More often than not, medical billing is a source of confusion for patients and families. Consumers rarely know the cost of health care at the time of service, and commonly receive bills and explanations of benefits from multiple sources for the same episode of care long after the encounter. There is currently no standard for consumer medical billing documents; bills vary in content, presentation, and use of health industry jargon. Patients are often surprised by the costs incurred, and unsure how to verify whether their bills are correct or complete. This can result in anxiety or frustration leading to inaction, non-payment, over-payment of medical expenses, or hesitancy to seek future care.
At the same time, consumers are struggling to understand the portion of expenses that their insurance plan may cover, and may not realize that they have received out-of-network care or non-covered services until it is too late. Consumers may not understand how a deductible impacts their financial responsibility for services, or miss opportunities for proactive financial planning. Even when consumers try their best to understand how much things will cost in advance of their treatment they struggle to find accurate and consistent information. At other times, particularly in urgent or emergency care situations, patients are unable to make decisions that will affect their expenses or cannot understand the financial impact of the care decisions they are making.
The business relationships, data flow, and technology infrastructure of the health care organizations involved impact the patient financial experience. All of these entities have a relationship with the patient, but they do not necessarily coordinate to give patients a cohesive understanding of what costs were associated with care, why and how patients take the necessary steps to pay what they owe. This forces patients to piece things together on their own.
Confusion and surprises related to medical bills undermine patient satisfaction with both providers and payers. Furthermore, negative experiences with the system and financial hardship may cause patients to experience anxiety and stress -- emotional states known to be detrimental to the healing process. As a result, some patients may even avoid seeking the care they need in the future.
Many health care organizations have been doing important work to address the complex problems that individuals face when navigating the medical billing process. A national challenge presents a unique opportunity both to support these ongoing efforts and to catalyze innovation by bringing new players that are traditionally outside the health care space—designers, developers, digital tech start-ups, entrepreneurs, and other innovators—to the table. Providers, payers, and consumers all benefit if we fix the current system. Challenge participants will compete to deliver a solution that results in clearer, less complex, and more understandable medical bills that ultimately improve the patient financial experience.
We encourage participants to tackle the challenge in two ways: first, to pursue incremental innovation that works within existing models and systems to improve the design of the bill, making it clearer and easier to understand; and second, to take a more sweeping, transformational approach, redesigning the entire patient experience to recommend a better process for billing patients for their health care services.
The challenge is sponsored by AARP and powered by Mad*Pow, a design agency that improves people’s experiences with technology, organizations, and each other, in collaboration with the U.S. Department of Health & Human Services. . Mad*Pow led the research effort to help shape the challenge, including a patient survey and interviews with patients, health care organizations, and other stakeholders. The insights from this research are available on the challenge website to help ensure that challenge participants have the information they need to understand the problem space. The winners of this challenge will be announced at the Health 2.0 10th Annual Fall Conference on September 25-28 in Santa Clara, California, and will be promoted throughout the Health 2.0 and Mad*Pow networks.
We are also pleased to announce the health systems and insurance companies who have committed to engaging with this challenge as “pilot partners,” bringing their expertise and support to challenge participants. These include:
- Cambia Health Solutions (Portland, OR)
- Geisinger Health System (Danville, PA)
- INTEGRIS Health (Oklahoma City, OK)
- The MetroHealth System (Cleveland, OH)
- Providence Health & Services (Seattle, WA)
- University of Utah Health Care (Salt Lake City, UT)
Additional collaborators include:
- American Hospital Association (AHA)
- American Medical Association (AMA)
- Center on Health Insurance Reforms, Health Policy Institute, Georgetown University
- Community Catalyst: Center for Consumer Engagement in Health Innovation
- Department of Health Care Policy, Harvard Medical School
- Families USA
- Healthcare Financial Management Association (HFMA)
- Kaiser Permanente
- Roundtable on Health Literacy of the National Academies of Sciences, Engineering, and Medicine