Brian Robertson, Founder and CEO of VisiQuate, describes the relationship between payers and providers, noting that payers have the advantage due to unified data and lower complexity than providers face. He emphasizes that providers could level the playing field by unifying their data and leveraging AI to predict and prevent claim denials and solve systemic problems. The ultimate goal of using data and AI in the revenue cycle should be patient-centered, ensuring that the technology leads to more accurate billing and better outcomes for patients, providers, and payers.
Brian explains, "I would say in general, and I think a lot of us in the industry know this, the payer or the health plan has the edge, partly because they have fewer jobs to be done every day. They manage a financial risk engine for the most part. And if you consider that the other side of that is the provider who has to have all the upfront labor, all of the upfront dollars, they have to think about every permutation of care and patient satisfaction and physician satisfaction. So good care benefits for patients. So there are a thousand jobs to be done on the provider side, and I'll just say fewer jobs to be done on the health plan side. And the health plan side controls the money."
"I think in today's world of AI, he who has the more unified data has the edge. And I think there's little debate that the payer right now has the edge because they have a unified dataset and are a financial risk engine. So, I think the opportunity is for providers to use the power of data now to begin to bring a little bit more balance to that question. And they've got a hard job ahead of them, for sure."
"So our core value proposition is really centered on data unification. We're getting into many case accounts, transactions, charges, claim files, remittance files, and third-party data sets from providers who sometimes are on one system of record. Often, they're on many systems of record. So we have to get all of that fragmented data, normalize, cleanse, unify, and curate that data for action."
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