In the complex world of healthcare, patients frequently feel powerless in actively participating in their care journey. The challenges extend from understanding which doctors are within network to deciphering the costs associated with medical procedures. Outdated systems and fragmented technology exacerbate these issues, leading to inefficiencies that affect all stakeholders. In an insightful discussion, Amanda Eisel, CEO of Zelis, sheds light on how improving health literacy and modernizing financial processes can benefit payers, providers, and consumers alike.
Eisel emphasizes that a significant barrier to accessing quality care is the low health literacy rate in the United States. According to research, only a small fraction of adults have proficient health literacy, making it difficult for them to navigate healthcare decisions confidently. Additionally, many Americans are unaware of tools that could assist them in understanding care costs, provider quality, and how to effectively use their healthcare benefits. This lack of awareness contributes to higher healthcare expenses and suboptimal decision-making.
One critical issue highlighted by Eisel is the prevalence of inaccuracies in provider directories. Studies show that a vast majority of directory entries contain errors, creating so-called "ghost networks." These inaccuracies not only frustrate consumers but also pose significant obstacles when seeking appropriate care. Accurate and up-to-date provider data are essential for members to access care efficiently and make informed choices about their health.
The healthcare industry's resistance to modernization further complicates matters. Legacy software and manual processes dominate, particularly among payers and providers. Different vendors handle various aspects of payments and healthcare services, leading to disjointed solutions that hinder efficiency. Eisel notes that this fragmentation results in delays and lost information during payment processing. To address these challenges, Zelis offers a connected platform that bridges gaps across the healthcare ecosystem, optimizing financial workflows and enhancing transparency.
Zelis aims to revolutionize the healthcare financial experience by providing comprehensive solutions that span the entire financial journey. From building high-performing networks to empowering consumers to shop for and access care, Zelis ensures accurate claims processing and seamless payment delivery. By streamlining operations, Zelis helps healthcare organizations achieve greater efficiency and better outcomes for all involved parties.
Empowering individuals with tools to understand their options and evaluate costs adds much-needed transparency to the payment process. This shift allows patients to focus more on their care rather than getting bogged down by administrative complexities. Through innovative solutions like Zelis ACH plus, healthcare systems can transform labor-intensive, manual payment processes into efficient, automated ones, reducing processing times from weeks to days.
Eisel underscores the importance of modernizing the healthcare industry to ensure its future success. Drawing parallels with other industries, she advocates for adopting best practices from sectors that have already embraced digital transformation. By doing so, healthcare can take significant steps forward, benefiting every constituent within the system.