Patients Are the New Payers Demanding Billing Transformation

May 19, 2018

Revenue Cycle teams are changing their billing processes and tools to engage with patients way before they check in to the hospitals. Here’s how providers, insurers and health tech innovators are stepping up to help patients slog through the billing quagmire and improve the financial health of everyone involved.

Provider changes: Patients pay for 30% of the bill they receive for hospital services. With high deductibles and co-pays the norm for insured patients, consumers are demanding price transparency up front and digital tools to manage healthcare costs. They want to be engaged with hospital finance departments as early as possible to talk pricing and digital options with mobile access.

Jonathan Wiik, Principal And Lead Of Revenue Cycle Management Solutions for TransUnion Healthcare, explains how the patient is the new payer. With many providers focusing on patient experience, it’s important for them to understand that the biggest dissatisfier is patient bills. “You can do everything perfectly but when the bill comes the patient could still have some pretty negative things to say if that process wasn’t engaged and focused on them. It’s important for providers to engage patients early through whatever mechanism they can.”

Insurer Changes

Bills are confusing for patients and the system to simply explain the cost for care is broken. “We need to find a way to make it clear to a member as soon as possible after a visit exactly how much they owe. We need benefit design that is smarter and easier to understand,” says David Krause, Vice President of the Business Improvement Group at Anthem.

Healthtech Changes

New healthtech players like Amazon are tackling the cost of care and billing processes head on. The driving focus is to be clear up front, so the patient can choose the care providers and price points that meet the demands for cost transparency.

Healthtech innovators like ClaraPrice realize the older orientation around focusing only on insurance or a fee-for-service healthcare delivery model is just fundamentally not sustainable as employers and customers demand more. New models are coming from collaborations between tech leaders and healthcare startups that understand the challenges patients and providers face.

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