Relationship Management Technology is Paramount in Healthcare’s Retail Transformation

Recently, HealthIT & mHealth explored whether patients should be considered customers in the strict sense of the word. Independent of this classification, there is a movement afoot in healthcare in which a transition is occurring from the status quo of a traditional market, to that of a retail market, with the patient at the center.

The retail revolution is transforming the healthcare business through the rise of consumerism, quality-based payments and accountable care. Employers are shifting more of the healthcare cost burden to employees through high-deductible health plans. With the shift toward health savings accounts (HSA) and high-deductible health plans, out-of-pocket expenses have grown. As a result, patients are evolving from uniformed price-takers into shrewd consumers of healthcare services. As they absorb more of the costs of their healthcare, patients are increasingly scrutinizing how they are spending their healthcare dollars.

Unfortunately, lack of healthcare cost and quality transparency inhibits patients from making the most-informed decision. The more the patient knows about pricing, the better they can budget for out of pocket expenses and routine costs related to chronic conditions. Recently, credit-reporting agency Transunion released the results of a survey that found that 80% of respondents listed price transparency as a factor in choosing a healthcare provider—on par with bedside manner. 79% said they’d be more likely to pay their bills in a timely manner if they had price estimates before getting care.

As such, whereas the focus of healthcare IT has been on implementing and integrating Electronic Health Record systems that demonstrate Meaningful Use standards over the last several years, the next several years will be devoted to healthcare organizations seeking solutions that help them acquire and retain patients within the complex healthcare environment. Hospital and health system economics are starting to experience this emergence of a new retail insurance market and growth of retail shopping for care. As a result of this tectonic shift, providers across the care continuum must put patient relationship management at the center of their operations and delivering quality in service to ensure patients return.

The technology backbone to patient relationship management is starting to take form and slowly permeate provider networks with new service delivery paradigms resulting. While recently at MGMA15 in Nashville, HealthIT & mHealth had a chance to catch-up with two health information technology vendors who offer solutions for the healthcare retail transformation.

The first, NaviNet, is an established health IT vendor, connecting over 40 health plans and 450,000 clinical and administrative healthcare professionals. The second is an entrepreneurial start-up, SpendWell Health, a wholly owned subsidiary of Cambia Health Solutions, which provides healthcare consumer e-commerce and retail enablement solutions for innovative employers looking to accelerate cost savings and offer a better consumer engagement / activation experience. In fact, both of these organizations recently announced a strategic partnership through which SpendWell will leverage NaviNet’s vast provider network to offer health plans, third-party administrators (TPAs) and self-funded employers an e-commerce platform that enables members to purchase bundled healthcare services directly from providers.

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By integrating SpendWell with NaviNet’s multi-payer portal platform, the joint solution helps payers and providers reduce administrative costs associated with eligibility verification, claims submissions, collection risks and customer service calls. It also improves member satisfaction and retention in an increasingly competitive marketplace. The market for shoppable procedures as defined by the Advisory Board is more than $700 billion according to its recent report, “Blueprint for Growth 2020: Product, Pricing, and Sales Strategies for a Retail Market for Health Care.”

“Being at the nexus of payer and provider, and having access to the size and scale of network that we do, there is a distinct opportunity for innovation to enhance the provider and patient experience,” said Grant Ho, Vice President of Marketing, NaviNet. “At our Customer Forum in Boston, it became clear that enabling access and delivering value-added service to a broad and deep network was critical to our strategy and allows partners such as SpendWell to complement the NaviNet experience.”

“When you are small and a startup, a partner with the credibility and scale of NaviNet helps open doors and provides a conduit to bring our novel retail enablement solution to a broader audience,” said Kerri Mansberg, Vice President, SpendWell. “It’s striking that in some cases it’s cheaper for patients to pursue domestic medical travel – leaving one’s home state or region to travel to a designated ‘center of excellence’ for high-quality, more-affordable surgical procedures or episodes of treatment. In this transforming retail, consumer-driven healthcare market, our solution provides the type of transparency for provider groups to retain those patients and for patients to better understand what they are getting for their dollar.”

While meeting Ho and Mansberg at MGMA15 and with the transformation to healthcare retail consumerism top of mind, there happened to be a panel on pricing transparency, in which Cheri Kane, managing director at PriceWaterhouseCoopers (PwC) was a panelist.

“It’s a huge opportunity for providers to start building pricing transparency because no one really trusts their insurance company,” said Kane. “People trust their providers; the providers have the relationship. It’s an opportunity for them to share the price, help them through that price, and develop that loyalty. If not, patients are going to start turning to the payers.”

Providers who are not taking advantage of this movement will end up losing patients, said Kane, especially the younger population. “Patients will pay more for a better consumer experience,” she noted. “We have to do a better job of supporting them through that process.”

It’s clear that the empowerment of the healthcare patient-consumer is upon us. NaviNet and SpendWell are two vendors whom are committed to innovating to enable increased access and transparency to the patients on behalf of the providers.

About NaviNet

NaviNet is America’s leading healthcare collaboration network. We connect over 40 health plans and 450,000 clinical and administrative healthcare professionals, representing 60% of the nation’s physicians. Through NaviNet Open, our payer-provider collaboration platform, and our ecosystem of partners, we help payers and providers lower costs and boost care quality, while enhancing the provider and patient experience. For more information, please visit and follow us @NaviNet on Twitter.

About SpendWell Health

SpendWell® is the leading digital health care e-commerce solution that empowers insured consumers to shop, compare and buy routine health services at actual prices. SpendWell’s online marketplace integrates benefit plans, removes consumer anxiety about surprise bills with upfront payments, eliminates patient collections risk for providers and reduces administrative inefficiencies and costs for payers. SpendWell transforms the traditional health care model for consumers, providers, employers, health plans and administrators into an online retail experience. SpendWell’s nationwide community of providers includes medical, dental, vision, behavioral health, chiropractic over here, alternative care, imaging and more. SpendWell is a wholly owned subsidiary of Cambia Health Solutions, Inc. Learn more at For more information about SpendWell, visit

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