It wasn’t that long ago that our industry was abuzz with headlines about “the rise of consumerism.” We became increasingly aware that as patients began taking greater financial responsibility for their care, they became “consumers” and would need greater price transparency and a digital experience. At the same time, clinician leaders began discussing the need for “patient-centered care” models. Today, nearly every payer and provider website tout the mission of focusing on patient-centered care, but what is needed to make that a reality? When we use or read the term “patient-centered care,” how many of us picture our family, our friends, or our neighbors? Or do we think about a faceless person lying in a hospital bed? In many ways, it’s become a marketing catchphrase and an abstract concept.
Creating long-lasting change requires that we stay focused on how critical it is that we—payers, providers, and other stakeholders—work together to deliver better patient experiences. Efficient connectivity and data sharing provide the foundation for bringing patient-centered care to life.
During the chaos of the pandemic, many patients had to be transported between care facilities. It wasn’t abnormal to see patients on their gurneys with CDs or files that contained their patient records. It was the only way to be sure the next provider had a copy of the patient’s record, which they needed to understand the patient’s existing conditions, medications, and care plans.
It is mind-numbing to think that in an age where consumers can go to almost any ATM worldwide and get their balance, withdraw cash, and move money between accounts, payers and providers can’t access patient data without faxes, chart chasing, phone calls, or extensive online searches. The reality is that the technology that we use for so many healthcare transactions was initially created to manage logistics for the steel and auto industries. Those industries have now moved on from latent, batch-based electronic communications because there are better ways of doing it.
When will healthcare catch up? Sooner than you may think. Today, there are a handful of payers and providers working together to address connectivity challenges and move healthcare forward – beginning with coverage information.
Recently, a large global healthcare system and a multi-state payer participated in a pilot program for a new type of collaboration solution that puts the “patient” back in “patient-centered care.” Their goal was to simplify data sharing to improve the patient experience and create short- and long-term financial stability in the process.
The solution is Avaneer Coverage Direct™, a peer-to-peer digital network that enables payers and providers to access accurate, continuously updated, and complete insurance coverage information right in their source systems.
In a recent podcast, a provider system’s senior director of operations and market network services says, “It opens doors for joint processes and improves communications that allow us to perform more effectively and have better outcomes as we continue to drive optimal population health across the ecosystem.”
Each Avaneer Coverage Direct payer and provider participant receives their own provisioned cloud environment on the Avaneer Network, known as a SparkZone™. Once participants load their patient/member coverage information into their SparkZone, the process begins:
One of Avaneer Coverage Direct’s most significant benefits is its ability to protect data. Because the data doesn’t need to be aggregated or sent to intermediaries like clearinghouses, it remains safely within the network and under the control of the data originator. Auditable records provide complete insight into how, when, and with whom data was shared.
The results have been significant for both the provider and the payer. Avaneer Coverage Direct provides between 5 to 12% more information than EDI and is faster 99% of the time.
Providers are estimated to achieve immediate hard savings of up to $5.75 per claim by saving costs on:
Payers can lower costs as well—up to $1.65 per claim, which is just the beginning. These savings are the result of:
Of the top focus areas for healthcare leaders in 2024, expanding the use of technology is near the top. According to an article published by Healthcare Financial Management Association, “The challenge for health systems will be to prioritize the possibilities and identify immediate opportunities versus long-term strategic positioning.” This includes addressing “financial pressures and the evolving needs of patients.”
Of the many essential initiatives that healthcare leaders must undertake to address financial pressures and patient needs, improving collaboration should be at the top of the list. It’s the only way to reduce inefficient, costly administrative and interoperability barriers and drive meaningful change in healthcare. Unless or until this takes place, all other initiatives will fall short.
We must remember that the value of patient-centered care comes from giving patients more transparency, a better experience, and optimal outcomes. The only way we can achieve this is to remove as many barriers between payers and providers as possible. The technology that enables this to happen is here today, and payers and providers are coming to the table to make it happen.
As the Avaneer Network grows, its value will escalate exponentially to payers, providers, patients, and the industry. Click here to learn more about Avaneer Coverage Direct.
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