The Evolution of Digital Communication Strategies: Optimizing Payer and Provider Communication

Fax technology in healthcare, and the associated workflow solutions, have evolved in parallel with the rest of the industry’s technological advancements. Today’s augmented intelligence solutions include artificial intelligence (AI), machine learning, and process automation. These technologies strengthen traditional fax communications and speed workflows, which naturally encourages more robust payer and provider collaboration.

The Evolution of Digital Communication Strategies: Optimizing Payer and Provider Communication

While paper fax technology is often utilized in both payer and provider offices, adding digital faxing capabilities, including AI-assisted processing of critical documentation, optimizes workflows without a hit to productivity. Integrating these more mature systems streamlines traditional processes and enables better business practices for organizations leveraging this new technology.

Content Summary

Cost of inefficient systems
Digital evolution, a hybrid environment
Optimizing solutions, adapting for disruption

Innovation in payer and provider communication technology is key to achieving efficiency through the rapid and consistent changes in healthcare. As the industry in general experiences unprecedented levels of strain, the need for coordinating care and payment increases, as does the need for strengthening the current lines of communication in the US healthcare system.

For the foreseeable future, fax technology will remain a crucial tool connecting providers and payers. Organizations large and small will continue to employ fax technology to facilitate vital information exchange toward optimal care and better financial outcomes for the patient or member. Fax in its many forms is used to share key organizational and patient-level quality and reimbursement data between the industry’s two most prominent stakeholders.

Without fax as the “universal connecter,” payers and providers would have no way to communicate this information securely and ubiquitously while adhering to HIPAA guidelines.

Fax technology and associated workflow solutions have evolved in parallel with the rest of the healthcare industry’s technological advancements, often being the primary bridge for communication or filling in system gaps. Today’s augmented intelligence solutions include artificial intelligence (AI), machine learning, and process automation. These technologies substantially strengthen traditional fax communications and speed workflows, which naturally encourages more robust payer and provider collaboration.

While original paper fax technology is often still utilized in both payer and provider offices, adding digital faxing capabilities, including analysis and artificial intelligence-assisted processing of critical documentation, can optimize workflows without a hit to productivity. Integrating these more mature systems can streamline traditional processes and enable better business practices for organizations leveraging the technology.

Concord Technologies commissioned a vendor-neutral survey of healthcare payers to understand how these stakeholders are using fax and other technologies to communicate with providers and to identify friction points in these workflows. Results confirm fax’s prevalence within payer organizations will continue to be the communication glue, bridging the gaps of disparate and unstandardized clinical and administrative technologies.

The survey results highlight how the industry is in a hybrid world—some reliant on paper faxing and others leveraging the most innovative fax communication solutions. To meet provider needs and accomplish their own business goals, payer organizations require solutions that can enable effective communication to and from all their providers, reduce administrative overhead, and meet the complex needs of their members.

Cost of inefficient systems

Nearly 40 percent of respondents believe that finding a more reliable and effective digital fax solution will increase staff productivity, and 30 percent believe it will improve a critical pain point of provider abrasion. Solutions for fast and effective communication between payer and provider translate to reduced friction, more informed responses, and an overall reduction in the time it takes for timely payment decisions.

Inefficient and laborious communication systems may also reflect negatively on the payer organization at large, creating tension with providers. One respondent spoke to this point directly,

“All the transactions that are an administrative burden can become abrasive points to our relationship with providers. If you become incredibly difficult to deal with, the provider will let members know. If you minimize the pain points, you will gain support.”

Streamlining communication from provider offices to payers creates a better user experience for the provider and reduces tension when working with payers in the future.

Externally, failures, delays, or errors in communication workflows have an impact on state and federal requirements. Payer organizations can be fined for delayed responses to grievances and appeals and missed deadlines to meet regulatory standards. The state of California alone fined payers $21.7 million from 2014 to 2019. And in Delaware, the highest fined health insurer had to pay the state $383,000 for penalties accrued from delayed appeals and misaligned benefits.

It is unsurprising that when asked how often they worry about the fax system’s performance preventing their team from rendering medical necessity or coverage decisions, 78 percent of respondents indicated that it is top of mind either daily, weekly, or monthly. Many of the challenges presented by unreliable systems are avoidable and do not need to cost payers’ reputation, capital, or time.

Digital evolution, a hybrid environment

Fax is the universal integrator in healthcare. One hundred percent of respondents indicate they use fax machines, multi-function printers with fax capabilities, or digital fax software to enable providers and members to submit patient clinical documentation.

In instances of utilization management, the documentation burden can be staggering: the average number of documents received daily can be over 500; the average number of pages per document is greater than 75. Other areas such as appeals and grievances, call centers, claims and adjudication, and risk adjustment show similar daily document and page volumes.

“Faxing is also used in our community relations, provider networking, and relationships with members, particularly during the authorization process,” one payer explained.

Currently, between 28 and 46 percent of clinical documents received by fax are processed manually, depending on the department receiving the information, which creates significant room for human error and delays. The number of administrative staff assigned to categorize manually is staggering, with 57 percent having one to ten full-time employees processing fax communications, 18 percent have 11 to 60, and 24 percent have over 61 employees. But an automated and enhanced faxing system would have the ability to reduce this burden.

Because fax stretches across multiple departments at payer organizations, enhancing fax capabilities can positively impact multiple business lines.

The average number of documents received daily can be over 500; the average number of pages per document is greater than 75.

Between 28 and 46 percent of clinical documents received by fax are processed manually.

Optimizing solutions, adapting for disruption

For evident reasons, 76 percent of respondents say investing in a more reliable and effective digital fax solution is a priority. And nearly half (48%) indicate that it is a medium to a high priority for their organization. Not only can it reduce provider abrasion, but a more reliable and effective fax system can improve internal workflow, optimize business needs, and reduce missed deadlines.

“Insurers know they have to communicate to keep their clients happy. Because of the pandemic, I think we communicate more digitally with our clients than ever before,” emphasized a respondent.

Digital faxing solutions can eliminate disparate systems’ challenges, moving holistically towards more reliable, innovative, and functional healthcare communications. These innovations include programmatic workflow and process automation and artificial intelligence (AI) for specific data extraction from a faxed document (e.g., patient name, MRN), document classification (identifying a claim vs. a prior authorization request), document handling, and routing.

Combined, the positive impact of digital fax solutions for a payer organization can be far-reaching. From appeals and grievances to risk adjustment, many departments across the business could see a decline in administrative overhead, less need for human intervention, more accuracy, and reduced error with implementing digital fax technologies. 76 percent of respondents say investing in a more reliable and effective digital fax solution is a priority.

The prevalence of fax communications within payer organizations will continue to be the communication glue, filling the gaps of disparate and non-standardized clinical and administrative technologies. Fax technology has continued to innovate, resulting in significant strides in the reliability, functionality, and precision of healthcare communications. Payers have an opportunity to leverage these continuous innovations in fax technologies to reduce administrative overhead and the manual burden associated with provider communications.

Content from Concord Technologies