Innovator: Vince Marzula, managing director of healthcare solutions, BNY Mellon
Recent Innovation: Access to SSI's eligibility services platform
Why It Matters: Healthcare payments is a complex market in which to develop payments
What's Next: Expansion of healthcare payments to mobile
When it comes to healthcare payments, banks are the kids in the candy store-the consumer-direct healthcare payments revolution is sparking a huge and fast-developing market when it comes to processing payments for providers. But it's not an easy market-there are a lot more moving parts than for other types of payments.
At BNY Mellon, the healthcare IT hot seat belongs to Vince Marzula, who's tapping every bit of his extensive and unique blend of experience in technology, financial services and healthcare to stake the institution's claim on this emerging and complex payments category.
There's large potential-the Employee Benefits Research Institute estimates that 22 million people were enrolled in consumer direct healthcare plans at the end of 2010, an expansion of more than 10 percent over the prior year. Marzula's expertise will go a long way toward the success of BNY's healthcare payments strategy, which is a mix of IT projects and partnerships.
Marzula says the goal of plan sponsors to shed costs by migrating consumers out of more expensive HMOs and PPOs into high deductible plans offset by HSAs and other consumer direct products is re-ordering the healthcare payments game. He's positioning BNY Mellon to take advantage by using a mix of front and back office tech muscle to be the savior that simplifies data access, navigation, execution and fulfillment for both consumers and providers. "If I'm a consumer and come in with my insurance card, how do I know if I'm covered and for how much?" he says. "It's become complex because now healthcare providers have to collect income from the patient before the insurance company pays."
Marzula's skills and experience-which includes serving as an EDI consultant for a global health enterprise, as well as a stint on a NACHA/ABA joint HIPAA task force-are in demand: BNY Mellon in January hired Marzula-who was a healthcare solutions specialist at cross town rival PNC Treasury Management-to be BNY Mellon's new managing director of healthcare solutions.
The University of Pittsburgh grad was immediately thrown into the deep end of the pool. BNY Mellon in January made an aggressive push by teaming with The SSI Group to extend the bank's electronic bill pay capabilities to SSI's healthcare clients. The partnership gives providers a "pay now" button on their screens that they use when interacting with SSI's eligibility services platform. The "pay now" button serves as a link between SSI and BNY Mellon's ClearTran operation in West Paterson, NJ, and is designed to enable faster and more accurate electronic bill presentment and payment processing.
ClearTran provides enterprise payment solutions that allow businesses to receive and capture customer payment information, automatically process payments with their financial intuitions, post payments to accounting and customer billing systems and manage payment processing systems with reporting and audit controls. Marzula and his four-person product team manage the tech pieces from the different parties, and present bills and transaction information to clients in an integrated form, delivered through a web presentation that Marzula likens to a cloud.
The components of the platform include information-analyzing consumer data to validate insurance coverage, verifying the cardholder's identity, and determining the out of pocket expense. Other data such as referrals for additional care, the existence of supplemental insurance and an estimation of the consumer's ability to pay, are analyzed to help providers develop a payment plan for the consumer's out-of-pocket expense. Payments from both the patient and insurance firm are then included as part of a data management piece that reconciles healthcare transactions with a consumer's bank account.
BNY Mellon stands to gain a lot of payments share, given its access to SSI's substantial client base. The firm is the second largest institutional healthcare claims clearing house, and processes more than 311 million transactions annually, including claims, eligibility, remittances and claim statuses, totaling about $600 billion in claims revenue.
The bank's plays, which also include plans to provide access to services on mobile devices, come as more banks begin to consider healthcare payments processing, with PNC, SunTrust, BofA and U.S. Bank being among BNY Mellon's primary competitors in healthcare processing.
Kunal Padya, a senior analyst for the healthcare payments and insurance practice at Aite, says providing back office processing to providers is an advantageous move, particularly when building relationships with private practice and primary care physicians. That places Marzula and his team right in the middle of where the health payments battle will be waged. "There is a disconnect for the smaller providers, who don't have the economy of scale [for integrating eligibility, cost estimates and processing,]" Padya says.