By PYMNTS
Posted on September 17, 2021

To hear Bob Raffo tell it, fear is one of the biggest hurdles standing in the way of medical treatment in the U.S. But the FirstView CEO isn’t talking about concern over getting a shot or undergoing a painful procedure; he’s talking about financial fear, or the crippling reality that keeps countless patients from seeking necessary healthcare solely because they’re afraid they won’t be able to afford it.

Imagine a patient sitting in a doctor’s office knowing right then and there how much the medication they need to take to stay healthy or the procedure they need to have will cost them, with payments options sorted based on insurance and other discounts and payments plans decided before they walk out the door.

Payment enabling those transitions is a big part of why Raffo told Karen Webster he’s excited to be part of the vast AmerisourceBergen ecosystem.

“We are taking the financial hurdle out of the way first,” he said, or “fear of that surprise invoice” as he called it.

Bringing more clarity and upfront transparency to the process will spur further innovation and disruption that will in turn reform the broader healthcare industry itself, Raffo said.

“Healthcare plans and healthcare insurance are going to be dramatically different in the near future,” he said. “There’s going to be a lot of disruptive technologies that are going to change the way we think about what healthcare really is and how we consume it.”

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In the meantime, with just one month post acquisition, Raffo said FirstView’s plans in the near term are to simply integrate its platform with Amerisource’s, speed up payments, integrate those into workflows and streamline the entire process.

Longer term, Raffo said the company will focus on ways to streamline the relationship between payments and the cost of healthcare with an eye toward eliminating financial barriers to access once and for all.

The Hard Part

That won’t be easy. At present, most healthcare and pharmaceutical providers try to operate an “adherence and persistence” model which they encourage patients to take the drugs they’re prescribed or stay on their therapy because doing so will be cheaper than going to a hospital later when they get really ill, Raffo said. But that doesn’t help make medicine any more affordable.

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Raffo said he believes change will happen, and that it will primarily be driven by innovation from disruptors in the space. He said there are many parallels with what’s happening now in healthcare and what happened in the financial services space, where FinTechs and neobanks came in and made capital more readily available to people.

“If you think about all these alternative financial services trying to bank the underbanked and the unbanked, that demographic really overlaps with healthcare,” he said.

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As to the exact nature of these new models, Raffo said he believes employers will have a very big role in shaping them because they have perhaps the biggest incentive to do so. In his vision, employers will no longer provide their staff with healthcare plans, but rather, financial benefits for healthcare.

“It makes good sense for companies to want to pay for that because we’ve just experience that if the country is not healthy, then the economy collapses,” he said.

In the future, he said, employers will likely work  with innovators to create a model in which someone’s financial ability to pay for healthcare is not a barrier to accessing it. Some might still think that’s a tall order, but Raffo responded that the government response to the pandemic shows that it’s possible.

“We just proved it’s possible to figure out a model where it doesn’t have to really be a financial burden,” he said. “The COVID vaccine is free, and it’s widely available, so it can be done.”

Three Key Pillars

FirstView sees its role in this transformation as an important one. The company believes it can enable disruption on a large scale by simplifying claims adjudication and transaction processes, Raffo said. The company has created an open set of application programming interfaces (APIs) that integrate with claims, pharmacy claims and electronic health record (EHR) systems in order to simplify the way they’re processed and provide greater transparency.

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Raffo said FirstView’s platform is creating three key value providers: convenience, transparency and control in how much medication or procedure costs, so that patients better understand what they’re spending money on, why and most important, how they can pay for it.

The platform leaves the bigger problem of evolving healthcare business models to the experts, he emphasized.

“We’re not in the clinical business, we’re not in the patient services business, and we’re not trying to help patients figure out what they should take or shouldn’t take,” Raffo said. “We’re just trying to simplify the back-end process and integrate across the [healthcare and pharma] ecosystem.”