The key to understanding consumer-centric healthcare
The point of highlighting the Indiana experience is to show that consumer-centric healthcare must be a true, balanced collaboration involving the health plan (or insurer), the medical group and, of course, the patient.
Everyone needs to make smart decisions as it regards the actual health of the patient and the business health of healthcare.
Regardless of the health plan, medical groups are seeing a greater portion of the financial obligation as the patient’s responsibility. Unlike the process of filing claims with insurance companies and getting paid every couple of weeks, collecting from patients is a real challenge.
It costs more, and takes more time to collect, as many aspects of patient billing woefully underutilize information technology and digital communications like email. Remarkably, nearly 9 out of every 10 healthcare bills issued by medical groups in the U.S. is in paper form and sent through the U.S. Postal Service. However, from a medical group perspective, this results in a payment cycle of 90 to 120 days or more, plus the total cost of sending these statements is incurred regardless of whether payment is remitted. That’s inefficiency that directly affects a medical group’s cash flow, hampering its ability to operate profitably and, perhaps, charge less.
All too often, attention is placed on the clinical side of healthcare. Granted, that’s done for good reason as positive, enhanced outcomes are what healthcare professionals strive for each day. Nonetheless, consumer-centric healthcare will create competitive forces in the marketplace that will demand that providers become more efficient in their business practices as well, in part by employing low-cost, high-quality technologies.
Anyone who thinks this can wait is wrong. Healthcare is consuming more of the U.S. economy than ever before. CMS notes “the delta between healthcare spending and GDP growth reached a six-year high in 2015,” representing 17.8% of GDP. It estimates that healthcare will total 20.1% of the economy by 2025.
William Blair, an investment house that concentrates on the healthcare industry, offers the view that “...recent healthcare reform legislation—while having positive attributes—does little to fundamentally alter the broken, siloed care delivery system in the United States. Similarly, we believe the law [ACA] does little to control healthcare expenditures. Rather, the legislation focuses on expanding health insurance coverage—a noble goal, but one that falls short of solving the underlying quality and cost issues that drove such a high level of uninsured individuals to begin with.