By Amanda Eisel
Amanda Eisel has focused the last 20 years of her career at the intersection of healthcare and technology. She has been deeply involved creating and scaling multiple growth technology companies including Waystar, Applied Systems and Viewpoint. Amanda has been a member of the Zelis team since 2019, playing a leadership role across Zelis’ growth, operational and talent strategies. Amanda started her career at McKinsey & Company, where she spent nearly a decade advising consumer companies. Prior to Zelis, Amanda was an Operating Partner at Bain Capital focused on technology and healthcare IT companies.
Taking the roadblocks out of the business side of healthcare helps create more equitable access.
EQUITY. It’s a hot topic these days, and I don’t mean the financial kind. It’s a well-publicized concern of the current federal administration. As part of total federal initiatives for achieving health equity, the Department of Health & Human Services’ Healthy People 2030 has set ambitious objectives for this goal. It defines health equity as, “the attainment of the highest level of health for all people.” The Department goes on to state, “achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.”
“The highest level of health” seems an overwhelming goal to meet in seven years’ time. However, if we maintain a holistic mindset regarding the business strategies in our corner of the healthcare industry that can even tangentially tie in, we can achieve a system that provides more equitable access to quality care.
Equity, Meet Efficiency
Equity and efficiency go hand in hand in healthcare. With more equity comes more efficiency, as the data shows that preventative care can prevent more costly and difficult to manage chronic conditions. And with more efficiency in the system, can come more equity. By taking out roadblocks in the business aspects of healthcare, creating a fairer system becomes less of a challenge. Digital transformations like modernizing ways that members can access cost and quality information as well as our payments systems can have huge downstream impacts. I couldn’t agree more with the Fed’s assertion that, “harnessing creative, population-specific technologies and service offerings can connect more patients to providers for health support.”
The more we can utilize automation and AI, the more efficient it becomes to identify and address weaknesses. Last month, the United Hospital Fund published a report about the role health plans play in health equity. It touched upon the importance of cleaner data in addressing inequities that remain unseen or unaddressed, but also noted how data will be critical to equity-focused alternative payment methodologies, such as value-based purchasing.
Such a transformation not only requires data, but underlying technology to support it. For example, payers could implement payment incentives for providers who are actively using population health data to drive interventions, but having the payments and communications platform to underpin it is a go-forward requirement to such a system. In any such example, a “support layer” that organizes data, prioritizes what’s important, and presents it to the user, at pace and at scale would be a basic requirement.
Equity and efficiency are fitting partners in the realm of healthcare. We have an opportunity (dare I say, an obligation?) to transform the industry from the inside out, and that applies to the financial as much as the clinical. The more we can streamline and consolidate processes surrounding administration and data, the easier it will be to dig in, evaluate and plan for future changes, regulation, and evolution of the system.
Keep It Real
To be sure, changes toward an equitable system have begun in earnest, especially as transparency in pricing is taking hold. Consumers are gaining more information about the quality and cost of their care and plans and providers are gaining more insights and tools for aligning with consumer needs.
This is where I can pointedly speak to the incredible work we do at Zelis on behalf of our clients. Our purpose is modernizing the healthcare financial experience for all. We help organizations weld their disjointed business management systems into a more consolidated ecosystem so that the financial experience of healthcare can become less of a source of stress while people are accessing and receiving care.
Ensuring equity in healthcare is complex, challenging, and requires our collective effort. Health plans and providers – and service providers — must work together to develop solutions that prioritize equitable care while meeting regulatory requirements. Those of us in tech can lend expertise by simplifying essential-but-inefficient processes and bring solutions that are omni-channel and meet the consumer at the right time and place. We must all do our part.
Until next time, stay well.
