Effortless Basware Invoice Processing for Insurance Industry

Basware invoice processing for Insurance Industry

earlier this week an Ivy League educated man in his mid 20s became the prime suspect in the murder of a healthc care executive last week in the aftermath of the killing there's been an outpouring of much anger that's been targeted at the healthcare industry and at Corporate America making many wonder if this incident could change the way Healthcare insur the healthcare insurance industry operates joining us right now with his expert insights is Mark berini he's the CEO of Oscar hell he's also the former chairman and CEO of Etna among a lot of other different positions that he's held in the healthcare industry and Mark I want to thank you very much for being here it's great to be here thank you Becky you you are somebody who has so many insights into how the healthc care industry works and I know you've got some big thoughts about what should change you've been thinking about this for a long time um we've talked to you for many years about these things but obviously there's a huge amount of attention that's being put on this um in the public and in Washington and there might be a real opportunity for change um just wonder first of all what you think about what you've been hearing back from the public and the anger over denials and and and where we stand at this point I mean it's kind of crazy that we've gotten to this point well I I think the anchor is Justified um you can't talk to anyone in this city and not get a story about a claim denial or a prior authorization was just talking with some of the people outside you know getting the right drugs whatever and I think what's happened is the provision of healthcare the investment in people's Health has changed dramatically while the insurance industry hasn't and the way we buy Healthcare hasn't um 80 years ago we created this employer sponsored system because we were trying to offset inflation so no wage increases but we could offer benefits at the same time there was this expected population explosion and then we had the hill Burton act in the ' 50s that built hospitals everywhere and so we created both demand and Supply increases that have not slowed since the population boom happened and all of this costs I mean if you look at the percentage of GDP going to healthcare it's now just under 20% and in 1984 it was 9% so as you look at these changes over time we've just outrun our ability to afford the way we do it there are questions about whether we get appropriate outcomes for the amount that we are spending on it I I would argue that since 1984 Healthcare has gotten better for the the vast majority of Americans but it still falls short um it falls short of expectations when you're talking about spending 20% of GDP and and life expectancy has gone down yeah is it is it lifestyle or is it I mean the healthc care is better and and we have the best we have the best right technology and healthc Care in the world but if we're going to if if 50% of the population is going to be obese it it it's you're running into a buz saw you can't there's no health care that that is is going to be great enough to to handle the the lifestyle problem your ZIP code matters more than your genetic code in your health so how you live and where you live actually matters and and so we have huge issues in rural communities around the country but probably the most important thing is that healthc care has now become very individualistic I want it to be fit for me m and when my employer buys my HealthCare coverage they buy for the average right so what would what would you do I mean look Elon Musk was out there just this earlier this week we were talking about it yesterday suggesting that the the answer is if we could get you know a huge percentage of Americans on gp1s we could bring the cost down uh of Healthcare in a remarkable way especially if you could get the price of GOP 1es to come down in a remarkable way what would what would you do what I would do is I would eliminate employer sponsored Insurance you say that and it it it stops my heart a little bit because those of us who who have employer Healthcare think oh my gosh getting thrown in so everybody's dealing with Medicare Advantage that seems like a pretty terrible thing and I would argue that my healthcare insurance while I'm not always thrilled with it at least I have an employer who can go and argue for the mass of us there's a lot of us and that that at least has some bulk if I'm if I'm out there on my own it feels like there wouldn't be any protection that comes with it the ability of your employer to negotiate against a large insurance company that has much a larger relationship with the provider Community is very stinted now you can't get stunted you can't do it now um and you're saying the companies have no leverage the companies have no leverage now interesting and you look at the basic Foundation of our economy which is small business and and and and Middle Market they have none and they're seeing double digit rate increases when just over at the in the individual Market our Trends been three and a half% each year why do but do do the claims get turned down more readily in the individual Market than they do so it's the same our denial rate is less than less than it's 12% is our United Healthcare I'd seen 23 to 33% yep and and the only one that's lower than we are is Kaiser because they don't do it um and Kaiser doesn't do it because the Physicians are taught to practice in a certain way with one another right so they know how to refer within the system and to the right people here's here's what we hear we we hear things like AI systems being put in place at United Healthcare that that are turning down claims and overruling doctors that are requesting it I I've heard Etna where you used to be the CEO uh that there were Health claims officials who said who testified that oh yeah we turned down we turned down we were denied people's requests without even seeing their medical records at times I mean it's it's that much of a system where doctors will complain that they have to hire multiple people just to sit online to get through to insurance companies to then be turned in what we've known for more than 20 years in the insurance industry is that the large majority of Prior authorizations that we do always get done anyway but yet we make everybody go through through the Hoops mhm and so and the reason is is again employers buy for the average of their employee population they buy large networks cuz their employees use a lot of providers and as a result the ability to negotiate a better rate with that provider group is a lot less because you got everybody in but when you get narrow networks which is what's happening in the middle in the individual market and you have everybody in an individual can find their Network they don't have to rely on their employer to build the network does it mean that as an individual if I'm really healthy and young I can get a much better premium but if I'm somebody who has a family and is using the Healthcare System I'm going to be paying a lot more so here's how you have to think about it you have to think about the employer giving to employees what they've traditionally given them for benefits it's defined contribution instead of defined benefit you allow that employee with some assistance to understand what's going on in their in their use of healthcare to get them into the right plan