While so much is changing, so much is still the same in healthcare, like the fact that some 85 percent of commercial health insurance payments are still paper-based.
That and other observations comes from "Money matters: Billing and payment for a New Health Economy," by PricewaterhouseCoopers' Health Research Institute.
PwC researchers studied commercial claims on a population of 34 million Americans, surveyed 1,000 adults and interviewed leaders from new and traditional healthcare companies. They found an industry in transition from a business-to-business model to a business-to-consumer model, particularly for insurers. As PwC put it, the "fragmented health industry has spawned a complex web of billing and payment solutions."
In 2013, commercial health insurers paid just 15 percent of claims digitally--while 43 percent of other U.S. commerce uses digital payment. What's more, 75 percent of Medicare payments are electronic, PwC found.
"The payment and billing system needs more standardization, and more companies that can aggregate across providers before it can happen at scale," the report argues.
On the patient side, for the millions of Americans paying an estimated $345 billion out-of-pocket in copayments, coinsurance, deductibles and other cost-sharing, the morass of billing is a major source of frustration.
Fifty percent of patients in poor or fair health who were polled agreed that hospitals do a bad job on price transparency and affordability. Almost half of those in poor or fair health (people likely to have used hospital and physician care) said they did not understand the costs before hand. More than 40 percent described their hospital bills as unaffordable, and 25 percent said the billing changed their view of the hospital for the worse.
Notably, it is the younger generation of patients--those ages 25 to 34--who are most likely to haggle with providers and challenge their health plan's decisions.
Almost 20 percent of millennials in the PwC survey said they've asked hospitals or clinics for a discount, compared to only 8 percent of the general population. Likewise, 20 percent of millennials said they've asked for a price check before getting a service, compared to 10 percent of the whole population, and 14 percent of 25- to 34-year-olds have appealed an insurance claim decision, compared to 8 percent in the general population.
The affluent, those with $100,000 in annual incomes (upper middle class in some areas), also reported deep frustrations with insurance and billing. More than a quarter said it's not easy to find details of benefits, 33 percent said their insurance and medical bills are not affordable, 19 percent said it's not easy to pay their bills, and 20 percent said payment issues have damaged their views of certain insurers.
At the same time, PwC argues, "Despite the challenges, green shoots are emerging from the system's long-dormant soil."
There are those many changes in the works bringing more choices, such as $40 walk-in care visits at a few Walmart stores (maybe more soon) and the increasingly available on-demand telehealth consults. In Atlanta, for instance, Alii Healthcare charges $100 for virtual visits with emergency room doctors.
"Savvy insured hospital patients are asking for self-pay and prompt pay discounts. And thanks to a partnership with healthcare payments network InstaMed, Apple Pay customers will be able to pay some medical bills with the swipe of their phones or watches," PwC notes.
The report gives a shout out to Aetna, whose members can pay bills online with Citi's Money 2 platform. A big Aetna provider partner, Arizona's Banner Health, is also making strides in offering patients a consolidated bill.
Other providers "are contemplating and, in some cases, offering, layaway for care, loyalty programs, healthcare subscriptions and more," the report adds.
"Technology will play a significant role in creating ways to consolidate billing and payments, and mobile apps, online portals and other innovations should become more commonplace in the immediate future," said Paul D'Alessandro, PwC principal and customer leader of health industries. "For longer term solutions, the system should be redesigned to remove complexity and support a seamless customer experience."