11:40 AM
Janna Meek, Humana
Janna Meek, Humana
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Cashing in on Technology Advances

Janna Meek
While healthcare finance hasn't progressed notably in 30 years, an ATM-like transformation is finally under way. And like so many great consumer innovations, technology is the enabler.

Think about it: In 1980, to get cash, you drove to the bank, waited in line, filled out paperwork, waited and finally got cash. To see a doctor, you went to the office, sat in a room, filled out paperwork, waited, saw a doctor, got a bill six weeks later and sent a check for payment.

But now, you walk to any ATM, insert a card, punch some numbers and get cash. To see a doctor … well, you still sit in a room, fill out paperwork, wait, see a doctor, get a bill six weeks later and then send a check.

In 2006, Humana committed to real-time claims adjudication (RTCA). Today, in multiple cities, patients experience the claim process in seconds - they see their doctors, swipe their IDs, pay with their HSA-linked Visa, and enjoy a life free of confusing bills and statements. It's been a challenging process, with only a few thousand physicians running RTCA today. But the number is growing - and fast. Why? Two reasons: New high-deductible health plans have pressured doctors' accounts receivables, incentivizing collection at time of service; and patients no longer tolerate antiquated payment systems, demanding simplicity, speed and accuracy.

Historically, two RTCA implementation barriers existed. First, insurers could only process claims in batches, meaning doctors had to collect claims, hold them and submit to insurers en masse. It made sense in a paper-driven world, but it's ludicrous in a digital age. Today, leading insurers can process claims in real time.

The second barrier has been outdated physician office systems. While they use cutting-edge technology to treat patients, physicians' office billing systems often are too antiquated for RTCA. Doctors haven't been incentivized to bring their systems into the 21st century. But that's changing. Patients are now questioning doctors' offices that lack electronic medical records, prescriptions and communication. Further helping things, the 2009 economic stimulus package incentivized doctors to update office systems.

RTCA markedly benefits patients by simplifying the system and doctors by slashing collections costs: a true win-win scenario.

Cashing In on Technology Advances
Making a Direct Connection Through Claims
Payer-Provider Partnerships: Creating Best Practices
Curing Claims Headaches

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