WORKWEEK

The U.S. spends nearly two times more on healthcare administrative costs than peer high-income nations, thanks to the health system’s administrative complexity.

But who bears the brunt of such administrative complexity and bureaucracy? The burden predominantly falls on provider groups, health plans, hospital systems, and digital health companies.

In this article, I’ll highlight the administrative costs of U.S. healthcare, dive into Medallion who’s successfully streamlining the administrative complexity, and share insights on why Medallion might just be the solution you need.

The Deets

Administrative spending accounts for 15-30% of all healthcare spending, amounting to hundreds of billions of dollars annually. To put it into perspective, on an individual scale, these administrative costs exceed $900 per person. This figure is alarmingly four times greater than the average administrative costs in other high-income countries.

But what exactly do I mean by ‘administrative costs’?

David Cutler succinctly defines them in the Hamilton Project as “the nonclinical costs of running a medical system.” These encompass expenses such as billing and insurance processing, physician administration, general business overhead, quality assurance checks, and credentialing processes.

The obvious way to reduce administrative spending in this fragmented and complex healthcare system is to standardize administrative activities. McKinsey has projected savings of approximately $265 billion annually just by standardizing procedures, from physician licensure to scheduling. Moreover, an initiative as straightforward as unifying provider directories onto a single platform (see Medallion below) can lead to an estimated annual saving of $1.1 billion. This not only simplifies the administrative process but also aids patients in effortlessly locating in-network providers.

Medallion: Standardizing Healthcare Operations

Medallion is an integrated platform that streamlines the most complex and burdensome aspects of healthcare operations by handling medical state licensure, payer contracting and enrollment, credentialing, and ongoing monitoring of provider networks. The company launched at the height of the pandemic when provider groups and other companies struggled with licensing telehealth providers across states. After quickly solving the licensing problem, Medallion evolved into a centralized provider network management platform.

Healthcare operations today are like taking the stairs when you could be taking an elevator. It’s slower, less efficient and more tiring.

Since 2020, Medallion has worked with 300+ provider groups, health systems, payer organizations, and digital health companies, saving them 500,000+ administrative hours. Now, Medallion has 32,000+ providers on their platform and has completed 78,000+ licenses, enrollments, and credentials.

Medallion focuses on three key areas that are significant pain points in healthcare operations:

• Credentialing
• Payer contracting and enrollment
• Licensing and continuing education

Credentialing

Medallion’s platform has pre-built integrations to hundreds of primary sources, allowing organizations to automate primary source verification and speed up credentialing. Their system will auto-check state licenses and board certifications, as well as check sanctions to ensure disqualified providers are out of networks. Medallion sends automated alerts about important provider eligibility changes, helping you manage risks and stay within regulations.

Payer contracting and enrollment

Medallion can handle the payer contract negotiations that all medical organizations dread. Medallion will take on the heavy lifting by taking over the negotiation process on organizations’ behalf, saving you time and resources. Medallion will also upkeep CAQH profiles, reducing administrative burden, preventing enrollment delays, and freeing up time for more essential tasks. They’ll pull provider data into their platform to complete 70% of a provider’s profile, reducing the repetitive nature of administrative and manual work. Recall from above that unifying provider directories can save costs!

Additionally, Medallion can help get providers in-network with government or commercial payers all through their integrated platform. And, to help maximize reimbursement opportunity, Medallion will notify organizations when enrollments are coming to an end—with one click, organizations can submit a revalidation request to reenroll the provider.

Licensing and continuing education

The automated process to license providers in new states while adhering to ever-evolving state license requirements is a standout feature of Medallion. Even better: beyond initial licensing, Medallion excels in tracking and automating license renewals, ensuring providers remain compliant without the hassle. Additionally, they assist organizations in organizing continuing education requirements for providers and enable tracking of completion.

Dash’s Dissection

When you dissect the intricacies of healthcare administrative tasks, the magnitude of responsibilities and the sheer potential for errors is evident. Every task, from credentialing to licensing, has its own set of challenges, intricacies, and repercussions if not done correctly. Such tasks, if handled manually, not only become a drain on time and resources but also become prone to human errors, potentially jeopardizing patient care and increasing financial and reputational risks for provider groups, health systems, payers, and digital health companies healthcare organizations.

Here’s why I think Medallion’s platform is transformative, what I’ll call the #MedallionAdvantage:

1. Single Point of Contact: Instead of juggling multiple systems or vendors, healthcare entities can centralize their operations. With Medallion, you don’t just have a tool; you have an end-to-end solution that simplifies the labyrinthine nature of healthcare administration.
2. Scalability: The platform’s capability to have 32,000+ providers and handle over 78,000 licenses, enrollments, and credentials highlights its robustness. As healthcare entities expand or diversify, Medallion can effortlessly scale up to accommodate growing needs.
3. Proactive Approach: With automated alerts, organizations don’t have to chase down essential changes. This proactive approach ensures that the required actions are taken in time, mitigating risks.
4. Economic Value: Beyond the apparent time-saving aspect, the financial implications of using Medallion are significant. If we recall the potential of saving billions by streamlining administrative processes, then an integrated platform like Medallion is a necessity.
5. User Experience: With the emphasis on automating repetitive tasks and offering a cohesive experience, users can focus on what truly matters—providing quality care to patients.

In summary, while the U.S. healthcare system may be riddled with complexities, solutions like Medallion are paving the way for a more streamlined and efficient future. By centralizing and simplifying operations, they’re ensuring that healthcare professionals can refocus their energy on their primary mission: patient care. For provider groups, digital health companies, and indeed, all stakeholders, partnering with Medallion seems less of a choice and more of a strategic imperative in today’s healthcare landscape.

Schedule a demo here!

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