A recent Wall Street Journal article highlights the differences between healthcare cost management solutions and what medical billing expenses they cover. What’s most obvious when comparing solutions is that there can be large gaps between what they cover resulting in customer dissatisfaction. For example, certain healthcare networks charged prices that were up to double the cash price of $7,066 for an abdominal CT scan.
With continually rising healthcare costs and new legislation like the No Surprises Act, being able to manage costs is more important than ever for payers as they navigate and negotiate payments for out-of-network charges. With a wide variety of savings solutions partners to choose from, this article looks at four factors that payers will want to consider when selecting a partner that will help them manage costs.
1. Customer Concentration
Being beholden to a few large customers puts pressure on the solutions partner since the organization is then reliant upon them for a disproportionately large part of their revenue. If one of these customers terminates the relationship, the organization could experience significant losses and, in the worst-case scenario, be unable to continue operations. When selecting a solutions partner, it is important to assess this and work with partners that have a sufficiently diverse customer base to reduce risks.
2. Cost Burdens
If the savings solutions provider holds a high level of debt this can limit business operations and expansion plans as they divert funds from expansion and growth to cover the costs not only of doing business, but also to cover debt. Limited funds within the organization can lead to an inability to grow the company with acquisitions and investments in product updates that can provide better experiences and solutions for customers.
3. Customer Dissatisfaction
Customer dissatisfaction and multiple class-action lawsuits from shareholders and providers can be costly and divert attention and business resources from the customers. Additionally, frequent ownership changes can create confusion and hints at unreliability for current and future customers. Both issues can damage the solutions provider’s reputation and perpetuate a cycle of customer loss.
4. Outdated Reimbursement Strategies
One common strategy used to re-price claims involves stacking multiple services and moving claims through each service until a discount is found. Stacked solutions became popular because they find a quick and easy discount. However, in most cases, these are single-pass/first-match solutions that move a claim to payment as soon as any discount, such as a network discount, is found. They do not continue to evaluate other savings solutions which may result in more effective savings.
With many cost-containment options available, payers should evaluate potential partners against these four factors: customer concentration, cost burdens, customer dissatisfaction, and reimbursement strategies. It is important to know which partners to trust and what organization’s ecosystem to become involved in. The right partner will demonstrate an ability to invest in their solutions and service their customers now and in the long term.