the risk of being removed from the payer’s network. However, this leverage is being eroded as providers must rely on collections from members for revenue. Payers that ignore these revenue challenges for providers erode their provider network satisfaction, their discounts and ultimately their competitive advantage in selling health plan benefits to employers and members.

Then and Now: Increases in Payment Responsibility for Members
Over the last decade, trends in healthcare payments consistently demonstrate that payers and employers have driven benefits towards higher consumer payment responsibility as a way to influence member behavior and to control medical cost ratios. Since 2010, payment responsibility for members has increased by more than 50% according to Aon Hewitt. This trend shows no sign of slowing down as consumer spending in the healthcare industry is expected to grow to $608 billion by 2019 (Kalorama Foundation).

Opportunities for Payers Created by Payment Assurance
Money is at the heart of the relationship between payers and providers. Network discounts are directly related to the number of patient visits and the level of payment assurance that a payer can deliver to a provider. The most significant way for payers to maintain and enhance their market and cost positions with providers is to return to what gave them the discounting leverage in the first place – payment assurance.

Payment Assurance Framework
Download the white paper for the essential payment assurance framework, which outlines the necessary steps to streamline the healthcare payments process for payer organizations and offers solutions to ensure member and provider satisfaction. These opportunities include embedding payment functionality in existing member portals to drive member portal utilization, increase consumer payments to their provider network and meet the new demands of employer groups.


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