a bill you can understand design challenge: lessons learned
TRANSCRIPT
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