The CEO of HXTechnologies, David Lenihan, discusses the evolution of payer-provider relationships.
Read the full transcript »
Host: What is the next big thing in Payer-Provider Relationships? David Lenihan: Payer-provider relationships, I believe, under consumer-directed healthcare are about to evolve to a new relationship. Currently, providers give payers a discount for the services that they render to the payers' members. That is based on discounts against patient flow. Because providers are experiencing very large accounts receivable growth and that accounts receivable growth is likely to increase as a problem under consumer-directed healthcare, I believe, a new model will ensue. Providers will give payers discount in return for payment assurance. This will bring banks or other underwriters into the process where doctors will be assured of payment at the time new services are rendered and the technology for this exists. It needs to be tied together so that this can happen, but it will -- our interactions in healthcare will look much more like a purchase of a gooder service, with a credit card or card-based technology than it does in a claim space technology world that we're in today. So that's what I think will be the next big thing in payer-provider relationships. Host: What else is in big demand? David Lenihan: I think the other big thing that's coming down the pike is the desire for personal health records. Personal heath records are a place where we as individuals can keep our medical history, our radiology data, our lab data, our pharmaceutical data, potentially claim's data or doctor notes. There is a demand on the part of the individual, a) to have those records and b) to have those records completely under their control. We've seen recently that Microsoft is offering a product called the HealthVault to allow individuals to do this. Google will also be offering and offering similar to that. That will allow individuals to engage in managing their personal health. The nice part of that is that it's web-based and that it's easily accessible no matter where you are with an increasingly portable and movable society. I think that's an important feature. But the key thing will be the security that those new accounts will have. They maybe domiciled in banks. They maybe domiciled in part at doctors' offices, maybe domiciled in part at health insurers. There is not going to be one solution for this, but there will be a very, very dramatic growth of personal health records and electronic health records in the coming years. Host: What is price-transparency less important than streamlining medical transactions? David Lenihan: Consumers who have consumer-directed benefit designs and who have to manage the financial accounts associated with paying for services, will be very interested in price transparency. There is no question about that. The streamlining of payments is really the whole idea of streamlining the existing claims process, which not everybody knows, but it actually eats up. The administrative part of healthcare today is chewing up 25% of the healthcare dollar, which is just far too much. So that streamlining and taking care of automating the back end processes will go a long way to reducing that administrative burden on the healthcare dollar, which will allow us to get more for less. I don't want to say it's bigger than price transparency, because we as consumers are increasingly going to want to know, at the time we're getting a service, how much that service will cost us in the form of out-of-pocket or charges against our healthcare accounts. Host: What are you hoping to learn from this Congress? David Lenihan: I learned actually quite a bit about a very new subject called medical tourism, and the conference was outstanding in terms of educating us on what is happening. Medical tourism actually is one of the areas where price transparency or price comparisons is going to give the consumer a whole new approach to things in elective surgery for cosmetic surgery or knee replacement that we didn't have access to earlier on. It will make our ow
Copyright © 2005 - 2015 Healthline Networks, Inc. All rights reserved for Healthline.