Improving Healthcare Business with Fintech

It’s an exciting moment in patient-centered healthcare.

The tech transformation of financial services isn’t only creating new opportunities for healthcare companies for improving service and outcomes. It’s also changing the way firms manage relationships with patients and third parties across the healthcare ecosystem—elevating a focus on accuracy, speed, and quality.

The coming fintech revolution in healthcare means opportunity for your business and patients, as long as we all take advantage of its most promising and effective tools.

Plan for a Digital Future

Electronic records mandates, insurance marketplaces, and payer mergers have been reshaping the healthcare industry for years. Yet, despite growing use of faster, more connected systems, back-office healthcare operations remain inefficient and expensive.

Administrative costs make up approximately 15% of all healthcare expenditures totaling well over $300 billion annually. And that number does not appear likely to recede any time soon; one analysis estimates U.S. payers and providers will spend roughly $496 billion on billing and insurance-related administrative costs in 2019.

If technology can reduce even a small percentage of the overhead spent on claims submission, reconciliation, and payment processing, it could drastically benefit a healthcare organization’s bottom line.

Amid insurer consolidation and economic uncertainties, fintech helps healthcare firms adapt to changing patient expectations, and plan financial management strategies for a digital future.

Phase-in for Fintech Success

In an industry with such deeply ingrained reliance on paper-based, legacy processes as healthcare, realizing the benefits of fintech investments takes time. Even out-of-the-box technologies can take years to deliver ROI. And innovations employing newer, less proven tech—blockchain, for example—are not quite market-ready.

As forward-thinking organizations embrace next-generation technologies, patience is key.

It’s also important throughout the process to remember that while fintech pilot projects and prototypes can help healthcare companies reach next-level performance, the tools often work best when brought online in phases, providing the opportunity to experiment with different approaches and combinations of tech, as well as to tailor a system from the ground up.

Here are a few components to consider as you explore this revolutionary new tech:

Modernized payment models have been available to healthcare firms for some time, but few organizations are taking full advantage. The subsequent loss in revenue is considerable: In 2016 it was estimated that each manual transaction cost providers and health plans approximately $3 more than each electronic transaction.

Outdated payment tools are costing firms in terms of patient goodwill as well: Though a full 80% of patients want to be able to pay their insurance bills digitally, 77% of providers still use paper billing statements to conduct at least some of their financial transactions.

Which is to say, modernizing a firm’s approach to medical accounts receivable is a fintech investment that reaps a near-immediate impact.

Real-time fee estimates and point of care collections tools, for example, lessen back-office follow-up effort and error risks. Paperless processing, patient payment portals, and automated collections accelerate cash flow. And with better visibility and streamlined processes, organizations reduce fraud risk and resource use.

Connecting payment data to patient data extends the benefits of modernized payment tools even further.

Today, the capabilities and benefits of linking transaction information with medical records are fairly simple and straightforward—think auto-posting payments into an organization’s practice management system for more accurate reports and patient outreach efforts.

The opportunities for connected data are continually expanding, however, alongside the shift to value- and quality-based care and reimbursement models.

Challenges remain. EHR technology designed to make healthcare data more accessible and interoperable is still taking shape. Efforts to track patients across various records systems had been stymied by low-cost, low-value resource use that drives $586M in wasteful spending.

Because value-based care relies on clinical data to measure quality, however, claims management systems are increasingly powerful for connecting payment data to patient data. Robust analytics systems increasingly help healthcare firms measure where to improve quality based on both costs and patient outcomes results—ripe with the very real potential to improve patient health.

Though the precise applications are still being determined, blockchain technologies will almost certainly play a substantial role in the administrative future of healthcare.

One focus area? Reducing unnecessary care. Innovators are exploring how blockchain technology aids data interoperability, price visibility, and the exchange of protected health information among patients and providers. Researchers believe blockchain could provide a new model for health information exchanges (HIE) by making electronic medical records more efficient, disintermediated, and secure—an immutable ledgering system for recording transactions among various parties in a given network.

Others are exploring the use of blockchain for managing clinical trial data and combating the $220 billion counterfeit drug market by creating a better understanding of the sourcing and movement of pharmaceuticals. Claims submission and remittances are growing area of application as well.

Opportunities abound for healthcare firms to participate in pilots that align with their organizational goals and learn alongside healthcare colleagues how blockchain will affect change in their industry.

Collaborate for Change

Ultimately, unless healthcare firms start prioritizing fintech investments that reap returns—beginning with better payment models and e-transactions—blockchain won’t change anything. Working with experts who understand technology and know how to apply it for maximum impact could be a major factor in the speed and degree of success achieved within this arena.

One innovation inspires another.

"If I could challenge developers on a mission,” Seema Verma, the chief of Medicare and Medicaid programs, told an audience in late 2018, “it's to help make doctors' offices a fax-free zone by 2020.”

Of course, for developers to meet her mission, healthcare firms have to make fax-free operations their commitment, too.

From that kind of humble starting point, healthcare leaders can conquer cash flow challenges while making better use of fiscal and medical data—helping transform patient experience and creating better outcomes.