Agentic AI + ACH Transforming Healthcare Payments

Hey everybody, Payments Professor here and I am excited because today we're going to kind of talk about how healthy your payments are. Stay tuned, there's more on that to come. I have Ryan Tennyson, He's from Solution Reach. There I go, messing things up right away.

I'm glad to get that out of the way. Those of you who know me know I'll mess something else along the way, so don't worry. But Ryan is from SolutionReach.com.

Ryan, did I get it right the second time? Yes, you did. Well, Ryan, I want to welcome you to the payments podium. I know you've listened to an episode before, so you probably know the first question I got for you.

When it comes to working in the world of electronic payments, I've only talked to two people in my life who said, that's what I wanted to do growing up. Most of us, we ended up here because we're like, I needed a job or I was able to process the ACH file. I've heard that one a lot too. But for you, how did you end up here today?

What got you into the world of electronic payments? Yeah. So I had started my career in the veterinary space and we had provided tools that over my career, I wanted to integrate into practice management systems. And what I found was more and more often, I got requests of how that would connect to payments.

So when I reached about nine years into my career, I was starting to get an itch to try something new. So I decided maybe I should actually explore FinTech a bit. It seems to be something on top of everybody's mind. And at that time, digital payments were rather new, not completely new, but something that I could see was going to start to become much more common in the future.

So I decided to go ahead and take the leap. And I worked at a payment gateway known as PaySimple for a while. Oh, okay. So just to be clear, you didn't come in, you know, kicking and screaming.

You voluntarily decided to come into the payments world. I did. I did. I found it a little bit interesting, a very complicated subject.

And that challenge kind of wanted me to move a little bit deeper in, see if I could become an expert in it. Well, I love you mentioned the challenges that exist in electronic payments. I know you're in the side of healthcare, and I know there are gaps that exist between where we have the industry and we have the payments taking place and sometimes even sub gaps that are in between there. Could you enlighten me a little bit on where there are gaps in happening right now with healthcare payments?

Absolutely. I'd say that it's interesting because as digital payments have become far more common in retail and other forms, you know, Amazon's taken over. Online checkout is by far the most common these days. Healthcare has lagged a bit behind.

And I think there's a couple of reasons that make sense. One, they like to really vet new technologies and make sure they're working. There's obviously a lot of sensitive information that these platforms interact with. However, I also think that because of the involvement with insurance, which is also heavily regulated, there is a bit of a gap before they even implement a technology they feel confident in.

And so what we've really seen in healthcare is primarily that they wanted to make sure everything worked the way that they'd like it to before they even gave it a real shot in implementation. Okay. So I heard you right. It is because, and I get that.

I'm really glad to hear, hey, we take a long time because there's a lot of sensitive information that we won't get out. And then the other side that some of us moan and groan about, the insurance companies being involved as well and taking those two. Now I'm concerned because if it takes too long, we're at a place in technology where three months later, it's a brand new version. I mean, so how do you fill that gap?

It's a great question. So I think that where we're actually finding this is insurance is paying less and less of the balance. There's still a majority of it, which is part of the reason why there's delays. But as more of the payments fall onto the consumer, those demands are going to drive more innovation and implementation for the industry at large.

And so what we're finding is features like surcharge that have been very common in other industries for years are now becoming more prominent and more well accepted. And I think that especially with the rise of AI and all of the buzz that's around that, we're finding that agentic AI especially is going to implement itself into RCM for healthcare. And with that, I think it's going to require them to be a little bit more on the nose and move quickly to keep up with the rest of the market.

Okay. You just said two words that get me real excited. I'm just letting you know. Agentic AI, Stablecoin, that type of stuff right now, FedNow, RTP, like these are key buzzwords that cause people to land on paymentsprofessor.

com. So when you say Agentic AI in healthcare, you really got my attention. Can you give me a little bit more where that's going to be happening? Absolutely.

So right now, one of the biggest pain points for revenue cycle management is the fact that you have to submit claims, verify insurance. Once you've determined what that will cover, how do we now address that? act on the patient's portion of that payment. Agentic AIIC is going to become more and more involved in that insurance process, checking on whether or not this insurance is actually covered and accepted at a particular practice, how much of that plan will cover this particular treatment or set of treatments in the future.

And as that starts to, I guess, relieve the individual staff members of having to make those phone calls and submit that paperwork, I think that ultimately we're going to see a much smoother cycle, a much more intuitive cycle that the patient's actually visible to and has more transparency with them. And as a result, I think that the patient's actually going to better understand their bill, which is one of the major complaints that we have today. Okay. I'm like getting excited over here because I sit around thinking of what are the different ways we're going to be able to incorporate this.

And one of the key things for everybody listening to is I tell people, AI is not going to replace your job. AI is going to enhance your job. And what I heard in that too, is it's allowing staff to do other things that would be a long, tedious task of them having to be on phone after phone with different insurance companies, trying to figure out what was going on to where now the AI can do it. And I also heard too, not just my treatment now but my treatment in the future So I loved hearing that And you said helping me is let say it me I the one getting some type of care Is it going to help me to know when the payments would go through, how much my payments are going to be, stuff like that too?

That's what we're seeing, is that ultimately by having AI handle a lot of this, we can report that out with a bit more accuracy. And so someone can see when the claim is submitted. Hopefully that is now taking minutes rather than hours or days. And they can actually see that review process actively through a portal almost like you see for a pizza delivery, where they know this stage is now complete, this is where we're at, and then it can estimate better, this is what is likely to be covered.

So you should be expecting information about a bill around this amount. Okay, I really do love that. I know something else that happens in a lot of businesses, and I believe it's probably happening in healthcare too, is we have payments integration needing to take place, but then we have all these communication layers that we got to be able to work through. How do you solve for that?

Right. So where I think the most intuitive place to put a payments tool, especially in healthcare, is actually the communication platform itself. This is where patients know their practice. It's where they engage with them the most.

So especially knowing things like scams, where phone numbers are being used to spoof real businesses today, and a lot of the hesitance and wariness that comes with that, now that we're able to actually take a payment link and embed it into a texted conversation. We know that not only are texts open much more frequently, about 98%, compared to say 20% for an email, or even less than that, around 9% for a phone number that you don't recognize. It's going to allow you now to say, this is my practice reaching out to me.

I know that phone number. They've reminded me of an appointment in this conversation thread before. And now not only are they telling me where I can pay in that same conversation thread, but I can actually see the invoice telling me what this is covering, how much insurance actually covered, and allow me to engage much more fluidly on what are my questions around this bill? What are the things I should know about my future treatments?

And all of that is a portion of the relationship they have with their practice. So that's where we should be talking about payments. Okay. So you're right.

A lot of people are afraid to click on things within text. I'm one of those that I will if it's in the way you just established. It's in the already established communication from somebody I know. But what I think really makes a difference that I see another layer almost of it's I wouldn't say it's a security layer for sure.

But the fact that I can look and see the invoice itself, that's huge. That makes a difference because how's a scammer supposed to know that? You know, they would not know that they would not know the details. So I love seeing you do that.

But I still can ask questions before I submit the payment. How's that work? So because it's an active conversation thread via text, you are actually speaking with a human on the other side. So while there are some automations that generate the link, make sure it's encrypted, even send that multi-factor authentication code, you can actually read that and then ask that person on the other end of the line, I thought that this was going to be a smaller payment, or I see here this is covering something for a future date.

Help me understand what's really going on. So I think that it really humanizes the experience as well. This is part of what helps these staff members. They came into this to take care of people.

You go into healthcare because you care about making sure somebody gets the proper care. They understand that they're cared about and they get the outcomes they want. You're not in it because you want to be collecting payments. And so when you can send something over very simply and securely, it allows you to open up that engagement in a much more empathetic way and have that conversation as though you were still in the practice face-to-face.

Okay, Ryan, I got to tell you, I got to ask this question because what happens is I do these podcasts, I record them, and then I'm out on the road at all these conferences and people come up and go, I listened to this podcast. I loved it. But why didn't you ask him this? And I know the one that, and it's really, it's my friends.

I got to admit, it's my friends that I hang out with at conferences. And I know they're going to all ask this one, what payment channels is he using? You got to ask him what payment channels is he using? Does the link just lock him into one way?

Do they have options? And the question of the day, you know, lately has been, can they do stablecoin? And I got to tell them, I mean, stablecoins are coming, so it's okay if you don't have stablecoin, but what payment options are there? That's a great question.

So we support credit card, debit card, HSA, FSA, all the same method, as well as ACH. And so when you engage with that link, you get to choose between the two. We've also made some strides to actually accept some of the more digital payment wallets like Apple Pay. Right now, stablecoin is not a part of that in healthcare.

I think there's a lot of weariness around it. But I think in the near future, it's going to be a requirement, especially as we talk about AI, the ability to spoof a phone number, to pretend that you're someone else's identity. I think that the anonymity and the security of stablecoin makes perfect sense for verifying an identity in healthcare. Ryan, I'm going to go ahead and tell you a couple of things.

Number one, you said ACH, which I know a lot of my followers are right now clicking on your LinkedIn profile because that's the language we speak. That's our love language. And you said Apple Pay. Do you know that some cards in the Apple Pay wallet are actually paying with stablecoin?

I was not aware of that. I knew that they were investigating it, but that makes perfect sense. You know, Apple's on the forefront of technology. And again, I think that this type of technology is going to become so prominent that it is something that you don't care about and wonder what it is.

It's embedded in workflows that you don't even realize. Agreed. And the thing with that one is too, is because you also mentioned the card rails. I'm sure you're doing like all of us on the card rails.

You've got the coding that, you know, if a certain card is attempted to be used, that if it doesn't meet everything, we'll be like, I'm sorry, I can't accept that card. And that's fine. And that works. Now, something else that, you know, is interesting in this too.

I usually hear healthcare payments and I'm thinking collections. I'm thinking people going in and, you know, Hey, how do we get our money back? But you're telling me, and I'm hearing from what I see of what you're doing out on your website things like that that it more of an ecosystem that you now able to build for people So how that shift from collections to it a real payments ecosystem with all these great features you telling me about happen How that take place So I think that it's a couple of different factors.

The first one is that the way that healthcare is always run is typically insurance will provide most of the payment, but they have to review it. They have to make sure what is covered is actually covered. And so there is a delay between the appointment itself and when the final bill will rise. And I think part of the frustration that patients have that you and I have likely felt as well is you come into an appointment and you're not exactly clear on what you're going to need to pay.

The copay itself may be rather transparent and upfront. That's in your paperwork. And ultimately, you might know it in advance. But that's where the insurance provider really needs to decide how much of this treatment is something that is covered.

As a result, I think that what we're building with this ecosystem across all versions of the healthcare industry is that as we have a better understanding of what these plans cover, how the review process really works, rather than seeing this as something that you delay till 30 days after an appointment, this is something we can start to be more proactive about. It is continuing to build trust with the patient. It is letting them know why this is a complicated process and why that's actually to their benefit.

And as a result, you're trying to make sure you meet them where they're actually at. It's already confusing enough. They've probably downloaded apps to make payments before, and they don't want to have to learn another system for every single provider they go to. So it's very important now that us as healthcare providers and those that support healthcare providers try to be intuitive around what the patient experience looks like and build the tools to fit their experience rather than the other way around.

So the ecosystem, I think is emerging both out of a need that the patients are experiencing and communicating, but also where technology has now allowed us to basically look at where things are today and where we'd like them to be and bridge that gap so much quicker. Okay. I love some of that because one of the worst things is I'll admit a younger Kevin, long time ago, got hit with one of those collections. And I was like, what is this?

Where's it coming from? Now, this was in the days of snail mail long before we had email. I'm old. And it was one of those that I was like, I can't believe it happened, you know, or how it happened.

So to hear that you're real quickly on top of it, monitoring what's happening, alerting people, keeping them part of the process, that's huge. Something that also comes to mind, and I think it's a little bit of, you know, a security concern is where do I download the app? Am I getting the app because it shows up in the bill and I can scan something? Is it something I see in the doctor's office or is it only in the app store?

That's a great question. And I'd say that that is the right question to ask if you are a patient in that particular situation. Most of the time we find that this is embedded into the invoice or the statement. And I think that that's the appropriate method for how things have typically run.

It lets you know this is coming from a trusted source. This is the provider telling you this is where you download it, scan a QR code, go to a website. You can often find these on the App Store, but you are specifically tied to that practice when you download through a link or a QR code they provide. But I think that more and more what we're going to find is that you actually move away from apps altogether.

So things like MyChart that allow you to see your test results, things like that are going to continue to grow. But the payments piece of things does not need to have that additional step. You should already have that built into the communication channel. And as a result, it makes it much easier for the patient.

I know it's coming from a trusted source. I can click the link here and pay right away. It can save my card on file or my bank account on file. And I don't have to manage yet another app where now I wonder, is this something I really need on my phone, along with the 100 other apps that I'm using day to day?

Yeah, that's true, too, because every now and then we all go through and it's like, can I delete that or not? You know, and I'm one of those. I like to delete it. It feels good.

That app is gone. And then they suddenly realize, oh, I needed it. That's not good. But here's something I got to ask, too, because I was on your site.

I just, I got to admit, I was out there doing my research and for folks listening, it's solutionreach.com. Let me get it right a third time. And one of the things I saw was streamlined care, maximize revenue.

And I know there's costs that are involved in payments. And, you know, I've heard the term, hey, this works. If it ain't broke, don't fix it. Or it's good enough.

You know, it's good enough to get done what's there. So how are you actually helping people to maximize their revenue? What are you doing when it comes to some of that hidden cost and maybe the older payments that they're doing? How do you fix that?

Great question. So the way that we like to see it is rather than requiring segmented tools where there are different logins for each individual portion, we try to centralize that into a single platform. So we offer a lot of different patient engagement tools today, things where you could schedule an appointment directly, where you could have these text conversations regarding reminders, even where you could actually provide a review of your experience online, whether that's through Google or a website.

So the goal is that we actually just keep the payments conversation within the existing relationship. When it comes to the costs themselves, we try to keep that very simple. We have a flat rate pricing based on our analysis of the industry. The goal there is that we are ultimately saving money by averaging things out.

We know that some cards on the high end are going to cause us as an organization to lose money. And ultimately, because there's a more proclivity towards HSA, FSA debit cards, those come with lower expenses. And because they're more common, they can average things back out. What I'd say most of all is that it's the workflow itself.

Right now, we find that it takes an average about three minutes to manually run a credit card where you type it into a system. Our hope is to bring that down to 60 seconds or less. And those things add up quite a bit. if we can save you around two to three hours of effort each day on something that's a requirement for the business, then hopefully you're enjoying your job better.

You're more empathetic and more friendly with people in the office, and you can focus on what really matters, which is the patient care itself Okay That cool I like it Okay I got another one I got to throw at you because when you said ACH and I telling you my friends are going to love this one And I want to I want to answer it from one or two points of view I mean I think you nail it in just one because I got the point of view of I got the person who works in electronic payments at a bank and they want to go talk to a healthcare provider about using like the ACH network and getting involved there, but it takes a strategy.

You've got to be able to implement a strategy on how to get that done. And healthcare and ACH is a huge movement through Notcher right now. So we go the other side and here you are, you got a solution. How do you approach that medical department, business, somebody in healthcare to say, here's you a strategy on being able to use payments more effectively?

So what we like to talk to them about is based on the industry, for instance, in optometry, usually what you find is there's three stages to that life cycle. Someone comes in for their eye exam, they get a diagnosis or a recommendation, a prescription itself. Then they actually have to deliver the product, whether that is a contact lens or the glasses themselves. What we really advise them around is when you're actually providing the product, are you billing right there in the office or are you giving them a trial period?

We find especially as more and more of these things go online, like contacts, what we recommend is give them the trial pair, let them use them for about a week or so, and then set that deadline around, say, their payday on a Friday. So when they reach that full week of having those contacts, now you can say, I am following up on a Friday. You know all of your collections and follow-ups will happen on the same day of the week. You know they're more likely to have the money in their wallet.

And then you can send them that payment request as a part of that follow-up. So rather than feeling like it's asking for money, it is, how are you liking the trial pair we've given you? If that's something you'd like to move forward with, we can send out that first month of contacts right now. I'll send you that payment link.

And as soon as we receive that confirmation, we'll go ahead and mail them out. And so it's really a matter of how are my patients using my particular services? When does it make sense to engage them on that payments piece? And instead of focusing purely on the payment, focus it around how their experience of that medical practice has been.

And then it becomes more of a conversation of if things are going well, let's go ahead and move forward. Naturally, we are a business. Let's go ahead and collect the payment piece so we can take that next step together. It's a partnership.

Okay. I love how you do that though. Here, try this. You know, once they try it, they're going to like it.

But I've said for years and And, you know, it's the 1st, the 15th or Friday. And ACH lets you be able to schedule those so well. All right. One last question I got, and this is a big one.

What's the future really look like? Because all of us, you know, want to get our crystal balls out and what's happening in payments. And here you are in one of the biggest industries in the nation. All right.

This is where the actually two biggest things meet. We got finance and we got health care meeting. What's the future really going to look like in health care payments? I love this question.

And it's interesting because anyone in the payments industry knows JPMorgan Chase comes out with a report on healthcare every year. And what's interesting is over the last 10 years, you see a lot of the same things brought up. We're still waiting for the future to arrive. And I think, again, that a large part of that is because of where insurance has really held the industry back and the concerns around regulations and implementation.

What I really think we're going to see is that over the next two to three years, more of the features you've experienced in retail and other industries will become commonplace in healthcare. So things like surcharge, interchange plus pricing, ACH as a default option in all cases. And as a result, I think that we're going to find that the convenience factor around that for patients really becomes on par with everything else. These new features like agentic AI, the automated workflows, I think are only a part of that.

We are talking about making sure that everything works properly before the next big step takes place. And so rather than seeing it as a new leap in a technology you've never seen before, I think what we're going to find is that technologies you are used to seeing everywhere else are going to become very, very common in your dental practice, in your optometrist, your dermatologist, wherever, even the hospitals. All right. That's cool.

I like that. Ryan, did I miss anything? I mean, because I'm sitting here getting excited on some of these things that you're mentioning. I just want to say, is there any closing comments you want to make?

Did I miss anything that I should have been asking you? What I'd really say is I think that the issue with payments in healthcare has largely been a matter of confusion and lack of education. And so one of the things we're trying to do at Solution Reach is make sure we're empowering practices to have those conversations a bit more naturally, organically. And so if we can better educate a patient around what their treatment entails, why that has the costs that are associated with it, and the different ways that we can structure that, whether that is paying via ACH in your bank account, using an HSA or FSA, maybe even breaking things up into flexible financing through various companies like CareCredit, Sunbit, Cherry.

These are the options that we need to be more forthcoming about at the beginning of the conversation to show that we understand how complicated these things are. And we really want to make sure we're structuring this in a way that makes the patient's experience better, easier, and smoother rather than focusing purely on making sure expenses are covered. I love it. It's Ryan Tennyson, solutionreach.

com. I know he's on LinkedIn, so you can go out there and find him there. This has been a great conversation. I learned something.

And that's really my number one goal. Number two is I want to make sure that everybody else is learning what I'm learning too. So we're making that happen. Ryan, thank you for being here today.

And for all those of you listening, you know, if there's somebody who needs to be on the payments podium, send me a message. We'll get them on here. If there's a topic you want to have discussed, send me a message. I'll make sure that we get that topic addressed.

Otherwise, this is the part where I get to say, class dismissed. We'll see you next time.