'No Surprise Act' Could Bring Unexpected Transparency, Innovation to Healthcare Payments

The No Surprise Act (NSA) and Transparency in Coverage rule recently issued by the Biden Administration is sending ripples through the healthcare sector, with firms racing to create new digital tools that enable consumer choice while bringing efficiency and clarity to the payments process

In a recent conversation with Karen Webster, Amanda Eisel, CEO of healthcare payments platform Zelis, said data-driven ecosystems align well with the spirit and letter of NSA, addressing transparency issues for consumers with an unambiguous front-end shoppable experience, while easing payments pains for providers and payers at the same time.

“The reality of how you drive cost out of healthcare is consumers making better decisions and making decisions up front to get the right care,” Eisel said.

When asked about the need for greater discoverability, price comparison, and payments choice in healthcare, Eisel said that was the best part of the NSA.

“I got so excited when [the NSA rules] came out so entrepreneurs and companies can figure out how to use it and drive better experiences for healthcare consumers,” she said.

NSA transparency rules are already in force for providers. Payer rules are going into effect in 2022.

“Providers have just been burdened by so many other factors, probably more so than in other industries with what's happened with COVID,” Eisel said. “That's what we've found from providers...this sense that they wanted to go to electronic and digital before, [and they] really want to get to it now, because the last thing [they] have time to be doing is getting in...paper checks, reconciling them, dealing with mail, all of that. It's accelerated the trend.”

That last point is doubly important, as Eisel told Webster that “Shockingly, $450 billion to $500 billion of healthcare [payments still go] through paper checks, which is an astounding number. That's what our business is really focused on, [taking] take those remaining paper checks, about 30% of payments in the system between payers and providers and making them electronic.”

See also: Healthcare Payments Firm Zelis Buys Sapphire Digital

Solving the Data Dilemma

Progress in Electronic Medical Records (EMR) and the portability of highly sensitive personal healthcare data generally are also daunting when creating end-to-end digital experiences.

On the thorny issue of using personal consumer health data as the ‘fuel’ for the next-gen of digital ecosystems, Eisel said, “people do want to share this information if it's going to be used for the betterment of healthcare. I think it's just about creating technology and systems that...draw that out in a consolidated way so that we can actually use the information.”

With Webster calling that notion “the holy grail” of healthcare payments, Eisel said, “It's not going to happen overnight. Step one is putting the various pieces together. Step two is creating the technology that can underpin end-to-end communication.”

“When I first started working with the business two years ago,” she added, “the very first thing we did with our payments business was to say we're going to invest deeply in building out scale technology with an eye to being able to create this integrated solution and pay across payer, provider and member. That's the foundation that you need to have.”

See also: RedCard, Zelis Merge To Optimize Healthcare Payments

Healthcare At An Inflection Point

As more decision makers opt for total transformation rather than adding digital tools in an ongoing series of point solution patches, Eisel said healthcare payments are at a crossroads.

“There is this inflection point,” she said. “So much of what we've talked about historically is taking cost out, and that is of course important, and particularly important here so that the cost can be deployed back into the system. It's about how to create a better experience for the member or the patient. There is common desire to do that on both sides.”

“I think it's about the payers and providers, back to the ones that are really investing in technology, that are investing in these experiences [that] are going to rise above because consumers have choice [and] employers have choice.”

Eisel said Sapphire’s Smart Shopper tool is an example of this; allowing patient-members to view treatment costs by health plan, geography, physician quality rating, specific tests and more gives consumers “perfect information” about providers in order to make informed decisions.

This informs her outlook on the evolution of healthcare ecosystems in coming years — a task requiring considerable innovation and digital modernization, all guided by regulation.

“I think the thing that will have the most impact on the system over the next four years is this legislation around NSA and transparency,” Eisel said.

“With the information [and] data that's coming to the market and some of the things that the government is requiring in terms of transparency around in-network providers and costs and sharing that with the consumer out ahead…that is what's going to start to change behavior.”