We all feel it. We all know it’s there, but we often gloss over the tension that exists between payers and providers. That’s why we were excited to sit down with Steve Rowe, Healthcare Industry Lead at 3Pillar, to talk about this topic head on. As a product development partner for both payers and providers, 3Pillar’s Steve Rowe has a front row seat to what he appropriately describes as a natural tension that exists. The reality is that health systems’ revenues are the payers’ expenses and that creates tension. However, that is just the surface level description of why there is tension between payers and providers.
Check out our video discussion with Rowe to learn more of the nuance around the tension between payers and providers, what can be done about it, and other ways payers and providers can create great experiences for their patients and members.
Rowe also dives into some areas where payers and providers can both win. He suggests that one of the overarching principles is making the process more effecient so everyone benefits. The ineffeciencies are a cost for both payers and providers. Plus, Rowe even highlights how some regional payers are looking at streamlined and accelerated reimbursement to providers in return for lower rates and network participation.
Diving in more specifically to payers, Rowe shared with us how payers should be approaching platform modernization. He highlighted how legacy technology at the payers is costing them a lot of money. One example he shared was a call center agent at a payer who had to access 5 different screens to be able to answer the member’s question. This was utterly ineffecient and frustrating for the member and call center agent. At 3Pillar they created a member-centric chatbot that could quickly navigate all of these systems and provide the answer to the member much quicker. This reduced the call center volume, improved the member experience, and reduced the payer’s cost.
On the provider side of things, Rowe shares how providers can better avoid payer denials by essentially reverse engineering the payer algorithm. Rowe shared how the key effort here is to move financial considerations and claims to the point of care. Be sure to check out 3Pillar’s eBook “The Revenue Cycle Playbook: 7 Opportunities to Modernize the Healthcare Payment Ecosystem” to hear more of their perspectives on improving RCM.
Finally, it wouldn’t be a health IT podcast without some discussion of AI and how AI can be leveraged to make the experience better. Although, I do also challenge Rowe on whether payers and providers are ready to improve the experience for patients and members. He makes a good case for why healthcare organizations of all types should prioritize modernizing their technology including the use of AI to create great experiences for their end users.
Learn more about 3Pillar: https://www.3pillarglobal.com/industries/healthcare/
Listen and subscribe to the Healthcare IT Today Interviews Podcast to hear all the latest insights from experts in healthcare IT.
And for an exclusive look at our top stories, subscribe to our newsletter and YouTube.
Tell us what you think. Contact us here or on Twitter at @hcitoday. And if you’re interested in advertising with us, check out our various advertising packages and request our Media Kit.
3Pillar is a proud sponsor of Healthcare Scene.
We all feel it. We all know it’s there, but we often gloss over the tension that exists between payers and providers. That’s why we were excited to sit down with Steve Rowe, Healthcare Industry Lead at 3Pillar, to talk about this topic head on. As a product development partner for both payers and providers, 3Pillar’s Steve Rowe has a front row seat to what he appropriately describes as a natural tension that exists. The reality is that health systems’ revenues are the payers’ expenses and that creates tension. However, that is just the surface level description of why there is tension between payers and providers.
Check out our video discussion with Rowe to learn more of the nuance around the tension between payers and providers, what can be done about it, and other ways payers and providers can create great experiences for their patients and members.
Rowe also dives into some areas where payers and providers can both win. He suggests that one of the overarching principles is making the process more effecient so everyone benefits. The ineffeciencies are a cost for both payers and providers. Plus, Rowe even highlights how some regional payers are looking at streamlined and accelerated reimbursement to providers in return for lower rates and network participation.
Diving in more specifically to payers, Rowe shared with us how payers should be approaching platform modernization. He highlighted how legacy technology at the payers is costing them a lot of money. One example he shared was a call center agent at a payer who had to access 5 different screens to be able to answer the member’s question. This was utterly ineffecient and frustrating for the member and call center agent. At 3Pillar they created a member-centric chatbot that could quickly navigate all of these systems and provide the answer to the member much quicker. This reduced the call center volume, improved the member experience, and reduced the payer’s cost.
On the provider side of things, Rowe shares how providers can better avoid payer denials by essentially reverse engineering the payer algorithm. Rowe shared how the key effort here is to move financial considerations and claims to the point of care. Be sure to check out 3Pillar’s eBook “The Revenue Cycle Playbook: 7 Opportunities to Modernize the Healthcare Payment Ecosystem” to hear more of their perspectives on improving RCM.
Finally, it wouldn’t be a health IT podcast without some discussion of AI and how AI can be leveraged to make the experience better. Although, I do also challenge Rowe on whether payers and providers are ready to improve the experience for patients and members. He makes a good case for why healthcare organizations of all types should prioritize modernizing their technology including the use of AI to create great experiences for their end users.
Learn more about 3Pillar: https://www.3pillarglobal.com/industries/healthcare/
Listen and subscribe to the Healthcare IT Today Interviews Podcast to hear all the latest insights from experts in healthcare IT.
And for an exclusive look at our top stories, subscribe to our newsletter and YouTube.
Tell us what you think. Contact us here or on Twitter at @hcitoday. And if you’re interested in advertising with us, check out our various advertising packages and request our Media Kit.
3Pillar is a proud sponsor of Healthcare Scene.
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2024-07-29 20:30
Except for the headline, this story has not been edited by Healthcare Central is published from a syndicated feed.
