Healthcare Transitions in the Making

By August 4, 2016Blog

Lynn Carroll, Chief Product Officer, Payspan

This is the second post in a series expanding on ideas from an article I originally wrote for Healthcare Innovation News.

As patients’ consumer roles expand so do expectations of healthcare providers. In response, providers have opened new channels of communication, education patients about health, medical risks and conditions, seeking to involve them more fully in decisions about ongoing care.

Patients increasingly want and expect clear, direct and timely communication about the actual cost of services, the amount covered by insurance, personal financial obligation and the payment options available to help meet these obligations.

Take this video for example.

In the past, collecting payment for medical care rendered was straightforward. Insurers paid the lion’s share of members’ costs and patients received bills for the balance. Since these balances were relatively manageable, compared to today, the majority of patients paid their share. What patients did not pay could be written off without harm to providers. With the increased adoption of high-deductible health plans, patients have more responsibility for payments than ever before making effective collection essential to provider viability.

Today the healthcare business is going through such disruption that consumers are looking for ways to cobble together a healthcare process that works for them.

According to McKinsey analysis, $300 billion a year – 15 cents of every dollar spent on healthcare – is never collected. These uncollected charges continue to rise. The dollar amounts leftover per visit to physician practices are smaller than those remaining on hospital bills, but these uncollected amounts represent “a large portion of addressable bad debt – as much as 90 percent of uncollected member liabilities are for physician and outpatient care – and the cost and complexity of consumer billing and collections are particularly onerous.”

A turning point in the transition of patient financial responsibility and transparency requires everyone participating and engaging, which is a lofty goal. This also demands we begin to ask what types of accountability we can create to facilitate this type of environment.

What have you seen that works (or doesn’t work) in building healthcare systems that bring transparency to the transactions process?