In the US, the myriad of transactions that run through the healthcare industry is clearly not as efficient as it should be. The ecosystem of health insurance premiums, insurance claims, reimbursements, patient history, bill payments and employee benefits are not really coordinated today. The clinics and doctors have issues with the insurance companies related to claim settlements. Both the employers and the employees have to do a lot of paperwork towards setting up health benefits accounts (HSAs, HRAs, FSAs) and reimbursements around these accounts. Even regular patients who have recurring treatments in one clinic have to feed in their historical information time and again with the same doctor. All these gaps in the healthcare industry’s transactions network lead to leakage of money and has slowed down the efficient flow of payments in the industry. Some of this problem is being solved by Third Party Administrators (TPAs). TPAs take away the burden of paperwork from employers. But that still doesn’t solve the entire problem. The paperwork doesn’t really go away. It just gets transferred from the employer to the TPAs. However with the rise in technology and the up and coming startups in this space, these problems are slowly getting solved. Many companies are trying to make payments easier for the healthcare industry. The prominent technology to enable simpler operations in the healthcare industry is the cloud-based EHR (Electronic Health Records) technology. We looked at a few companies in the healthcare industry which are trying to make payments simpler for medical groups and benefits programs easier for employers.
CareCloud’s Concierge is a platform that provides medical groups like clinics with a revenue management solution. CareCloud Concierge allows clinics to simplify the insurance claim process and make payments acceptance easier with cloud-based EHR technology. On the other hand, CareCloud’s patient portal allows a patient to make online payments to the clinic easily. It also provides medical groups with a clear and visually impressive dashboard of the pending bills, account receivables and revenue cycle.
Just like CareCloud, AthenaHealth provides cloud-based EHR to medical groups to enable patient’s historical data and factsheets to be available at one place. AthenaHealth also provides medical billing services via athenaCollector that combines cloud-based software, networked intelligence, an efficient workflow and back-office services so that the medical groups get paid faster from the patients and the insurance companies. athenaCollector checks a patient’s insurance eligibility even before he enters the clinic. athenaCollector lets clinics accept payments via credit cards or other payment methods. It allows clinics to set up a payment plan for different patients. Like CareCloud, AthenaHealth also provides a healthcare analytics dashboard for its customers.
There are similar companies in the same space that provide solutions to clinicians on the basis of cloud-based EHR and big data analytics. These companies include iCare, Practice Fusion, CureMD, MedPlus/Quest Diagnostics, Sevocity, OptumInsight (formerly Ingenix), AdvancedMD, Waiting Room Solutions and Bizmatics.
On the other hand, there are companies like InstaMed which purely aim at simplifying healthcare payments. InstaMed reduces every cost in the healthcare payments process by connecting payers (insurance companies), healthcare providers (clinic, doctors), members, patients and banks on a single, integrated network to securely and efficiently manage every healthcare payment transaction. On InstaMed platforms, patients can easily make online payments to the healthcare provider using their Patient Portal. InstaMed has helped TPAs reduce costs by 90% with InstaMed Claims Settlement, a solution that eliminates paper and postage to consolidate payments.
Another interesting startup in this area is HealthExpense, which is trying to reduce costs for employers by making claims and reimbursements paperless via their payment platform. HealthExpense provides access to claims/EOB data from most of the major health plans to allow automated HSA, FSA, and HRA reimbursement and electronic claim substantiation. With HealthExpense, member employees can pay or request reimbursements with one click. It also allows secure messaging between TPAs and member employees.
ClearGage is another company that has developed innovative healthcare payment solutions and financial services that employ HIPAA and PCI compliant revenue cycle technology. ClearGage’s range of services include Payment Accelerator, which is a complete suite of patient payment products and solutions, including credit and debit card processing, Virtual Check (ACH) from checking and savings accounts, online bill pay and mobile payments. It also provides Patient Financing that includes flexible patient payment solutions and finance programs without credit check.
These are just few of hundreds of companies in the healthcare industry that are trying to ease payments and save time for clinics and doctors, employers, employees, TPAs, insurance providers and financial institutions. There are many others in the same area of focus more or less providing a similar range of services. Payments has been an important topic everywhere in this industry. Every business demands and expects continuous cash flow and these businesses are ready to spend to make it happen. Financial technology and other cloud based technologies are expected to fill in the gaps in the healthcare industry by making transactions more efficient overall.