Interoperable Data and Payments Are Healthcare’s Future, Says Bank of America

Amid an array of healthcare data and reams of medical payments handled by banks exists a triage opportunity.

This, as inroads are being made to decades-old standards used by both sides, to make it all more cohesive and interoperable.

“Especially in the healthcare industry, as more organizations merge and become bigger,” Andres Jimenez , director, healthcare receivables product lead at Bank of America (BofA) told PYMNTS. “What ends up happening is you get these clients that have multiple systems that they need to maintain, and then they need to create integrations between their banks and all the other financial revenue cycle systems that they’re using to analyze the challenges to healthcare data interoperability for banks.”

That’s been a heavy lift for all the expected reasons — strict healthcare data laws, almost as stringent banking regulations — but the trio of payors, patients and providers have tasted the connected experience and want healthcare payments to move with the same seamlessness.

Providers and payors want fewer integrations to maintain using application programming interfaces (APIs). Banks must shift to providing these solutions for healthcare clients as interoperability grows into a modernized state that benefits all stakeholders.

“Especially in the environment that we’re in today, economically, there’s a need to focus on cost and efficiency,” Jimenez said. “What you see with systems that aren’t interoperable, or when you have solutions that don’t work well together, you create more costs.”

At present, he calls the system “convoluted” and anathema to the frictionless end-to-end payment experiences payers, patients and providers now want. It won’t happen overnight, but banks can play a pivotal role in creating the envisioned smooth interoperability.

The Optimal Healthcare Middleware

With the current approach of FinTechs and solution providers often directed to solving pieces of the puzzle, banks already have most of the data needed to solve interoperability issues in healthcare payments. It’s moving the broader industry in this direction that takes some doing.

Jimenez said, “One of the reasons I came to Bank of America is that unique opportunity where we sit in the middle of all of that. We’re moving the payments between, in some way, shape, or form, from one account to the other across those three different stakeholders.”

That creates an opportunity to forge a platform through which all this information and payment data can pass to shorten revenue cycles. It begins with simplifying how the information passes between disparate systems.

“That’s really the goal we have here at Bank of America. Our strategy is to get to a place whereby having all three stakeholders in one environment, we can achieve automation that has never been able to be put in place in the industry before,” he said.

Given the regulatory scrutiny to which banks are accustomed, from data security to payment accuracy, they are in many ways better suited to the task than FinTechs focused on one aspect.

Jimenez said with banks involved, “What you end up having is these platforms and security protocols that are probably more robust than your average FinTech and or HealthTech technology company are able to implement.”

Not only do banks have the deep pockets to afford to perform and maintain these integrations, but as they focus more on connecting the banking ecosystem and the healthcare technology ecosystem, “you end up in this area where you can get a robust and secure platform by going through a bank rather than through a secondary technology company just because of the amount of investment and the regulatory environment” that banks tend to handle best.

Building Healthcare Data ‘Exit Ramps’

Harking back to the old information superhighway analogy, but updated, Jimenez said payers, providers and patients “are already on our interstate. We just need to build the exit ramps to the appropriate systems, and then we can facilitate the exchange there.”

This simplifies the integration process and obviates the need for apps, usernames, passwords and the old-school way of accessing and exchanging healthcare and payments data.

“I would rather have something simple where I can log in once and have all the data flow directly there,” he said. “That’s kind of the vision that we have for healthcare banking and healthcare interoperability through a bank. It’s one of the things that we’re most excited about here at Bank of America.”

Again, this is a journey more than a destination in a healthcare industry still manually processing 10 billion to 11 billion documents annually, with many providers particularly still married to fax and manual data entry. Costs, time and errors can be eradicated, but the industry must confront the issue for that to happen.

Rather than tossing out new API standards and hoping others pick up on them, BofA is working with industry leaders across payers, providers and patient experience platforms to evolve interoperability without adding yet more operational complexity.

“It makes more sense [for this data] to live with the banks than with a random or smaller company that is breaking into the space. There’s a lot out there, and we’re looking to make this a collaborative approach with the industry and other banks and financial institutions to solve for this across the board so everybody can benefit,” Jimenez said.