This is a PYMNTS Original Podcast.

KAREN: Hey, Bill. Thanks so much for joining me today. It's great to catch up, and I'm looking forward to chatting about health care payments and the whole lot that has happened since the acquisition by JP Morgan Chase about a year ago, and certainly the global pandemic, which has changed just about everything along every aspect of our economy, obviously, including health care and health care payments. So thanks for making the time.

BILL: Yeah, thanks, Karen. It's good to be with you. Thanks for having me.

KAREN: So let's start with a little way back time travel. So it's been about a year, a little more, than the acquisition of InstaMed by JP Morgan, and obviously a lot has changed just by the nature of that acquisition. At the same time, we've obviously been wrestling with the impact of the global pandemic on the health care system.

Break it down for us. What's the journey been like, and what has been the biggest impact of all of that on InstaMed and the business?

BILL: Yeah. It is quite a journey. And first things first is we're very customer-focused. And when things started to look like we'd have to go into a disaster recovery mode or work from home mode, the first thing we thought about was our customers. And you could see how difficult it was starting to become to engage with them, and you want to give them every bit of space that they have to run their business. Without them, we're nothing. So we want to make our customers successful.

And just seeing how health care has been impacted unlike any other industry, here's an industry that has all hands on deck, yet at the same time they can't work from home. And while they're all hands on deck, they're not getting paid. They're having to shut down areas of their business where their more profitable areas had to be shut down or throttled and held back.

And I think every other industry out there where you had to work and you had to push through this has gotten rewarded, in many ways. But it's been very different for the health care industry. So it's an area that's impacted unlike any other industry. And I think what we've tried to do is just really bring forth a lot of online education, online support for our customers.

And really, we were welcomed right away with thanks, and hey, I was thinking about how to start taking online payments, and I know we use you guys for point of sale and first some telephone payments. But we really want to address that online payment capability that you've talked to us about for so long, and we've held off for. So can we engage on that?

And of course, when that kind of phone call or inbound would come from one of our customers, they wanted it done ASAP. So it was really an interesting journey, and one that we've had a lot of empathy for with our customers. And I think that we're just seeing that a lot of the extra bells and whistles, and the online and digital kind of technologies that we have to offer, which a lot of times people will start working with you, they want to do everything, but they just do 10%, 20% of what you offer, we're getting more and more adoption of the more advanced capabilities that we have on our platform. And so it feels like the market is really valuing what we do more and we're seeing this in our existing customers, and we're seeing it in new customers.

KAREN: So Bill, let me ask you a couple questions about some of the digital shifts. And we see this in so many other aspects of what we've all been through in every aspect of our lives. And I'm curious to get your thoughts on which of the trends were pre-COVID that have accelerated? And where are you seeing things that are just different, perhaps because of COVID and the pandemic, where you've had to step in and work with your customers to innovate and deliver a product or an experience to deal with whatever those points of friction or issues might have been?

BILL: Yeah. So really, for us, we've had an omnichannel approach to payments for a long time now, for over 10 years. And so we didn't have to rush to package new things up or partner or rush to market with a new offering. It's been more about walking our clients and new clients quickly through the implementation process to get up and running and. A lot of times, where an organization might take their time and be pretty diligent over a couple month period, they're moving in days.

So we're seeing, I think, some really good signs for health care. And that is, put simply, health care can rapidly implement technology. And case in point would be those health care providers moving to telehealth very quickly and doing it in a matter of days rather than months, and then realizing, OK, now I have telehealth. How am I getting it paid for what I just did?

And so you know wrapping that payment experience in around the telehealth delivery model is important. And oftentimes, I think payment is an afterthought for the folks who are very focused on health care and their customers and their patients, I should say-- for them, their customers are the patients. They're thinking about how to cure them. They're thinking about-- they go home at night they read medical journals.

Like my father, who was a cardiologist. He would be in his office reading medical journals. And that's what they do. They're not tinkering around on the web looking at new technologies. Some of them are. More and more today are. But by and large, they're thinking about care and delivering care.

So delivering care, here comes telehealth. Great thing to accelerate the adoption of in your practice if you want to start seeing patients again quickly. And then the afterthought, oftentimes, is, well, how am I going to get paid for it now?

So we've had a lot of these conversations and a lot of implementations around this. And I think to your question, Karen, it's just pulling through a lot of technology that you have been talking about and that we and other innovators, fintech innovators, have been doing in the marketplace for a while. But it's pulling that adoption curve forward rapidly. And for me, it's pulling it forward in the health care industry, which has traditionally been an area that has not moved quickly.

KAREN: But Bill, why is it that they could move in days, not months or many months? Decision process is one thing, but then there is the implementation and execution. Walk me through the decision. So the inertia was broken. Yes, we need to figure out how to get paid. Yes, we need to figure out how to be more digital because that's what our patients need. But how do we actually deploy that inside of our organization? How did you help them reconcile what I've now decided to do with what I actually need to deliver?

BILL: I think us, as innovators and people who deliver cloud-based technologies, know that we can stand up our technology very quickly. And in the implementation world, we have this saying called pushing a rope. When you push a rope, you go nowhere. When you pull a rope, you go somewhere. But when you're trying to work with a customer on an implementation, let's say in 2018, well pre-COVID, there's only so many things you can do to turn that app on quickly when they're busy running their business.

And busy running their business pre-COVID meant you have an emergency, you have a new therapy or a new technology that you're deploying to help patients get better care and help their wellness. And those things are coming top of mind, and getting the bandwidth of the leadership to get into the administrative side is kind of always this lower priority thread in health care.

Now take that same organization, and they're not seeing patients anymore. Their doors are closed. There's no one in their waiting room asking questions. Where does their bandwidth go? Where does their time go? It goes to how do we get this engine moving again? So now they're no longer pushing a rope in the implementation process.

They're like, I need this configured. I need it connected, integrated to the system over here. Can you show me a sample statement of what things will look like? Instead of that statement being a multi-week review process with multiple sign-offs, it's just give me what you got. Give me the basic template. I want to get it going. I want to stand this thing up.

It's like what we call in software development minimum viable products. we're? Talking about minimum viable implementations where you're going to stand it up quickly, and you're going to get it live quickly, and you'll come back to the pretty logo you want on the statement or the digital email and text notifications, and customizing that, and the language you want with your brand and your voice versus just the stock stuff that we have out of box that you can turn on instantly.

So we're turning things on instantly, and we're giving them what we got out of the box, and they're not taking the time to slow the implementation down and customize and configure and do all those other things. So that's how this process has worked in the last several months.

KAREN: Interesting. So where are most of your customers now in the journey? Hopefully they're starting to see patients again. There is more activity in the medical field. People still get sick. They still need to see the doctors. Are they sticking with their minimum viable product? Are they asking for customization? What now is the problem they need to solve, and how are you helping them solve it?

BILL: That's a good question. I don't have data specifically on this. I'd say business as usual for us was probably about half the number of advanced feature implementations in the product platform a year ago as it is today. So there is a lot of existing customers digging in more, and then new customers that are coming on board reaching deeper into the product, into things like contactless payments, automatic payments, digital electronic statements.

We don't want to touch a kiosk. When we do open up the waiting room, we don't want to touch a kiosk. We want to support a bring-your-own-device model for checking in. Just really, in general, I think, embracing the omnichannel payment approach, where you can take a payment any which way you can, whether it's phone, point of service, initiated from different communication mechanisms.

This is the journey that I see the clients taking. And I also think it's important to recognize-- I don't want to say where this ends, but kind of everyone talks about this get back to normal, get back to normal thing. And in other industries you hear that term used a lot.

I don't see us getting back to normal in health care. I think it's going to be a whole new normal in a very different sense than what we're going to see in an airport, for example. In health care, these organizations are figuring out literally how to take one floor and make it a COVID floor, or how to take one wing and make it a COVID wing, and kind of quarantine off that side of their care so that the rest of the patient population can feel comfortable walking in that other door again.

So building trust. And trust, as a theme, is something that the health care organization is have to do more. It goes beyond technology for health care. It goes to infrastructure and how physical plants are set up. So this is going to take some time to get back to normal, or if there even is a normal, it'll be very different from before.

KAREN: It strikes me, Bill, that what these practices are doing is they're rethinking the flow, the workflow. I had to see my doctor a couple of weeks ago, and everything was staged before I got there. So all that silly paperwork that they still hand you a clipboard to fill out, what is that all about? We're still doing clipboards? But we were doing clipboards in January with the pen and the paper.

And now all of that is done electronically, and copays are taken care of electronically. And when you arrive, there is a very different experience in that waiting room, which, of course, has social distance. But there's no there's none of that shuffle with payment and check in that there used to be, and it's such a better experience for the provider and such a better experience for the patient. It's a shame that it took a pandemic to kind of move us there.

BILL: Yeah. And just think about this. You've got Millennials now, the largest part of our workforce, they have employer-sponsored insurance. These Millennials are natives to digital. They've grown up with it, unlike you and I grew up with it. And they're looking for digital experiences. And their loyalty is actually levered on the digital experience, unlike loyalty that we've seen in other demographic segments of patients.

So now you have not just a small segment of a patient customer base that's technically savvy, but you have a whole new generation of digital natives that are looking for digital experiences and will drive their loyalty levered on how well that digital experience works for them.

KAREN: For sure. And it's just a much more efficient process. Let's talk about the revenue cycle management piece of payments, and rethinking the workflows for providers, who now can not only accept digital payments, but in so doing, manage those payment schedules. I had to pay my copay upfront. I usually do. But getting people to pay at the point of service versus having to chase people down and get collections from them months down the road. Is that also a driver for digitizing and modernizing the digital health care experience?

BILL: Yes, it is. And I think that you look at the hotel industry, and we all check into a hotel, and we don't know exactly what we're going to owe before we check out. But there is a process in that industry that works really well where you can leave the hotel and get billed the right amount and get a invoice via email. And there's trust in that transaction.

Health care is always going to be a little different because of the extra regulatory responsibilities that parties have. And we're never going to quite get to the experience in the hotel industry because the forces in health care are different. It's a three-party payment system. So there's other people's money involved. It's not just you, the consumer and the hotel. It's you the patient, and a lot of times it's your employer. That employer could be self-funded, so it's the employer's money now. There are agents that are custodians and fiduciaries of that money.

And there are penalties for providers who abuse, over bill, or there's fraud and other things that kind of create this additional friction that also adds to complexity in health care. So I think as we're seeing newer models come to health care, where it's more direct to the consumer, I think you'll see more of a hotel seamless checkout kind of experience.

But in the third party system where other people's money is involved, the patient's money and someone else's money, trust is lower, complexity is higher. And there continues to be a need for more clarity, more information, more digital tools in order to make that whole cycle work better and work faster.

KAREN: So Bill, as you think about the evolution-- you used that word to talk about the payment cycles and the innovation around it-- where do you see the evolution of your customers taking advantage of these advanced capabilities in terms of ratcheting up the digital experience? Where do you think we go from here? I agree with you that who wants to go back to January of 2020 when we've made such great progress in digitizing and making the experience better for provider and patient. But where do you see the next crest of the wave?

BILL: I think, just stepping back a bit, the health care industry has been digitizing since I founded my first company back in the early '90s and we did the electronic claims. And that was kind of the first wave of digitization was take that claim and make it electronic. And then in the early 2000s, it was the internet's here. We can do eligibility, and driving that transaction electronic.

And I won't enumerate everything in the last 30 years, but we've kind of seen a continuous move towards digitization going transaction by transaction that's involved in health care. And there are several different communications between payers, providers, and patients or consumers that need to happen for this to flow. And we're definitely at the stage now where the consumer transactions, like your patient statement, like your patient payment, that's the digitization frontier now.

And the number of patients that want an electronic statement out there today is over 80%. And we do this survey, and over 80% of the population of patients out there want to get their statement electronically. Yet there's this massive dislocation between supply and demand because 10% are actually able to send an electronic statement. So there's a whole new frontier.

And I think what we'll see, Karen, when we look back at this era, is there'll be like a step change in the adoption curve. The curve was moving up at a certain slope, and then it hit COVID first quarter of 2020, and there's this inflection where the slope just went vertical. And we get up to this new step, and it'll be a step change.

But the thing about health care, with the three party system and with regulatory pressures on the different parties, it's going to continue to be a block and tackle, chip away at it, one digital transaction at a time kind of adoption curve. But we will have seen in this year a big step change moving us forward.

So no going back. Is part of that step change telehealth and how that is going to influence care as well as payment going forward?

KAREN: Yeah, I think telehealth is part of it. And I'll just tell you how we look at telehealth because I think it can be confusing looking at this stuff from the outside, and it's all digital, it's all technology. But we compartmentalize it by saying, anything that has to do with care or wellness is in kind of this one camp over here. And anything that has to do with the administration of health care and actually getting paid and moving money and moving information for the purpose of getting paid is in this other camp.

BILL: And so telehealth, at its essence, is about wellness. It's reaching out to people faster, more real time on the patient's terms, maybe when they're in their home, versus making them get up in the cold and take a bus in and take it to a hospital.

So telehealth, at the core, is a wellness capability. But it gets tied into what we do on the administrative side because it's just natural to go from that making the patient better step to OK, now we need to pay for it step. It can be done better now because it's digital on digital versus real world, and now I need to go to a point of service and swipe a credit card. It's 100% digital and digital.

KAREN: Yep. Well, Bill, there's so much to talk about. It's such a it's such a fascinating area of digitization. Your perspective on the journey has been great. And the gap that exists in terms of what patients want in terms of the digital experience, and how many providers can actually provide it shows the opportunity ahead. And the step change, the jump discontinuity, as we would describe it, that is no going back. We can't go back. We have the tools to continue to go forward in a very innovative, positive way for an ecosystem.

And Bill, I look forward to teacher conversations where we can continue to talk about that progress. Thanks again for your time.

BILL: Yeah. Thank you, Karen. And if I could just say in parting that health care really needs this digitization. Our [INAUDIBLE] need it. Health care needs it. It's great for patients. It's better to have digital interactions than paper interactions. And we're in a time where we're health care really needs this digital technology. So thank you for the time. And thank you for what you do. And we'll look to talk again soon.

KAREN: Yes, for sure. Thanks again, Bill.

BILL: All right. Bye bye.