Jay Fulkerson, president and CEO of HPS, talks about a streamlined payment method that helps providers and consumers, and shares his thoughts on the importance of payment reform in the healthcare industry.
Organization Overview: Health Payment Systems (HPS) is a healthcare technology company aimed at taking waste out of the claims administration process, while making the healthcare payment experience easier for consumers to understand. The company's provider network includes more than 6, 500 healthcare practitioners in Wisconsin. HPS enrolls more than 75, 000 patient members and has 40 employees.
Bio: Jay Fulkerson joined HPS in 2011 and serves as the president and CEO of HPS. Previous to his role at HPS, Fulkerson served as Chief Executive Officer of Touchpoint Health Plan in northeast Wisconsin. Following the acquisition of Touchpoint by United Healthcare, he served as Chief Executive Officer for Wisconsin and then as Regional Chief Executive Officer for United Healthcare's Midwest Region.
Q: Why is the need for Payment Reform so vital for the future of healthcare?
A: The current payment system is convoluted, confusing and wasteful. We need to rethink it from the ground up if we're serious about doing the very best for healthcare consumers. Providers often forget how important the payment and claims process is in shaping patient opinion, and how damaging it can be to their reputation if it's mismanaged. Studies show patient satisfaction with their provider decreases 10 percent from the time of discharge to after receipt of the bill. We'd like to see that turn around-where the payment process is another opportunity to affirm the strength of that provider's brand and mission.
Q: Which approaches do you think show the most promise?
A: As a technology company, we look for ways to close existing gaps or delays by streamlining the payment process and connecting its various components. For example, we've put all of a family's medical claims on one Super EOB, so they don't get inundated with bills. We pay providers the entire claim-both payer and patient portions-in a single payment to help reduce providers' risk. We've also worked with Provider Owned Health Plans and ACOs to consolidate their billing process, so they can focus on delivering care, not on collecting bills.
Q: What are some "small wins" you've seen in the Payment Reform space over the last couple years?
A: The fact that stakeholders on all sides are now talking seriously about this issue is a huge step forward. We've seen some great innovative thinking and people who are willing to take a fresh look at the roles each entity plays in the payment process. Our single-payment model has been a win for providers, and we've gotten feedback from patients about how much they appreciate the simplicity of our Super EOB.
Q: What challenges remain?
A: No one is sure where to play in the game right now. I think that's something we, as the collective healthcare industry, need to continue to work through. We need to shift our idea of competition in order to work together toward better value for patients and communities.
Q: What advice can you share with leaders who want to address Payment Reform?
A: Be proactive. Look for opportunities to learn from and engage with people who are thinking about this differently. Small changes within the current framework aren't going to be enough-you need to connect with companies who are reshaping the healthcare landscape for five and ten years down the road. Also, let your internal team know how important this is for your organization. The payment process is big and messy, and employees can be hesitant to change how they've always done things. Lead by example and let them know they have your full support.
Q: What would you say are the most important next steps toward Payment Reform?
A: One of the initiatives we're working on, which we're very excited about, is launching a Payment Value Stream. In partnership with a local provider system, we'll be examining each step in the current process to see where we can remove waste and create value. This is an area of care not many people have looked at through the lean lens, and we think it'll give us great insights. We also continue to work at incorporating the voice of the customer and transparent performance data into our approach.
Q: What questions should healthcare leaders ask (of themselves or others) when considering Payment reform?
A: Are you ready to put skin in the game? The healthcare industry is all about caring for patients, but the truth is we've been failing them (and ourselves) on the payment side. Leaders need to shed their old mindsets and look for ways to make sustainable change.
Q: What are some tips for engaging physicians or staff in payment experiments?
A: Ask them to think like a patient. Would they want their parents or neighbors to go through the existing payment process? No. It becomes a burning platform for becoming engaged around new solutions.
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