Healthcare Payments

Healthcare Providers Have Become Lending Organizations

Post by
Justin Nicols

Last month I was proud to announce that Sift had closed an important round of funding that will enable us to grow our data science team. We’re honored to have forward-thinking partners, including the Winnebago Seed Fund and Rock River Capital, who believe in our mission -- as well as innovative clients, like State Collection, who are committed to leading the industry in technology.

Our funding, our partners and our clients have equipped Sift to be able to expand our footprint, helping us further our mission to reduce waste and bring advanced intelligence to healthcare payments.

What does that look like? It’s helping providers “do more with less,” work smarter, get ahead of insurance trends and proactively work with patients on flexible payment options.

The Problem In Healthcare Payments

In healthcare, waste is easily overlooked. When you’re immersed in daily healthcare operations, it’s easy to forget that nearly $.30 of every dollar spent is allocated to administrative functions that are not at the core of providing better care. We readily accept that, for every 10 healthcare providers, there are 7 additional full-time employees who support those providers by ensuring they and their employers get paid.

As a country, we’re at a tipping point; healthcare spending now makes up nearly 17% of the US GDP, and the “simple solution” of hiring more people to solve payment problems is not scalable. Healthcare payments need flexible technology solutions that help reduce the cost and waste associated with collecting payments. Technology, not more bodies, is what will help those scarce dollars both find their way back into consumer’s pockets and enable providers to allocate more resources to what matters in healthCARE, the actual care and services delivered.

Providers Are Lending Organizations

On the surface, getting paid in healthcare seems simple. Healthcare providers are typically collecting payment from two parties: First, healthcare providers collect from the insurance company based upon contracted rates, and then, the remaining balance (whether deductible or coinsurance) is collected from the patient. However, collecting payments on both sides has become increasingly difficult, with new challenges emerging each year. The complexities in collecting payments tie to two major trends:

  1. Insurance companies increasingly deny claims from healthcare providers and change the requirements for payment.
  2. Patients are now responsible for paying a much greater portion of their healthcare costs due to the rise of high deductible plans.

These factors are driving greater provider write-offs and have massively increased the cost to collect. As a result, providers have effectively become lending organizations. Every day healthcare providers are extending credit in the form of care, and they have little idea whether, how much or when they will be paid. It’s time for healthcare providers to start deploying well-established data and analytics tools to forecast payments and optimize outcomes.

A Command Center Mentality

Healthcare providers have invested heavily in clinical command centers so they can deliver the best possible patient care while maximizing their operational efficiencies. This approach to centralizing clinical data to improve quality of care while simultaneously utilizing resources more efficiently has proven to be an impactful investment and necessary industry move. But when it comes to addressing how to actually pay for the care they provide, provider systems of all types are sorely behind.

Few providers have centralized their payments data in order to better understand payment trends and problems, and even fewer have invested in effective technologies that optimize payment outcomes and reduce the cost to collect.

The industry needs to invest in data and analytics platforms that both drive a deeper understanding of current payment trends and future payment outcomes and empower and enable their existing workforce and partners to collect payments more successfully and efficiently.

This is the first place where Sift provides value. Sift’s data and analytics platform -- built for healthcare payments -- unifies and organizes payments data, giving providers a complete picture of how their payments perform. Sift provides a command center for healthcare payments, equipping providers to take action.

Well-Developed Technologies

There are plenty of buzz-worthy technologies, like artificial intelligence, robotic process automation and machine learning, that are being sold to healthcare providers. What often gets lost is the core mission -- helping providers collect more money, more efficiently.

Sift’s platform provides a unified view of payments data -- looking at the past, present and future. This foundation enables Sift to build predictive models that are based on historical payments data and also consider current trends. Sift deploys machine learning in a focused manner, always working to drive improvements to payment outcomes and resource allocation.

With both a command-center approach to payments data and proprietary machine learning models, Sift leverages historical data to inform best practices and prioritize workflows based upon returns and results, enabling providers to establish custom data strategies that boost their employees’ performance. The focus is on results and not just productivity -- not just clicks and touches and account volumes. This improvement in efficacy and efficiency directly impacts both money and morale.

It’s time for healthcare to approach payments with the strategies that industries like financial services, e-commerce, and insurance providers have used successfully for years. Through truly understanding payment trends and proactively driving intelligence into their workflows, providers will be prepared not only to survive but eventually thrive; they’ll be able to invest more time/resources/money into what matters most in healthcare -- patient care.

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