Zelis is on a mission to modernize healthcare payments through its Zelis Advanced Payment Platform (ZAPP). The first-of-its-kind platform simplifies and streamlines operations and reduces complexity, while providing a payment experience that meets the needs of providers and members today, and in the future.
Zelis' president of Payment Optimization, Yusuf Qasim, believes that ZAPP is a solution to the industry's reliance on outdated, paper-based systems. “Today the industry’s still roughly, call it anywhere from 30 to 40 to 50% paper-based, which is a huge number,” Qasim said. “There is a ton of costs, there’s a ton of complexities and there’s a ton of pain associated with the fact that we’re truly not digital.”
Qasim believes the cost of not modernizing the healthcare payment process is significant. He points to the administrative burden and security risks associated with paper-based payments. “Checks are particularly vulnerable to fraud and theft,” Qasim said. A Zelis survey found that 67% of payers admitted relying on legacy platforms inhibits efficiency improvements, while 74% said legacy platforms increase risk exposure.
Despite the benefits of modernization, Qasim acknowledges that the transition from paper to digital has been slow. He attributes this to the industry's reliance on legacy systems and the need for a comprehensive approach. “When you think about what’s holding the industry back, I think it takes a lot of effort and time and money to really unwind and sort of build from scratch,” Qasim said. He believes that Zelis' ZAPP platform is uniquely positioned to address the complexities and nuances of healthcare payments.
Chris Hayden:
Hi, everybody. My name is Chris Hayden. I'm a producer here at Fierce Pharma. Today I'm going to be joined by Yusuf Qasim, president of Payment Optimization at Zelis. Today, Yusuf and I, we're going to be talking about how Zelis is helping to remove friction from the healthcare payment system, the cost of inaction for not digitizing the payment process, and what steps can be made to create more harmony and trust between payers and providers.
Yusuf Qasim:
That sounds great.
Chris Hayden:
How is Zelis helping to remove friction from the healthcare payments? And what does this look like for payers, providers, and members?
Yusuf Qasim:
So at Zelis, we streamline healthcare payments and communications through one comprehensive platform we call ZAPP, the Zelis Advanced Payment Platform. We've been on this mission for over a decade because we saw unique pain point in healthcare payments where there was a lot of legacy systems and processes that were built over the last decade that really did not solve the problem of truly digitizing the electronic payment data as well as the dollars. So through that journey, we've really built our platform from scratch to be able to handle all the complexities and nuances that come with managing healthcare payments.
If you think about payments in general, they should be pretty effortless. They should be fast, they should be digital, and they should be moving really easily. Unfortunately, in healthcare, that's not necessarily been the case. Right? So I'd say over the last three to five years, the industry as a whole has made significant strides to get to more digitization, but there's more work that we can even do. Today, the industry still roughly call it anywhere from 30 to 40 to 50% paper-based, which is a huge number. There is a ton of costs, there's a ton of complexities, and there's a ton of pain associated with the fact that we're truly not digital.
So at Zelis, we do try to make healthcare payments more effortless by driving more efficiency, by speeding up the transactions, and really making sure that we can deliver digital and transparent experience for payers, providers, and healthcare members. Along the way, I mentioned each of those stakeholders, they all want to get to that digital sort of evolution, that revolution. Right? I think for payers, it makes their lives a lot easier. It allows transactions to flow quickly. It also provides, I'd say, the security and the compliance aspect that they have to make sure that they live up to on a daily basis.
For providers, they really want to get paid electronically, they want to get paid fast, but they also want to get their data. So making sure that we can provide different modalities, different choice, and making sure that we can get them the data wherever they would like it, because that only accelerates the revenue cycle. And for the patient or the member, they won't want to be stuck in the middle. Right? If the payers and providers can actually communicate and get things done on a timely basis, it creates an amazing experience for the patient at the end. So that way they're not caught in the middle from a billing perspective. So at the end of the day, we're really designed and destined to help reduce the payment friction in the entire ecosystem and by enabling and bringing a high level of satisfaction for both payers, providers, and healthcare members.
Chris Hayden:
Yeah, it's interesting. The second question is a good one too. I mean, I hope everybody's kind of getting on board with this, but what is the cost of inaction for not digitizing the payments process?
Yusuf Qasim:
There is a ton of even what I would call actual tangible costs, but there's also a lot of hidden costs associated to not really digitizing the payment process. So at its macro level, if providers are not getting paid electronically, it has massive disruption in terms of their revenue cycle, but also not just for their business, but as a healthcare consumer, if your provider is not getting paid accurately, that could actually have an impact on you as the healthcare consumer as well.
There are big themes we like to talk about related to the digitization of electronic payments. First and foremost, I think front and center is security. Right? Checks are particularly really vulnerable to fraud and theft. They can obviously easily counterfeit checks, and there's also a lot of significant losses in terms of timeliness of payment. There's other pieces of this too. The actual cost of CAQH I think did an estimate roughly two years ago and said there's roughly $20 billion in terms of the cost associated to administrative complexity with payments not going out electronically. That is an astonishing number, $20 billion with a B.
But when you really start to even break it down even further, there's just little things. I mean, imagine, today providers are getting challenged with staffing shortages. Right? That's a really real problem right now. And if they're getting inundated with paper, if they're getting inundated with different processes on how to get paid or how to receive their payments, that's really unnecessary burden on the provider's back office. Right? So when you really kind of pull back, I mean just manual processes, no one likes checks, everybody is in the electronic world today, there's security, there's administrative complexities, there's just the overall cost and time that it takes to reconcile payments.
But at the end of it, I mean we are living in an electronic world today. For me, particularly as a healthcare consumer, it's still a big astonishing point to say that we're not fully electronic, whereas in other industries, they are. They're moving, they are well past this point. So I think that the thing that we always try to educate our customers is, the time is now. Healthcare should not be a laggard. We should be able to meet up and keep up the speed with other market dynamics. So making sure we can drive full digitization within healthcare will significantly reduce not just the administrative burden, but obviously the cost associated to some of these complexities that have existed for over a decade.
Chris Hayden:
Now, let me ask you this. What do you believe is holding the industry back from accomplishing the move from paper to digital?
Yusuf Qasim:
I often use this analogy, when you see a really big thriving city and you could sort of think about redoing it, what it would look like, you'd build the roads probably a little more eloquently, you'd build the transportation. Really, healthcare and healthcare payments has long been a very fragmented process. And I would say there's really no one thing to blame. Payers did their own thing and started to have to build a lot of manual processes. That obviously came downstream to the providers and having to really catch it and meet it where they are. And in the middle, there's been bank and financial institutions, and they're all kind of running trying to figure out, are we figuring out the money problem or the data problem? Reality is, everybody's been impacted through I'd say the unintended building blocks of legacy systems. Right.
So when you think about what's holding the industry back, I think it takes a lot of effort and time and money to really unwind and sort of build from scratch. If you really started to take a look at what that would look like, I mean, that's essentially how Zelis was built. I mean, we really decided to build something from the ground up. We decided to not retrofit another industry, another vertical, and say, "Well, we'll just take this code or this system or this platform and apply it to healthcare." That doesn't work. You really need to understand you needed to build something from the ground up that can handle the rules, the complexities, and a lot of the nuances that healthcare comes along with the way.
So having a system that can handle multiple data, multiple pain points, making sure that you're bringing things with choice. It's not a one-size-fits-all. You really need to meet the stakeholders, whether it's a payer, a provider, or healthcare consumer, and meet them where they are, and making sure that you can make things really flexible along the way. So bringing a really strong platform that can handle the complexities and I'd say the regulatory dynamics of healthcare, being able to bring innovation from other industries that have had a lot of acceleration or innovation around the payment experience, but then also building something that can really be built for the future. So when you think about an analogy is, imagine building a city from scratch, you could do some pretty incredible things. When you do it, it allows yourself to have the foundation and the building blocks to solve I think a lot of the historic pain points, but also really get yourself ready for future innovations and future things that you want to bring into the city.
Chris Hayden:
Yeah. Yeah, that's actually a really good analogy. I like that. I'm probably going to steal that. Okay?
Yusuf Qasim:
You got it. You got it. Just maybe quote me out every now and then.
Chris Hayden:
That was really good. I like that. I like that. Last question kind of flows into that as well. What steps can be made to create more harmony, more trust between payers and providers?
Yusuf Qasim:
As I think about healthcare payments or as we think about healthcare payments from Zelis' viewpoint is, this is a flywheel. Everyone can actually win when there's, first and foremost, trust and there's their harmony. I think more and more, because there's so much administrative complexity, because every stakeholder is getting pressured in some way, shape or form, I think folks are coming and being more vulnerable and being able to say, "If I help you, how do you help me?" So I think creating that transparency and the visibility into the entire process is I think one of the biggest steps that's enabling a healthier, and so what I call harmonious relationship between the payers and providers.
I think the other one is just choice and flexibility. So if you're putting the payer hat on, making sure that you're giving as much options or what we like to call modalities in terms of how providers want to get paid and how they want to get their data, I think is a big unlock. I think conversely, for the providers, if you're wearing the provider hat on, is making sure you understand that not all payers are created equal. Some are really, really sophisticated and should be able to do things I think faster, quicker, easier, but others may not have the means to be able to do that. So making sure that your systems can also catch the way payers are sort of being able to extend themselves and being able to receive the data and the dollars the same way, I think creates that opportunity in that environment for everybody to win in the equation. Right?
So I'd say that's one of the biggest first steps. I think the other one is just making sure everybody has skin in the game. Everybody wants to move things faster. Everybody wants to be able to get their data, wants to be able to get things on a timely manner. So making sure, regardless of the stakeholder, that there are shorter turnaround times, things are provided in a transparent way, in a usable way. So being able to just bring that level of confidence I think will allow, I think, the walls to continue to come down even further and just, again, empower and accelerate that flywheel of the healthcare transaction system.
Chris Hayden:
And at the end of the day too, patients win in that as well.
Yusuf Qasim:
When everything upfront happens timely, accurately, with no noise, the patient and the consumer, we, we always win. Right?
Chris Hayden:
Right.
Yusuf Qasim:
We're always stuck in the middle, and a lot of times it's because something's not making sense, and here we are either holding out or getting overbilled or mistakenly billed. These are things that can be done way upstream and all with the eye towards, we all want the healthcare consumer or the patient, we use those words interchangeably here, we all want them to be happy at the end of the day. They don't want to be stuck in the middle with two different stakeholders that didn't talk or we didn't necessarily get the data we needed to do our job.
Chris Hayden:
Thank you so much, Yusuf. That was excellent. Once again, I was joined by Yusuf Qasim, president of Payment Optimization at Zelis. He joined us today to talk about how Zelis is leading in the digital payment space. We really appreciate your time and your effort for joining us today, and we hope to see you soon. Thank you.