Payviders and providers that are closely integrated with a health plan might be the entities most well-suited to innovate the infamously frustrating patient payment process, as patients’ process of paying their healthcare bills often begins by trying to make sense of different information sent by both insurers and providers.
For Americans, billing remains an incredibly confusing part of the healthcare experience. Research shows that most U.S. adults still don’t understand fundamental health insurance terms like copay, deductible, coinsurance and out-of-pocket maximum.
To address this problem, healthcare billing startup Cedar recently launched a new set of features to bring the disconnected ecosystem of healthcare entities together. Pittsburgh-based payer Highmark Health and its health system, Allegheny Health Network (AHN) are the first customers to implement the product, which Cedar dubbed its “payer intelligence layer.”
Highmark and AHN adopted the provider intelligence layer because they have had a unique opportunity to improve the patient billing process, being that the insurer and provider are both part of the same company, James Rohrbaugh, AHN’s chief financial officer and treasurer, said in an interview.
Cedar’s new product integrates data from both insurers and providers so that patients can access a single source of information to help them manage their healthcare bills.
With the payer intelligence layer, patients can access their insurer’s explanation of benefits, real-time deductible status and health benefit accounts all in the same place where they view and resolve medical bills. The product is initially available with Cedar Pay, the company’s billing and payment solution.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
All AHN patients can access the integrated billing platform. For AHN patients who are also Highmark members, they now can receive their insurance information incorporated directly into a single billing statement. The statement shows patients how their benefits have been applied to the bill and how they are progressing toward their deductible and out-of-pocket limits, as well as if there are available health spending account funds.
Highmark and AHN chose to use Cedar’s technology because the company has proven it can work well with both providers and payers, according to Rohrbaugh. He didn’t disclose if Highmark and AHN were considering other tech vendors for this initiative.
“There aren’t a lot of companies out there that are focused on both bringing the payer and the provider together,” Rohrbaugh said. “And yet Cedar has that unique distinction, because they actually, were formed from two companies coming together — one that worked with providers and one worked with payers. And so I think as we look at our organization, they were a good strategic match.”
Highmark and AHN’s adoption of Cedar’s technology comes a couple weeks after Banner|Aetna, the Arizona payvider owned by Banner Health and Aetna, rolled out a frictionless billing program designed to minimize confusion among members by combining billing information from both the provider and payer.
Brad Tinnermon, Banner Health’s vice president of revenue cycle and revenue integrity, told MedCity News that while many payers and providers have established initiatives to reduce patients’ billing confusion, these efforts often fail to have a meaningful impact because they lack operational and financial alignment between the insurer and provider.
Rohrbaugh agreed with Tinnermon, echoing that payers and providers really need to be on the same page if they want to improve patients’ understanding of their medical bills.
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