The Optimal Payments Healthcare Mix. Mark Goettel WEX Inc. Senior Product Manager William Bill Barbato Alegeus Technologies Sales Executive

Transcription

1 The Optimal Payments Healthcare Mix Mark Goettel WEX Inc. Senior Product Manager William Bill Barbato Alegeus Technologies Sales Executive

2 Agenda Introduction Who is WEX What is a Virtual Payment? How Do They Work? The Payment Landscape: Check/ACH/Virtual Payment Method Pros and Cons Healthcare Claims Payment Optimization: 7 things to consider Optimized, Outsourced Payment Solution WEX / Alegeus Solution Who is Alegeus Payment Optimization Case Studies

3 Who We Are

4 What is a Virtual Payment? A virtual credit card is an electronic B2B payment solution designed to pay your providers No physical plastic (It s electronic!) One time use, secure account number Real-time processing Near real-time payment availability Transaction specific controls Enhanced data quality 400,000 of 650,000 healthcare providers have accepted commercial MasterCard payments for healthcare claim payments. $5B in 2013.

5 Virtual Payment Process Payer Manage & Approve Claims for Payment (Existing Claims System) Send Check File Run Wait for Check Cash and Clear Customers continue to manage claims through existing processes but send a file to WEX/Alegeus for automatic processing Provider Accepts Payment Through POS Send Electronic Payment Instructions File Push Payment to Provider (Credit Card Network) Controls assigned Real-time, automatically 5

6 Virtual Payments: More Cost Efficient Payer cost: $0 Payer cost: $ Provider cost: $ Provider cost: $ Total: $3.12 Total: $13.86 Virtual Payment Cost $0 1: Reflects average payment cost of $ using Claimsnet data sample for $0-$300 payment segment. 2: Scotiabank check issuance cost model 3: WEX estimate based on Scotiabank model.

7 I refuse providers Provider Payments: Many Potential Users Current Spend Small Dollar 90% by Paper Check Big Dollar Mostly ACH 600, , , , ,000 EFT-averse providers Sophisticated providers 100,000 0 $ $ $ $ $ $ $5000+ CHECK USERS Small physician offices VIRTUAL CARD USERS Small and Medium physician groups ACH USERS Large hospital systems

8 Pros and cons of payment methods Payment Method Pros Cons Check Universally Accepted No Specialized Equipment or Expertise ACH Efficient Reliable Cost Effective Funds Availability Remittance Detail Virtual Card Ease of Acceptance Ease of Implementation Funds Availability Float Risk Remittance Detail Slow Less Secure Expensive Inefficient Not Free Cost of Implementation Competing Priorities Enrollment Financial Privacy Cost of Acceptance

9 Healthcare claims payment optimization: 7 things to consider 1) Provider request 2) Recurring payment 3) Frequency of payment 4) Percentage contribution to provider revenue 5) Average size of payment 6) Is your provider ready and willing for ACH-CCD+ payment? 7) Payments to non-hipaa covered entities

10 The game of healthcare payments

11 Healthcare claims payment optimization: 7 things to consider 1) Provider request Legislation: ACA Operating Rules 2) Recurring payment One-off or infrequent payments Low return on ACH setup investment

12 Healthcare claims payment optimization: 7 things to consider 3) Frequency of Payment Set a threshold 4) Percentage contribution to provider revenue Set a threshold and model, by provider

13 Healthcare claims payment optimization: 7 things to consider 5) Average Size of Payment Consider impact on merchant acceptance fees 6) Is the provider ready and willing for ACH-CCD+ payment? Is Provider Ready Technically and Administratively Will Provider Supply Banking Information? Can the Provider Support Enrollment? 7) Payments to non HIPAA Covered Entities Workers Compensation, and Casualty, etc.

14 WEX Alegeus Relationship Payment Outsource Solution ERA/835 CHECK ACH PAYER/TPA PMT FILE VIRTUAL CARD PROVIDER

15 15 Payment Optimization Case Studies

16 Strategic Partnership to Help You Unlock Your Potential You need a trusted partner to Provide insights into the market direction, employer needs & provider acceptance Determine the go-to-market strategy to best position your business for growth Deliver the best solution & capabilities in the market The right strategy & partnership will deliver: Revenue growth Differentiated value Market leadership Increased customer stickiness Superior consumer & employer experience Provide the best service experience for you, your customers and your participants 16

17 Client brand awareness; builds credibility Processed just like a patient payment Alegeus answers all payment related calls, including providers who want to Opt Out Presentment of front and back side of card 17

18 Use Case 1: Large Benefit TPA TPA Bio: Providing a claim crossover service Printing with a large scale third party print vendor Innovative cultural personality Seeking economic savings and relief from postage dependency Goals: Seeking financial savings and relief from postage dependency Continue offering claim crossover service to employer clients Minimize disruption to banking and operations teams Ensure provider community is treated fairly 18

19 Use Case 1: Large Benefit TPA (cont.) Success Story: Year 1 payment mix: Virtual Card ~ 85% Check ~ 15% Tailored provider communication Financial Benefits: Saved $165k per year payment mix change No expense, virtual card solution Year 1 benefits = $165k 19

20 Use Case 2: Small Medical TPA TPA Bio: Supporting self-funded employer groups Seeking economic savings and relief from postage dependency Current Alegeus print fulfillment client Financials: 20k provider payments per year $1,550 per payment average $30M spend per year 20

21 Use Case 2: Small Medical TPA (cont.) Success Story: Year 1 payment mix: Virtual Card ~ 55% ACH ~ 25% Check ~ 20% Tailored provider communication Financial Benefits: Saved $26k per year payment mix change No expense, virtual card solution Year 1 Benefits = $26k 21

22 22 Questions & Answers?

23 Thank You