PREPARED BYPREPARED BY

Lessons Learned from A Bill You Can Understand

DATE

Paul Kahn, Experience Design Director November 9, 2016

Project TimelineFebruary

Concept collaboration with Health and Human Services

March

Pilot Partners & AARP sponsorship

April

Announcement at HxR

Research Report and Website

May 10: Launch at Health Datapalooza

June-July: Webinar + Social Media campaign

Aug 10: Competition Deadline

Aug 22: Advisory panel review

Sept 7: Patient focus group review

Sept 15: Federal panel review

Sept 21: Winners/Honorable Mentions chosen

Sept 28: Winners/Honorable Mentions announced at Health 2.0

Our Pilot Partners

Mad*Pow Research Report• Identify major issues in the current

medical billing system facing patients today from the point of view of

• Healthcare systems

• Insurance companies

• Patients

Seven Top Concerns:

• Patients Don’t Know What They Don’t Know

• Volume of Communication

• Understandability

• Terminology

• Timing

• Financial Planning

• Trust

Patients Don’t Know What They Don’t Know • Providers don’t inform Patients about how their medical care and

related costs are distributed among providers. • Patients don’t know when and where to ask questions about

decisions that affect their medical care and related costs. • Patients don’t know when a denied claim will be resubmitted,

processed and accepted.

Volume of Communication • Patient typically receive a large number of documents from payers,

multiple providers and third-party benefits manager for a single medical event. • “Going paperless” can result in a large volume of emails from

multiple sources with links to multiple patient portals, each requiring its own credentials, containing PDF copies of the same documents that arrived in the mail.

Understandability • These diverse documents do not provide a clear indication of how they

relate to one another or how they define the patient’s healthcare costs. • The same charge may be described differently in a bill and in a benefit

statement. • The name the physician treating the patient may not appear on the bill,

while the name of physicians’ unknown to the patient do appear.• Hospitalization charges are divided into categories incomprehensible to

the patient, professional and facility services defined by the provider’s contract with the payer.

Terminology • Treatments are described in unfamiliar terms. • Payment options are difficult to find and written in legal jargon.

Timing • The time needed to reconcile claims to determine actual patient

charges separates the patient’s experience of care from their experience of cost. • The unpredictability and distance in time makes the entire

experience unreal, followed by bad surprises.

Financial Planning • The lack of awareness of cost before and during care leads to patients

unprepared for managing final cost. • Faced with bills that far exceed their available resource to pay,

patients don’t know their options for managing long-term payments.

Trust Many factors undermine patient trust of the charges on the bill • The contentious provider-payer relationship that generates denial

and resubmission of claims • The enormous difference between charge master and allowed

charges. • The patients’ experiences of duplicate bills and unrecognizable

charges.

Problems Are Closely Inter-related• Providers struggle to manage their revenue flow.

• Negotiating payment contracts with a variety of payers makes it challenging to estimate the cost for a patient at the point of care.

• Large payers operating in multiple states are faced with enormous variations in data reporting practices.

• A significant amount of communication in the healthcare business is done by fax and copies of paper forms, then re-entered into data processing systems.

• Inter-system communication in the healthcare billing world between providers, insurers and pharmacies is one of the last bastion of non-digital communication.

Real Estate is based on

LocationLocationLocation

Medical Billing is based on

SurpriseConfusionDelay

What we heard from Patients

RATED THEIR MEDICAL BILLS AS CONFUSING OR VERY CONFUSING.

DIDN’T DO ANY RESEARCH ABOUT

COST PRIOR TO THEIR MEDICAL VISIT

What we heard from Providers

Bills and Benefit Statements

Bills and Benefit Statements

Guidelines and Literature

Medical Billing Ecosystem

Medical Billing Ecosystem

Medical Billing Ecosystem

Medical Billing Ecosystem

Patient Journey Map

Patient Journey Map(3-7)Being presented with enormous differences between Charge master fees and adjusted fees challenges understandability of charges and undermines trust in Providers

(5)Timing delays for medical bills are unlike any other retail or service experience

(7)Incomplete or inaccurate cost estimates undermines trust in both Insurer and Provider

PAIN POINTS

Medical Billing Top Concerns:

(1) Patients Don’t Know What They Don’t Know(2) Volume of Communication(3) Understandability(4) Terminology(5) Timing(6) Financial Planning(7) Trust

(3-5-7)Introducing Third Party payers complicates the process and further undermines trust

(2)Maintaining accounts on multiple Patient Portals for access and payment of bills from different Providers

Multiple sites makes it difficult to keep track of what has been paid

Patient Journey Map

(6)Insurer could estimate the total cost of procedure at the time it is recommended and prepare Patient for total cost.

Hospital could estimate when costs will be due and explain payment options

OPPORTUNITIES

Medical Billing Top Concerns:

(1) Patients Don’t Know What They Don’t Know(2) Volume of Communication(3) Understandability(4) Terminology(5) Timing(6) Financial Planning(7) Trust(2)

Coordinated statements or a unified portal to review Provider claims to Insurer, bills from all providers, and the Patient’s FSA/ HRA/ Deductible status would reduce concern about volume of communication

(5-6-7)Patient will be able to pay the bill and plan for the financial consequences knowing that all pending claims have been resolved, that the bills all agree with expected cost estimates, that no further adjustments will change their cost.

Who submitted entries?• Healthcare organizations• Non-profits working in the healthcare sector• Doctors and healthcare workers• Interaction design companies• Health information and financial services software companies • Graduate student teams from public health and design schools• Ad hoc groups of people passionate about the topic

Prize 1: Easiest Bill to Understand• Winner• RadNet

• Honorable Mentions• A Better Health System • Change Healthcare• Renown Health • Up To 11

Prize 1 Winner:

Prize 2: Transformational Approach• Winner• Sequence

• Honorable Mentions• Business Innovation Factory• EveryBill • FAIR Health• gravitytank • Health Payment Systems • iVinci

Prize 2 Winner:

What about the EoB?

Charlotte UX

Offer multiple payment options

Include patient’s insurance status

Omit un-discounted charges from statement

Cost estimate before the bill

Separate amount owed from detail of charges

Image of provider or institution

Three ApproachesEntries demonstrated three approaches for unifying the billing experience• Provider Network becomes the single source managing all charges

from in-network and out-of-network providers• Insurer becomes the single source of payments to be redistributed to

all providers• A new Third-Party Service Platform manages claims and payment

between providers, payers and patients

Current Medical Billing System

Provider Model

Insurer Model

Service Model

Conclusion: Shore Up the Fragments• Alleviate the current fragmentation of financial relationships• Transform the stream of invoices from unrelated providers and

interpretations of unconnected payer benefits into a single financial relationship• Create a coherent service for managing patient’s experience of

healthcare providers and their associated cost