The time for payer and provider industry collaboration is now: insights from SKYGEN Summit Transform 2022

Updated on April 12, 2023

Payers and providers share a common ground on doing what is best for the patient, both from a care and cost standpoint. However, amidst changing regulations, technological advancements, economic fluctuation and consumer expectations, the payer and provider relationship can often be strained. At SKYGEN Summit Transform 2022 — an invite-only annual event bringing together leaders in specialty benefits management and technology — four leaders in the dental and vision industries discussed the future of the providers’ digital journey, and why that future is a brighter one of opportunity when payers and providers collaborate. SKYGEN is a leader in the vision and dental specialty benefits management, technology and administration space.

Featured participants of “The Future of the Provider’s Digital Journey” presented at Transform 2022 include: 

  • Jeff Meyerhofer, group head, commercial payments, Optum
  • Teresa Duncan, president, Odyssey Management Inc.
  • Heather McDermott, product manager II, specialty benefits, Principal
  • Ankit Khandelwal, engagement director, OverJet

Current landscape

Whether you’re speaking from the payer or provider perspective, the types of challenges may vary but one thing most can agree on is that recent years have put pressure on payers and providers in a number of different ways, including: 

  • Demands on customer service: A growing need among providers to have all the correct payer information has created undue demands on customer service. Coupled with the loss of institutional knowledge as a result of the COVID-19 pandemic and practitioners leaving the industry, new workers who are untrained in dental insurance are struggling to keep up. This is only exacerbated by a lack of transparency between payer and provider portals, such as clarity regarding pay structure, fee schedules and care estimates.
  • Rising consumer expectations: As Uber and Amazon-type shopping experiences become the norm, consumers now expect that their healthcare providers offer some level of centricity by leveraging technology. 
  • Provider expectations: The COVID-19 pandemic forced many operations to shift from in-person to digital. For healthcare providers, this includes shifting from processing claims through physical checks to electronic payment submissions. With payment processing time reduced and the overall customer and employee experience improved, technology like this is no longer a differentiator but a must-have to enable digital transformation across the entire provider domain. 

Future landscape

The COVID-19 pandemic changed the culture of dental and vision practices but also created future areas of opportunity for trust, interoperability and transparency.

  1. Opportunities for payer and provider collaboration: There is a growing recognition that there is more to be gained through payer and provider collaboration than without it, with 92% of providers wanting greater collaboration with health plans, according to a HealthSparq survey of 100 hospitals and health systems. 

    One way this could be achieved is through increased collaboration between practice management software, payers and offices, either through the payer and provider working together to establish best practices around data flow or by investing in technologies like automation and AI that bridge the gap between the three.  

    As traditional methods for payer and provider data sharing are timely and cumbersome, having a clear flow of data exchange by making information clearer and readily available on portals can encourage trust and transparency, improve consumer satisfaction and reduce administrative burden. 
  2. Investment and improvements in technology and automation: The advancement of digitalization as a result of COVID-19 has come a long way in healthcare but there is still progress to be made in investing in technology and automating manual processes. 

Opportunities for innovation include electronic claims adjudication, online real-time estimates, treatment planning and benefit eligibility information, as well as self-service capabilities like online chat tools and PPO applications. 

Using AI as a companion to the physician to quantify information can furthermore build transparency between the payer and provider. For instance, AI can be built into the claims adjudication process with automated criteria that determine when information is missing and notifying appropriately when manual action is required. 

  1. Opportunities for member and provider: There will always be opportunities to improve the member and provider experience but where this will become increasingly evident is in how providers’ self-service capabilities and tools evolve in response to meet member trends. 

    With a heightened focus on data transparency, the provider will need to listen to the member needs and continue to add new features to existing portals to enhance the member experience.

SKYGEN bridging the gap between current and future landscape

SKYGEN, a leader in transforming benefits management and administration, is bridging the gap between the current and future landscape by embracing opportunities for advancements in technology and innovation. In looking for opportunities to go from manual to automated, SKYGEN is investing in tools like OCR and chatbots to facilitate a digitally interactive relationship.

Furthermore, the creation of an online appointment system that actually taps into provider practice management systems to understand the availability of those appointments will create new avenues for efficiency.

Whether you’re a provider, payer or a specialty benefits management company like SKYGEN, at the end of the day, it’s all about sharing a common sense of purpose of putting the patient first and making each touchpoint along the member and patient journey more seamless. 

Klotz Kyle 0
Kyle Koltz

Kyle Koltz is chief operations officer for SKYGEN.