Simon Terry

Home » Future of Work » Designing the Future of Health & Care Payments: Portals and Platforms

Designing the Future of Health & Care Payments: Portals and Platforms

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Digital transformation in health, care and disability is delivering new customer and provider experiences. A focus on design of customer experiences is important, but equally important is leveraging the digital potential of provider platforms. Government and private schemes need to consider both portals and platforms in designing their claim and payment approach for providers.

Designing Experiences for all Stakeholders

Design thinking is now a standard part of any digital transformation project, especially in health and care. We now understand the value of taking the stakeholder’s perspective as we shape new digital interactions. These insights can deliver significant benefits from new, more flexible processes and interactions.

Choice and control requires three parties to collaborate. While schemes are focused on delivering choice and control to consumers by designing new customer experiences, enabling providers to support choice and control in health and care is equally important to achieve the policy outcomes. A design that does not cater to providers by delivering easy and certain claim and payment, will fail to deliver its goals.

Choice and control for consumers = Creating new customer experiences + Enabling providers

Many payers use portals for consumers and providers to manage transparency of their funding and payment of their claims. Portals force everyone through a dedicated app, website or digital channels. The payer has full control of the experience and can design it to suit its needs and preferred experiences, but they have lost the flexibility consumers and providers need.

At LanternPay we see an open multi-scheme platform is a better way to deliver choice and control in health and care. A multi-scheme platform like LanternPay offers simplicity that reduces costs for all participants and integration with the wider ecosystem of health and care solutions.

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A platform approach also means providers and consumers can interact in the ways that best suit them. LanternPay does not dictate a single channel and seeks to integrate with a range of customer and provider solutions. This way the choice extends to where each party prefers to transact. For example, there is a rich and vibrant market of consumer search and booking applications, a scheme that is looking to bring transparency and choice to the market can launch its own to compete and gain a share of the market or it can leverage a platform to deliver an experience to its customers wherever they are.

Bringing Provider Focus to Consumer Experience

Design thinking challenges us to put ourselves in the shoes of each stakeholder and that means making choices to suit the breadth of consumer and provider needs. The best digital experience is not always the one that fits in a single channel. This is particularly the case for providers, whose needs are often given less attention.

When we put ourselves in the shoes of a consumer or a provider, we see the hidden costs of portals. Consider a physiotherapist starting their day by delivering care to a Transport Accident Commission of Victoria client at 9am. Their appointments that include a mix of private patients, worker’s compensation patients and several other government schemes. Given a typical health or care provider can deal with many schemes in a single day, adapting invoicing to each scheme’s unique payment approach can be costly, complex and filled with uncertainty. In addition, providers often must bear the challenge of explaining the payment processes to the consumer, which can mean they bear the brunt of customer frustrations.

The scheme controls its interactions to suit its needs. Consumers and providers need to go to the portal and manage the process for that scheme. This results in inconvenience and cost. Also, winning adoption for new processes can be challenging. Scheme portals need to invest in marketing and communication activities to win provider adoption. Given the many demands on provider system vendors for integration, scheme portals often fail to deliver integrated solutions that fit into providers’ standard business processes.

Providers are in the business of providing care, not adapting to multiple claiming portals. If the complexity or cost to the provider is too great, providers will either stop providing services to that scheme or increase charges to cover the extra costs. Many government schemes already see the costs of small pools of providers and high service costs. Consumer choice and control is meant to help address these issues. Imposing costs and complexity on providers in the claiming process will directly impact the benefits of consumer choice and control.

Platforms bring a diversity and volume of ready-to-transact providers to a scheme. Providers are familiar with the standard claiming processes and integrations in place make that an easier part of their business. At LanternPay, we have been able to work with schemes to deliver rapid provider claiming pilots with schemes. These pilots easily demonstrate the value of bringing providers to payers and enabling consumers to take control of their care in new ways.

The market for health and care is complex. No one solution is likely to meet the needs of all consumers, providers and payers. At LanternPay, we believe a focus on design thinking requires payers to consider the value of both portals and platforms. In the next post, I will look at the added value that platforms can bring in enabling access for payers to an ecosystem of innovation.

Simon Terry is the Head of Markets of LanternPay. LanternPay is an open cloud-based claim payment platform designed to standardise claim payments across the health, care, disability, insurance and ageing sectors. 


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