Addressing the patient financial experience in today's challenging healthcare environment

The global Coronavirus (COVID-19) pandemic has transformed nearly every facet of our daily lives, from how we live and work to how we seek and receive healthcare. Within the U.S. health system, Coronavirus has driven rapid innovation and agility as providers and healthcare organizations seek new ways to meet the needs of patients and ensure continuity of care. Meanwhile, some hospitals and health systems are managing difficult and rapidly evolving situations involving an influx of Coronavirus patients and facing financial constraints as elective procedures have been cancelled or postponed.

While the pandemic has highlighted areas for improvement within the U.S. healthcare system, it has also been a catalyst for innovation and resourcefulness that will reshape the future of healthcare. Coronavirus has rapidly propelled healthcare consumerism forward, and as we enter the next chapter, providers and hospitals will need to balance patient concerns about the timing of non-emergent procedures with the desire for access to and more convenient interactions with their providers. About 44 percent of Americans cancelled or postponed medical appointments due to the Coronavirus1, with 5 percent of American consumers reporting that they or a family member used telehealth for the first time during the pandemic. Among those new to telehealth, 88 percent reported they would use it again.2 Convenience features, including remote consults and touchless payments, are likely to become a crucial way for patients to access the care they need, while providing a positive patient experience that will help support and sustain a provider’s practice.

During this time consumers may become more conscious of their finances and financial planning needs, with 32 percent of consumers making or planning to adjust their spending on healthcare visits as a result of Coronavirus2. Increasing engagement for these consumers may rely on the trust health systems are able to build with them over the next few months, particularly as it relates to billing and other financial matters. Prior to the pandemic, we conducted a study4 to understand patients’ financial needs throughout their healthcare journey. We examined the assumptions, needs and motivations of patients at various stages of their healthcare experience, from first learning one needs care, through making and having appointments, to receiving post-care bills. We surveyed over 2,000 U.S. adults who had visited a doctor or healthcare facility within the past twelve months for routine, follow-up, or unplanned care for themselves or their dependents. Much of what we learned likely still applies — or may be even more important—in today's environment. Here’s what we learned.

The Impact of Cost

The cost of healthcare is having a significant impact on patients' decisions about their care. Forty-three percent of patients surveyed said they had changed their behavior due to costs.4 Nearly all of those changes involved decreased or delayed care, including not filling prescriptions, not fully complying with a recommended medical treatment plan or taking less than a recommended dosage of a prescription.

Uncertainty around healthcare costs is also impacting patients' relationships with their healthcare providers. An Instamed study found that 93 percent of consumers surveyed said they were surprised by a medical bill in 2018.3 Given the extent of surprise billing, it's not surprising that nearly two-thirds of the patients CareCredit surveyed (65 percent) said they would consider switching providers after receiving an unexpected high bill, and 28 percent said they would very likely do so.4 Nearly 59 percent said they would consider switching providers if the office staff could not tell them the cost of a visit or procedure.4

The Patient Journey

To better understand the patient financial experience and the decision-making factors patients encounter, our study focused on these six stages of the healthcare journey:

1. Realizing that medical care is needed

2. Scheduling an appointment

3. Checking in at their provider's office

4. Seeing their healthcare provider

5. Checking out at their provider's office

6. Receiving a post-care bill for any balance due

Understanding the gaps and challenges patients face in each of these stages can help providers improve how they inform and engage patients and prioritize the patient financial experience.

Sources of Stress

Patients experience varying levels of stress throughout the six stages of their healthcare journey, and not surprisingly, the type of visit — whether routine, follow-up or unplanned — also affects patients’ stress levels at each stage.

For all types of visits, the initial realization that medical care is needed caused the greatest concern (60 percent).4 When unplanned care was needed, this surges to 78 percent.4

Receiving a post-care bill also caused great concern. More than half of all survey respondents (53 percent) indicated they felt stressed at this point.4 Learning about the cost of treatment (27 percent) and what’s covered by insurance (24 percent) was also worrisome.4

As patients take on more of their healthcare financial responsibilities, paying for unplanned expenses is becoming a serious burden, and budgeting and saving for these scenarios aren’t necessarily happening. In fact, a survey by The Physicians Foundation late last year found that 73 percent of Americans said they are concerned about being able to pay for medical treatment if they got sick.5

Filling the Information Gap

While the cost of treatment is a concern for many patients, few (less than 15 percent) researched cost information before seeking care or making an appointment.4 Of those who researched costs ahead of time, patients seeking follow-up care spent the most time researching, with nearly half spending an hour or more; however, about 1 in 4 had difficulty finding the information they needed.4

Although few consumers research healthcare costs, our study shows that almost half (49 percent) believe they have some responsibility in finding the cost information they need, but they also expect insurance companies (54 percent), healthcare staff (48 percent) and doctors or other healthcare professionals (18 percent) to share in that responsibility.4

Other survey results show that 88 percent of consumers surveyed said they want to know their payment responsibility up front,3 which underscores a need for greater access to cost and payment information.

Information at Each Stage

Once patients begin interacting with a healthcare practice or facility after making initial contact, staff and providers have an opportunity to provide treatment cost and payment information. However, our research shows this does not happen in many cases. At every stage of the healthcare journey, more patients report wanting cost-related information than say they received it.4

Additionally, at every stage of the journey, patients reported having more interest in co-pay information versus their overall out-of-pocket costs.4 Healthcare staff were able to provide co-pay information more often, especially during the check-in stage (33 percent).4 This may suggest a greater familiarity and comfort with copays by all parties, and it is possible patients sometimes assume a co-pay represents the complete out-of-pocket obligation.

Post-Care Billing

As previously mentioned, the second-most stressful stage of the healthcare journey for patients, after realizing that medical care is needed, is when they receive a bill after their appointment. The majority of survey respondents (53 percent) reported being surprised by the amount they owed.4

More concerning, nearly a third of patients owing a balance reported difficulty in being able to pay the amount owed, and almost a quarter (23 percent) considered using a financial solution, such as healthcare financing, to help with payment.4

Significant increases in out-of-pocket healthcare costs may explain why receiving a bill is so stressful for the majority of healthcare consumers: deductibles have increased 183 percent since 2006, and they have doubled (100 percent increase) in the past decade (since 2009).6

Help with Payments Regardless of the type of visit — routine, follow-up or unplanned — patients who face difficulty paying their balances owed may welcome information on ways to help plan for and help cover the costs. More than a third (35 percent) of patients expressed interest in learning about payment plans when receiving a medical bill.4 Among younger patients, interest levels are nearly double, with almost two-thirds (64 percent) saying they wanted information on payment plans to be included in their medical bills.4

An Opportunity for Impact

The results of our study highlight that at every stage of the patient’s healthcare journey — from realizing that medical care is needed to receiving a post-care bill— patients want easy access to cost information, an understanding of what their out-of-pocket costs will be, a financial solution to assist, and overall reassurance and support.

Healthcare staff have the opportunity to help patients understand and plan for their financial responsibilities by offering them options to pay for their care in a way that's helpful for them. We understand that talking about money can feel uncomfortable, both for patients and providers, but it's a critical aspect of the overall healthcare experience. When you talk about cost and payment options early and often, you can better support patients at all stages of their journey with you. You can also help patients prepare for and fulfill their financial obligations, making it easier to get the care they want and need while fitting healthcare payments into their budget.

1 GCI Health and Harris Poll, The COVID-19 Health Impact Survey: Select Findings for Communicators, May 2020

2 Price Waterhouse Cooper, The COVID-19 pandemic is influencing consumer health behavior. Are the changes here to stay?, April 2020

3 Instamed, Trends in Healthcare Payments Ninth Annual Report: 2018, Feb. 2019

4 CareCredit, Understanding the Medical Journey Research, Aug. 2019

5 The Physicians Foundation, 2019 Survey of America’s Patients, Oct. 2019

6 Kaiser Family Foundation, Employer Health Benefits 2019 Annual Survey, Sept. 2019 (Among those with individual coverage under employer-sponsored plans that include a general annual deductible).

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