OODA Health, a company focused on eliminating administrative waste and empowering patients and providers with a real-time payments experience, today released the results of a study on the impact of patient payment trends on provider and payer performance. The research, conducted by HIMSS in partnership with OODA Health, reveals how consumer healthcare payment dysfunction affects all healthcare stakeholders, creating unforeseen system-wide issues and interfering with patient care. The study surveyed executives from U.S. hospitals and health systems, health insurers, payers and health plan administrators.
Key findings include:
- Two-thirds of clinicians indicated that dealing with patient collections takes time away from patient care
- Providers say 44% of patients are frequently distracted by bills and payment concerns, resulting in a lower level of compliance and adherence to medical plans
- 67% of providers use patient collections to justify rate increases during payer negotiations
- 85% of payers report that member satisfaction drives benefit design, at least to a moderate extent
- 63% of payers report they want greater insight into how plan complexity is experienced by the member
- Payers do not know what portion of medical bills are paid by the patient, and there is a broad range of assumptions over how much consumers actually pay. 74% of payers indicated that having actual consumer payment data would improve their models
Patient billing has become the subject of increasing public scrutiny in recent months, from surprise bills that saddle patients with tens of thousands of dollars of debt, to questionable collections processes from hospitals, to the steady rise of high, unaffordable deductibles.
However, in spite of the scrutiny, the industry’s understanding of the problem has been generally limited to the provider and patient point of view. This research strives to understand how consumer behavior affects benefit and product design at health insurers/payers, as well as how patient payment trends are factored into managed care contract negotiations.
“Provider billing is mapped to contracting and billing relationships, not to how the patient experiences care. From a single hospital visit, a patient could receive five or six bills, depending on their providers’ contract and billing relationships,” said Seth Cohen, president and co-founder, OODA Health. “The research findings reflect what we have been seeing in the market – patients are struggling to pay and manage their medical bills, providers are ill-equipped to manage patient payments, and a lack of insight creates a disconnect with payers. This creates a vicious cycle of bad debt and higher deductibles, while also negatively impacting patient care. It is a system-wide problem and we need a system-wide solution to fix it.”
The study surveyed qualified respondents from U.S. hospitals and health systems as well as qualified respondents from health insurers, payers and health plan administrators, during June 2019. One-quarter of those surveyed hold C-level titles.
A more detailed report on the research findings, as well as more information on the survey methodology, is available in a white paper from OODA Health, which can be downloaded here.
About OODA Health
OODA Health was founded by a team of seasoned healthcare entrepreneurs who envision a healthcare system freed from an estimated $400 billion in administrative waste and powered by real-time payments. Using a collaborative and innovative approach, the company enables payers and providers to dramatically improve the payment experience for members. For more information about OODA Health, please visit www.ooda-health.com.
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