How Payers Can Master Core Administrative Transactions and Deliver a World-class Experience to their Members and Providers w/ Steve Krupa

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, CEO of Health Edge, 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.

 

Steve Krupa, CEO, HealthEdge Software, Inc. 

As the leader of HealthEdge, Steve has the unique opportunity to leverage the various aspects of his professional experience. He started out as a Mechanical Engineer and programmer for Johnson Controls, using software and digital interfaces to control large mechanical systems. Later, Steve became involved in the healthcare mergers and acquisitions business, where he worked on over $12BN of strategic acquisitions and recapitalizations, including the landmark acquisition of US Healthcare by Aetna. Prior to HealthEdge, spent 18 years as a healthcare venture capital partner at the Psilos Group. Today, Steve’s professional passion is for the people and customers of HealthEdge, and its vision to build its substantial and unique intellectual property into the most innovative solutions partner in the HCIT marketplace. Steve holds an M.B.A. with Distinction from the Wharton School of the University of Pennsylvania, where he graduated a Palmer Scholar; and a B.S. in Mechanical Engineering from the University of South Florida where he was elected to Tau Beta Pi.

 

About HealthEdge

HealthEdge provides modern, disruptive healthcare IT solutions that health insurers use to leverage new business models, improve outcomes, drastically reduce administrative costs, and connect everyone in the healthcare delivery cycle. Its next-generation enterprise solution suite, HealthRules, is built on modern, patented technology and is delivered to customers via the HealthEdge Cloud or onsite deployment. An award-winning company, HealthEdge empowers health insurers to capitalize on the innovations, challenges and opportunities that await in the new healthcare economy. For more information, visit www.healthedge.com.

LinkedIn. https://www.linkedin.com/company/healthedge/

Twitter. https://twitter.com/HealthEdge

Website. www.healthedge.com

 

Relevant Links and Resources

 

• Episode #141 The State of Payer Data with Jordan Bazinsky of Cotiviti: Learn about the converging data management challenges that will change the payer industry forever, including clinical data integration and the CMS 2020 Final Rule.
• Episode 104: Why HIEs Will Lead the Way on Healthcare Quality Measurement w/ John D’Amore
• Episode 096: The CMS NPRM: Opportunities from the Payer Perspective
• Episode 094: The Path to Healthcare Interoperability
• Checkout #HCBiz's extensive coverage of the Provider Directory problem
• Providence Digital Innovation Group: Publications, research and perspectives on issues that are reshaping health care through digital innovation

 

The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media.