We have reached point solution fatigue. The future of health care transformation depends on integrated platforms.
Have you ever wondered what happens once a patient’s insurance card is scanned at their doctor’s office? The answer: a lot.
Each time a patient visits a doctor, it sets off a cascade of behind-the-scenes work. These critical “back-of-house” tasks include patient identification, insurance verification, and prior authorization reviews. They are essential functions that ensure transactions between patients, payers and providers are accurately accounted for, billed and paid.
But these crucial steps come at a steep price: the administration of financial health care transactions in the U.S. accounts for $200 billion annually. As the industry continues to face cost pressures, payers and providers must find ways to make their operations more efficient and lower expenses.
Many have turned to point solutions that address these needs. Point solution help automate specific tasks, such as patient information management, eligibility checks and claims processing. Their promise is to increase data accuracy and reduce administrative delays, leading to more efficient processing and cost savings.
But there’s a major downside: these point solution systems don’t “talk” to each other.
Because of proprietary APIs and software systems, many health care-specific point solutions serve only one specific function at a time, such as appointment scheduling or in-person visit summaries. This creates a patchwork of disconnected systems – each solving a single problem, but none can communicate with one another.
Providers lose nearly 90 minutes per day on administrative tasks navigating multiple disconnected systems. The result? Data gets lost between systems, workflows get tangled and compliance risks go up.
The Challenges with Point Solutions
While point solutions can deliver efficiencies for individual tasks, they often fall short when tackling complex, interconnected processes, such as health insurance claims processing. It is estimated that about 85% of claim denials are avoidable, with many stemming from incomplete or inconsistent data.
Imagine a team trying to put out a fire: if each person grabs a bucket, fills it with water and runs one by one to pour it on the fire, the effort quickly becomes slow, exhausting and inefficient. Meanwhile, the fire continues to spread as valuable time and energy are wasted on these individual, repetitive actions.
Now, imagine if the team uses a hose instead of buckets of water. Water flows continuously and powerfully, and the entire team can focus their efforts on controlling the hose and directing the stream to areas where it’s needed most. This simple shift illustrates the transformation needed for health care claims processing. Rather than relying on “buckets” of individual solutions, the industry needs scalable platforms that enable data to flow smoothly between providers and payers.
The AI Shift to Platforms
Industry leaders are beginning to recognize the limitations of point solutions and are exploring ways to pivot to more integrated platform systems. It’s a change that can reshape the industry’s technological capabilities—and it’s possible now due in large part to the evolution of AI.
AI innovation has made notoriously challenging tasks simpler through automation, and the industry is increasingly using it to launch platform systems that focus on practical needs, such as claims processing, with capabilities that extend far beyond thoseof point solutions.
This shift to platforms isn’t just about efficiency. It is about spotting trends in patient behavior, such as missed appointments or gaps in preventive care, allowing providers to reach out with timely reminders or support. On the payer side, AI can flag out-of-network services and help route patients to in-network services. When information from scheduling, billing and clinical records flows through one integrated platform, AI can analyze the full picture rather than isolated fragments.
However, a platform system can only work if it has accurate and transparent information from all stakeholders. For example, to process a claim, the system requires visibility into contracts executed by both providers and payers, details of services rendered, and coverage parameters. The more comprehensive the information in the system, the faster and more accurately claims can be finalized.
This collaborative stakeholder approach is still new, and there are only a few examples of platforms that bring payers and providers together. However, that is beginning to change. Industry leaders are increasingly working together to develop solutions that address systemic challenges. And that’s where platform solutions can truly make an impact.
The Future of Care
The future of health care administration is about moving away from isolated, single-purpose tools and investing in smart, connected platforms powered by AI. Industry analysts estimate that fully automating and integrating administrative transactions could save the health care sector more than $20 billion annually.
For patients, an integrated platform will help provide transparency and minimize or remove surprises. Instead of waiting days or weeks for paperwork to be processed or worrying about the status of insurance claims, patients gain immediate clarity. They can leave their doctor’s office knowing exactly what they owe, whether their authorization has been approved, and have a follow-up appointment scheduled—all in real time. The experience becomes similar to a retail check-out experience.
Ultimately, to truly address the rising cost and complexity of care, the industry must embrace integrated platform solutions that encourage interoperability, streamline workflows and provide real-time insights.
By moving beyond isolated fixes and investing in scalable, AI-enabled, connected platforms, payers and providers can unlock new efficiencies, improve data accuracy and focus their resources where it matters most—delivering better outcomes for patients.
About Madhu Pawar
Madhu Pawar is the Chief Product Officer at Optum Insight, a part of UnitedHealth Group, where she leads the product strategy and commercialization of AI-enabled solutions that streamline clinical, administrative, and financial processes in health care. She is widely recognized for her expertise in intelligent engagement platforms and applied AI and is driven by a deep passion for solving complex health care challenges through innovation.
