Expert perspectives on healthcare’s toughest challenges 

Q&A with Echo’s Senior Vice President, Brendan Borst

Brendan Borst, Senior Vice President for Echo, discusses challenges with the healthcare payment process and strategies for improving outcomes.  

“Patients are burdened by the inefficiencies that exist between payments from a healthcare payer to a provider.“

The healthcare payment process involves multiple stakeholders across the financial ecosystem. Understanding the challenges and barriers to optimization can help organizations identify opportunities to improve their workflows and processes to ultimately make the system work better for everyone.

Looking to simplify your payment process?

Claritev Payments clarifies the complexity.

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Transcript*

Q: Can you tell us the main challenges with the healthcare payment process? 

 Healthcare is faced with a number of challenges with payments. I will focus on a few of the primary things that we see. So with health plans, and medical TPAs specifically, in order to do payments effectively, it requires a number of unique integration points to appropriately serve the needs of their providers and members who are ultimately being paid. There is just a number of connections that are required to do this effectively.

Additional challenges are around fraud prevention, just like payments in any industry. I think healthcare seems to be more targeted, but no matter the modality of payment that you leverage, there is significant risk for fraud.

And then finally, a challenge that we consistently see is just around 1099 reporting; there is a significant amount of risk in that process as well. Couple all that together, it’s difficult to manage operationally.

Q: What is the main barrier to operational efficiency? 

There is this conundrum that exists where, so a provider has to take action to get electronic payment, right? And providers are thin on resources. They have a million other priorities and keeping up with electronic enrollments for both the payment, as well as the data. takes time and resources for a provider. And what has happened is you have what we always say is the long tail of healthcare, right? Where these providers deal with potentially a hundred different payers and health plans and medical TPAs that are paying into their office.  

Q: How does this impact patients? 

Patients are definitely burdened by the inefficiencies that exist between payments from a healthcare payer to a provider. There are a number of factors that result in that, denials, etc. But even if you think purely about the point that a claim is adjudicated to the point that a provider receives a payment, and then the provider needs to take action to post the transaction into their patient accounting system, get all of that straight, and then the patient receives their bill. The time lag there is significant, and it creates a significant burden for patients that they are not used to seeing in other facets of their life.

Q: How can we make the payment process work better? 

I think really what we aim to do and what we see in the industry that works well is to offer as many options as possible. When you provide those options, that is what we see drives a well greater level of electronic adoption.

Q: Why did ECHO choose Claritev? 

One of the key advantages with Claritev is that Claritev brings to bear an entire suite of solutions for the healthcare industry that solve financial challenges. That is critical, and there is a ton of inefficiency in that process [of solving financial challenges]. So much so that I would argue it is not even, at this point, feasible for a health plan or a medical TPA to do this in-house. There is so much complexity. There is so much risk of fraud. There are a ton of benefits to working with Claritev.

*This transcript has been lightly edited for readability, including the removal of filler words, false starts, contractions and repetitive language. No substantive changes have been made to the content.