InstaMed points HIMSS20 attendees toward price transparency, consumerism and interoperability
InstaMed, a J.P. Morgan Company, a healthcare payments network connecting providers, payers and patients, will have a large presence at the HIMSS20 Global Conference and sees three overarching trends affecting conference attendees and their healthcare organizations: price transparency, consumerism and interoperability.
Healthcare is less than a year away from when the final rule on hospital price transparency is set to go into effect January 1, 2021. The rule issued by the Centers for Medicare & Medicaid Services calls for healthcare providers to publish the prices for services to patients. There are steep penalties proposed for any providers who do not comply with the rule. However, the exact impact of the rule on patient experience remains unclear.
“Nine out of 10 patients have been surprised by a medical bill, according to the Trends in Healthcare Payments Ninth Annual Report,” said Jeff Lin, head of product at InstaMed. “The reasons for patient surprise include getting a bill for more than expected and not knowing they would get a bill at all. Those reasons have little to do with the exact price of the service and more to do with a misunderstanding of payment responsibility that is determined after claim adjudication.”
“The industry has seen considerable buzz in recent years around bringing consumerism to healthcare, yet these actions have not yielded any significant results.”
Jeff Lin, InstaMed
Factors such as contracted rates, deductible balances and coinsurance percentages can all impact payment responsibility, he added.
“The crux of the issue is that prices for healthcare services and a patient’s payment responsibility are two very different things,” he stated. “The reality is that most patients are in the dark throughout the healthcare payments journey, not just when searching for healthcare providers. A fixed price, independent of health plan coverage, will do little help clear up that confusion.”
Healthcare organizations that consistently offer ways for patients and members to understand their payment responsibility throughout the journey will help to alleviate the surprise and confusion that they now experience, he added.
Surprise and confusion around medical bills are just the tip of the iceberg when evaluating the current payment experience for consumers.
“The industry has seen considerable buzz in recent years around bringing consumerism to healthcare, yet these actions have not yielded any significant results,” Lin said. “This is apparent in the payments journey where consumers are still relegated to paper statements and check payments for their medical bills and health plan premiums.”
What other industry relies on paper for collections, Lin asked.
“I’ve certainly never received a paper statement for my Netflix monthly charge or reached for my checkbook to pay for an Amazon purchase,” he remarked. “Yes, healthcare payments are much more complex than other industries, so a streamlined and convenient payment experience can be difficult to deliver – but, none of that matters to consumers.”
The majority of consumers are ready to switch healthcare providers for a better healthcare payments experience, according to the Trends in Healthcare Payments Ninth Annual Report. For payers, the lack of convenience contributes to late or missing premium payments from individual members.
“As Millennials continue to become the dominant generation in the workforce and beyond, healthcare organizations will increasingly feel the impact of dismissing the digital world that this generation has fully embraced since childhood,” he said.
Interoperability makes headlines on the clinical side of healthcare.
“There also are tremendous benefits on the administrative side of healthcare, and they shouldn’t be ignored,” Lin stated. “Interoperability requires adoption of electronic transactions and payments for the information exchanged between providers and payers across the medical and dental industries. The 2019 CAQH Index estimates the industry could save $13.3 billion annually.”
A move to 100% electronic exchange of data and payments within healthcare not only delivers cost savings, it also creates a strong foundation for improving the experience for all stakeholders, he contended.
“Providers, payers and consumers all benefit when data and payments move electronically,” he continued. “For example, when payers are delivering remittance data and claim payments electronically through ERA/EFT, payers cut down on transaction costs and staff involvement, and providers receive payment and data faster.”
This ease and speed of data exchange and payment flow enable a better consumer experience where payment responsibility is understood closer to the date of service, he concluded.
InstaMed will be in booth 2187 at HIMSS20.
Email the writer: [email protected]
Healthcare IT News is a HIMSS Media publication.
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