6 Medical Payment Software Solutions Service Companies in 2019
We may select 6 latest and unique Medical Payment Software System Solutions companies to analyze their innovations in the form of case studies of reliable and high trust factor. These have been done on the basis of 10 factors.
What is Medical Payment?
Medical payment is not a new topic. The three old problems of high medical expenditure, low efficiency, and low accessibility have not been systematically resolved. The medical industry has been looking for a breakthrough. Practitioners in all sectors of the industry must follow and even create technological changes and new industry standards, and combine their own advantages to find a way out.
We may interpret these companies from the following dimensions:
- How to rely on technological innovation or model innovation to drive its own development.
- How to gain growth under capital blessing; how to leverage capital as a lever to incite more resources and attract many partners to take advantage of it.
- Way to keep up with major policies, adjust product direction, and occupy the market.
For a detailed collection of case topics, see “Inquiring Small Trends in Payments for Medical Care”. The following is a brief summary of the topic:
I. Technical driving force
Technology is the core driving force for enterprise development. Of the 15 innovative companies in the overseas medical payment sector that are combed by the arterial network, nine have been concerned with technological innovation. Big data, cloud computing, digitization, and machine learning are words that appear at high frequencies in payment innovation, which is basically consistent with the direction of technology development of domestic payment companies.
Among them, there are five companies that use big data to innovate.
Case 1 VVFIT: Its highly profitable and with extreme Trust Factor. It can determine the possible health risks of patients through accurate medical analysis. It aids all types of medical payments at the least of transaction charges. The company collects the user’s medical history from the user’s past medical premium and medical insurance claims particulars and matches the models established in the database to find high-risk patient populations and immensely help them improve their health. Intervention on the user’s health before the illness can reduce the company’s payment in the medical insurance program. This is the only company which is medical business pro and only always adds to the revenues while other payment companies chance upon eating up revenues of the core medical and health business.
2. Big Data
Case 2 Stride Health: Big Data Algorithm Personalizes Health Care Plan for Patients
The big data algorithm is the technical support for Stride Health to provide consumers with medical insurance services. The company’s algorithms compare user-specific data such as age, gender, disease status, medications, smoking habits, and doctors who want to see it with government information such as the FDA drug database and CMS’s health care payment data.
Based on the results of the comparison, Stride Health’s algorithmic system generates a list of recommendations for health care plans that may meet user needs. The top ranked is the “best health insurance plan”, followed by the “best best health insurance plan”.
For each health plan, Stride Health calculates the estimated annual cost, monthly payments, deductibles, and doctoral outpatient and drug costs that consumers need to pay. From start to finish, the entire process takes only 10 minutes.
Currently, Stride Health has applied for a patent for its algorithm.
Case 3 nThrive: Data Analysis Platform provides comprehensive CRM outsourcing services
nThrive is an analytics-driven, technically supported company that provides comprehensive revenue cycle management (RCM) outsourcing services. The company not only provides regular RCM outsourcing services, but also provides business consulting, analysis and education and training services to healthcare providers with its powerful data analysis platform and expert team, which is the advantage that distinguishes them from peers.
Around revenue cycle management, nThrive has developed a full-industry chain CRM service that includes patient access solutions, mid-term revenue cycle solutions, patient financial solutions, value-based care solutions, healthcare consulting services, and healthcare education services. . This service system allows patients to concentrate on their visits, doctors focus on the consultation, and medical service providers turn into a sustainable high-performance engine.
4. Clover Health
Case 4 Cover Health: Big Data + Deep Learning Algorithm identifies patient health risks in advance
Traditional insurance companies often intervene at the time after the customer’s claim settlement. Clover Health hopes to advance the insurance company’s health management intervention point before the claims occur, and identify the risk of customer complications through data analysis technology and deep learning algorithms. Intervene.
Clover Health’s data processing process is extremely complex. The company first collects data including public health, electronic medical records, inspection results, drugs, claims, etc., to understand the customer’s medical history; then the data is cleaned and processed, matching the model established in the database, the complications Make predictions; find high-risk patient populations and give intervention solutions to help them improve their health.
Clover Health has developed a product to predict which patients are most likely to be hospitalized within the next 28 days. It is said to have an accuracy rate of 85%, even exceeding the data model of the Google brain team.
5. Centene Corporation
Case 5 Centene: Big Data Analytics Reduces User Medical Expenditure
Centene Corporation can determine the possible health risks of patients through accurate medical big data analysis. The team collects the user’s medical history from the user’s past medical insurance claims data and matches the models established in the database to find high-risk patient populations and help them improve their health. Intervention of the user’s health before the illness can reduce the company’s payment in the medical insurance program.
Case 6 Humna: Big Data + Machine Learning, Service Covers the Whole Industry Chain
Humana uses emerging technologies such as robotic process automation, machine learning, cloud native application platforms, and open innovation architectures. From processing big data, interacting with devices through the Internet of Things, to electronic medical records, digital, mobile and cloud systems technologies, to traditional IT-related technologies.
In the field of healthcare services, Humana offers preventive treatment programs to help people who need to improve their health. The company uses intelligent analytics and works with clinicians to focus on the social impact of health issues, providing members with online resources and online services to help them understand the latest health benefits.
Other technical innovation hotspots on Medical Payments include:
II. Medical Payments and Machine learning
Case Cotiviti Holdings: Machine learning technology and natural language processing improve payment accuracy
As the cost of the US healthcare industry continues to rise, healthcare industry participants face increasingly complex clinical and financial risks. The core mission of Cotiviti Holdings is to help clients optimize financial performance, increase payment efficiency and overall medical value.
Cotiviti Holdings deploys clinical research in natural language processing (NLP) and machine learning, and employs analytical experts, more than 1,000 certified coding professionals, and more than 450 search specialists to provide comprehensive, end-to-end health planning Forward-looking and retrospective risk adjustment services and support. Combining expertise in natural language processing, artificial intelligence, and data analysis, Cotiviti Holdings ensures that risk-related revenues are optimized while maintaining appropriate compliance.
With its payment accuracy solution, Cotiviti Holdings recovered $2.7 billion in losses for its customers in 2015, and as a result, the company has since gained a reputation in the medical payment arena.
III. Medical Payments and Cloud Computing
Case ABILITY Network: “Cloud Computing + Medical” Simplified Claims Process
ABILITY Network is a typical representative of innovative payment companies in the field of cloud computing + medical. By connecting payers and suppliers through the SaAS-based myABILITYTM software platform, ABILITY Network simplifies the management of payer online access claims processing and reimbursement.
At the same time, ABILITY Network has also developed a number of online technology products, which are recognized by customers for their functional segmentation. In addition, ABILITY Network provides users with a complete solution that supports real-time medical services from pharmaceutical companies, equipment manufacturers and diagnostics companies to patient care centers, focusing on convenient payments, optimized claims processing and reimbursement, and improved care management. Quality.
IV. Medical Payment Digitization
Case Alan: Digital platform to improve user insurance experience
Alan achieved 100% online digitization. Through its partner PayFit’s digital online management platform, the company helps employers integrate employee payrolls with supplementary health insurance policies.
When purchasing Alan Insurance, users can send files via smartphone or upload files via PC-side website and pay online.
Alan automatically handles all paperwork for it and sends the data directly to the company’s payroll management platform. Before the visit, users can view insurance plan coverage, reimbursement policies and other information on the Alan platform. When reimbursing medical expenses, users can send medical bills to Alan platform, and directly contact Alan, and communicate the claims, the platform customer service will respond within 2 minutes.
This process not only simplifies the company’s salary management and human resource management procedures, but also optimizes the insurance purchase and claims process, transparent reimbursement policies, and helps employers save on health care management costs.
If “medical + cloud computing” and big data algorithms are the core guarantees that medical payment can be successfully realized, then the encryption technology in the payment process is the safety belt for medical payment. There are also representative companies in the field of payment encryption and natural language processing (NLP) technology.
V. Medical Payment Encryption
Case AxiaMed: Encryption technology guarantees payment security
AxiaMed, a healthcare financial technology company, has developed a PCI-certified point-to-point encryption technology for medical payments.
AxiaMed works with independent software vendors (ISVs) to provide secure patient payment solutions in their healthcare applications. By extending the payment options available to patients, the program simplifies management workflows, reduces bad debts, and effectively improves the financial performance of healthcare providers, making patient payments easier.
AxiaMed’s payment convergence technology platform fully integrates payment card functionality into electronic health record (EHR) systems, practice management systems (PMS), revenue cycle management (RCM) solutions, and patient-participating applications. Payment Convergence technology can be built into existing healthcare workflows to accelerate patient payments and streamline management workflows by accurately and timely updating accounting systems and ledgers.
The business model driving force
Business model innovation is a magic weapon for medical payment companies to find growth points. In the 15 medical payment innovation enterprises combed by the arterial network, five companies started from the perspectives of payment methods, payment channels, product design, etc., and explored the business model. However, at this track, Chinese companies seem to be more creative.
VI. Medical Payment method innovation
Case 1 Carrum Health: Bundled Payments Reduce Billing Management Complexity
Bundled payments based on value-based medicine are the biggest features of Carrum Health. Through a bundled payment program, Carrum Health connects self-insurance employers with local and nationwide healthcare facilities that provide high quality services.
In this mechanism, Carrum Health first collaborated with a number of small and medium-sized enterprises to aggregate large-scale insured people and form a certain market influence. Carrum Health then negotiates on behalf of these small and medium-sized business employers for specific medical services and medical institutions, and signs bundled payment contracts.
For employers, Carrum Health uses pre-determined bundles to pay prices, eliminating price discrepancies and unpredictability. Employees usually only pay a small fee. Contracted cooperative medical institutions can obtain additional customer sources through Carrum Health, and do not have to sign a bundled payment contract with each employer alone, greatly reducing the complexity of bill management.
Case 2 AccessOne: Bad credit can also apply, medical version of “Flower”
AccessOne is a medical credit card company that provides loan programs for people facing financial constraints such as high self-funding and high deductibles. AccessOne does not reject any patients who apply for loans, nor does it have a credit scoring mechanism.
When a patient applies for a loan, AccessOne evaluates the patient’s credit history and develops a suitable repayment plan based on their actual situation.
When the patient is about to expire, they will receive a dunning notice from AccessOne. If the interest-free loan patient fails to pay the loan within the time limit, it will be transferred to the interest-bearing account until the patient has paid off the balance and interest. If the low-interest loans are overdue, the repayment interest will be raised to 18%. If the patient stops repaying or refuses to pay, AccessOne will not report to the credit agency as other medical credit card companies, but will return the patient’s account to the visiting medical facility.
In order to guarantee the repayment rate, AccessOne will use its platform’s predictive analytics tools to assess the patient’s propensity to pay in advance and adjust the repayment amount to be controlled within the patient’s monthly repayment range.
VII. Medical Payment channel innovation
Case OODA Health: Real-time payment, medical version of “Alipay”
OADA Health, a third-party medical payment platform, is trying to establish a real-time payment system that allows doctors, patients, and insurance companies to perform their duties without worrying about bill payment.
OODA Health teamed up with California Blue Shield Health Insurance to create a cloud-based software platform. The platform simplifies claims ruling, medical billing and patient information collection processes, and provides intuitive patient care bills.
At the same time, OODA Health establishes partnerships with healthcare providers and acts as a middleman in the processing of billing documents, helping healthcare providers to exit the business process of bill collection. When the patient receives treatment, OODA Health’s software platform pays the medical service provider the first time based on the content in the electronic health record. Any unresolved payment issues are no longer handled directly by the health care provider, but OODA Health is responsible for negotiating with the patient.
In the new medical payment system, OODA Health is more like a “lubricant” between medical service providers, payers and patients.
VIII. Product Design Innovation
Case 1 Health IQ: High health literacy can enjoy premium discounts
Health IQ is a life insurance agency that connects both B and C. It is data-oriented and only provides premium discounts for health-conscious policyholders.
Health IQ assesses people’s health awareness through online health literacy tests. If the insured person is concerned about health and can pass various assessments, his life insurance costs can be as low as 33% lower than the average person. With 30 years of regular life insurance, policyholders can save nearly $10,000. According to Health IQ’s official website, 76% of policyholders who apply for insurance through Health IQ are rated by the insurance company as the best underwriting level, such as Preperred Plus, Preferred Best.
The reason why Health IQ dared to give such a large discount and be able to profit from large-scale customers was that the company created a large database from the beginning, which also became a moat for Health IQ to kill in new areas.
Case 2 Sempre Health: Highly compliant patients can enjoy prescription drug discounts
Sempre Health has established a prescription drug discount payment platform that enhances patient compliance with care plans, which is a combination of payers and pharmaceuticals to reduce prescription drug prices and patient care costs.
Sempre Health’s platform dynamically adjusts payment methods based on individual compliance and behavior, and the drug program is consistent with the user’s financial and clinical arrangements.
The Sempre Health platform uses a registered membership system. In order to allow patients to fill in prescription drugs in time and purchase on time according to the date of medication, Sempre Health has set a discount system for members; and in order to allow patients to go to nearby pharmacies to buy medicines in time, Sempre Health platform strives to open a nationwide network of pharmacies to achieve maximum convenience. Chemical.
When the Sempre Health member completes the first payment, in addition to triggering an update to the health plan, another piece of information is obtained that encourages the member to quickly complete the next tonic plan and calculate the appropriate discount based on the time limit.
In general, Sempre Health’s approach not only helps patients save money, but also urges patients to take medicine on time.
IX. Medical Payments Capital driving force
In the capital context, Clover Health and Humana show two paths to becoming industry giants.
Case 1 Clover Health: 6 years of financing $900 million, capital to help him become a unicorn
In 2013, Clover Health was established. With its core technology of big data and deep learning algorithms and differentiated competitive advantages, it has always been favored by the capital side.
In September 2015, Clover Health’s Series A financing reached US$100 million, and in December of the same year, Bank B raised US$35 million. In May 2016, Group C raised US$160 million.
In May 2017, the D round of financing was 130 million US dollars. As of this financing, Clover Health’s company valuation reached 1.2 billion US dollars, becoming a “unicorn”.
In January 2019, Clover Health received $500 million in Series E financing. So far, the company has raised a total of $925 million.
In six years, Clover Health completed six large-scale financings and quickly became an industry unicorn. Investors include Alphabet’s venture capital divisions GV, Sequoia Capital, Floodgate, Bracket Capital, First Round Capital and other large investment institutions.
Case 2 Humana: Acquisition + Cross-border Cooperation
In July 2018, Humana teamed up with two other companies to complete the acquisition of Kindred Healthcare for $4.1 billion. The acquisition continues the trend of insurance companies acquiring pharmaceutical suppliers and extends Humana’s reach into acute post-care.
According to the official website of Crunchbase, since its establishment, Humana has conducted 13 mergers and acquisitions:
In addition to mergers and acquisitions, Humana is also constantly cooperating with companies large and small outside.
Beginning in October 2010, Humana and Wal-Mart teamed up to provide services for Federal Health Insurance Part D (Prescription Drug Insurance).
In 2012, the two parties reached an agreement again, the two companies to provide co-branded prescription drugs program, in the Wal-Mart store for some customers of Humana to provide exclusive discounts on health foods.
In June 2018, Humana announced a partnership with Walgreens, a leading pharmaceutical retailer in the United States. Five months later, the company and Walgreens plan to expand their existing partnerships and hold shares in each other.
In September 2018, Humana announced a partnership with Fitbit, the world’s leading wearable health device brand, to help Humana members adopt and implement healthy behaviors to prevent and manage chronic diseases.
On March 15, 2019, Humana announced a partnership with Accolad, a similar company. The two companies will integrate their capabilities to create differentiated medical and welfare experiences for consumers.
It is these acquisitions and cooperation that have created Hubana’s current position in the medical payment arena.
X. Medical Policy Dividend driving force
As Amazon founder Jeff Bezos said, “Hold the trend, you will take advantage of the trend.” Policy-oriented, some companies have successfully captured the vent.
Case 1 Centene Corporation: Stick to the Affordable Care Act
The “Affordable Care Act” is in implementation since 2010. The main purpose is to increase the coverage of medical insurance and control medical expenses. The measures include providing medical insurance for low-income people, forcing companies to purchase insurance for employees, and prohibiting insurance companies from refusing to take sick insurance. And increase premiums, as well as more detailed insurance plans, including inspections, drugs, surgery, etc.
Trump has been trying to revise the Obamacare reform program since he took office, and in October 2017 canceled the government’s cost-sharing reduction payments, which are designed to help low-income people in the United States share the payment. Personal health insurance premiums for the Affordable Care Act.
Centene Corporation is a representative of a health insurance company that conducts business in a highly market-oriented economy in the United States with a changing policy orientation.
Company’s success attributable to the CEO
The company’s success is inseparable from the grasp of the situation of the two parties in the United States by Michael Neidorff, CEO of Centene Corporation.
Michael Neidorff said in the company’s quarterly earnings conference call: “Centene Corporation will continue to work with the two parties to achieve the goal of stabilizing the personal health care business market and improving the medical service system. At the same time, we believe that important institutional changes require two parties. The joint efforts of people. From the perspective of business and social welfare, Centene Corporation hopes to bring the best and most cost-effective service to more users.”
Centene Corporation has consistently stated that it will not abandon the personal health insurance business of the Affordable Care Act. On the contrary, the company is still expanding this business. In 2018, Centene Corporation expanded the personal health care business in Kansas, Missouri and Nevada and increased the promotion of the business in six other states that have already entered.
Case 2 Alan: Looking for opportunities in the new health insurance regulations
After more than 50 years of reform and improvement, the French medical security system has covered all citizens.
At present, the French medical security system is divided into two major areas: first, basic medical insurance (Sécurité sociale); second, supplementary medical insurance (Mutuelle). In 2016, France again enacted new regulations: from January 1, 2016, France requires all companies to purchase supplementary medical insurance for their employees and pay at least 50% of the premium.
The founder of Alan realized that the French regulations on supplementary medical insurance brought benefits to employees, but also burdened French small businesses and freelancers. Smaller companies and freelancers could not afford management and welfare. High cost.
Therefore, unlike the multi-line layout of large insurance companies, Alan focuses on providing health insurance services and has introduced medical insurance and life insurance for SMEs and freelancers. These two types of insurance are transparent in pricing, relatively low in premiums, and relatively detailed in reimbursement policies.
Alan is also the only independent health insurance company in France that has been approved by the French Financial Prudential Regulation Authority (ACPR) for 30 years.
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