Can you design an innovation to improve patients' experiences with medical billing?
Patients in the U.S. struggle to understand their medical bills and the medical billing process. Providers, payers, and consumers all benefit if we improve the current system. This design and innovation challenge seeks to tackle a current consumer pain point to help deliver solutions that result in clearer, less complex, and more understandable medical bills that ultimately improve the patient financial experience.
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 to both support these ongoing efforts and catalyze innovation by bringing new players to the table – designers, developers, digital tech start-ups, entrepreneurs, and other innovators - who may traditionally be outside the healthcare space.
The submission requirements include:
- A written design brief (not to exceed 2,250 words) describing the concept, the design principles it follows, and how it meets the evaluation criteria
- A brief video (less than 3 minutes) describing the concept, the design principles it follows, and how it meets the evaluation criteria
- Visual compositions (including information, layout, and aesthetic) of the tools and materials the patient may see and interact with, including the medical bill itself
- A journey map that illustrates changes to the medical billing process from the patient’s perspective in terms of his/her specific experience and what solutions are provided by the health care organizations involved
- All submission components, with the exception of the brief video, should be submitted in PDF format
Recognition & Prizes
Winners of the challenge will receive recognition and prizes including:
- Winners will receive up to $10,000 in cash prizes:
- $5,000 – Prize 1: Easiest Bill to Understand
- $5,000 – Prize 2: Transformational Approach
- Honorable Mentions: Entries that do not win but demonstrate a compelling concept or solution may receive an honorable mention.
- Winners will be announced at the 10th Annual Health 2.0 Fall Conference on September 25-28, 2016 in Santa Clara, CA.
- Winners will draw national attention from organizations across the health ecosystem, as well as the press.
- Winners will be promoted throughout the Health 2.0 and Mad*Pow networks.
- Winners may have the opportunity to work with health care organizations engaged with the challenge to implement their concepts (in whole or in part) in the real world.
Please review all resources and information on the challenge background page as they provide the basis on which entries will be judged and consider them in the concept you develop for your challenge entry. Winners will be selected based on the following evaluation criteria.
Most Appropriate Use of Information and Data
This includes how the data is presented, translated, and explained. See "Medical Bill Information and Data” document for a listing of sample information and data that can be used. Each participant should determine what to include based upon their interpretation of what is necessary as supported by the insights shared in the research report.
Addresses Top Concerns Associated with the Current Medical Billing Experience (See Research Report for listing of top concerns)
Usefulness and Understandability of Patient Facing Materials and Tools (Including the medical bill and any other patient facing materials and tools)
Use of Human-Centered Design Process in Creation of Concept (See human-centered design guidelines)
Use of Plain Language (See clear communication guidelines)
Uniqueness and Creativity of Solution
Additional Criteria for Prize 1: Easiest Bill to Understand
(FOCUSING ON THE DESIGN OF THE BILL ITSELF)
- Addresses Issues and Opportunities associated with Bill Design
- Incremental Innovation – Works within Existing Models (Workflow, Data, Technology, Patient Facing Materials, and Tools)
Additional Criteria for Prize 2: Transformational Approach
(FOCUSING ON WHAT THE PATIENT SEES & DOES THROUGHOUT THEIR MEDICAL COST ESTIMATION & BILLING EXPERIENCE)
- Addresses Issues and Opportunities associated with Medical Cost Estimation and Billing Journey
- Alignment with Modern Consumer Expectations
- Future Forward Innovation – Evolves Existing Models (Workflow, Data, Technology, Patient Facing Materials and Tools)
The Advisory Panel will provide assistance to challenge participants on interpreting these criteria. This site will continue to be updated with answers to frequently asked questions and a Q&A webinar will be held where questions will be asked and answered live. The exact date and time of this call is to be determined and will be announced via the website.
We are here to help.
We’ve provided the below FAQs to support your efforts with the design challenge, but please feel free to also send questions via email.
Why should I enter the Design Challenge?
To make the world a better place, of course! Plus, the opportunity to work with our incredible group of pilot partners who are committed to working with the winning design, in whole or in part. To get lots of eyes on your brilliant designs. And for the chance to take home up to $10,000 in prizes.
Who is eligible to participate?
Refer to Eligibility Rules for Participating in the Terms & Conditions on the challenge website: The Challenge is open to teams and individuals. You can read more details about this in the Eligibility Rules for Participating in the Competition on the challenge website (Section II, Part B in the Terms and Conditions).
What do I submit?
A complete submission contains four parts (all parts, with the exception of the video, should be submitted in PDF format):
- A design brief under 2,250 words describing how your submission addresses the evaluation criteria [Note: The judges will be doing a lot of reading, so err on the side of legibility & brevity.]
- A visual composition that illustrates “what the patient sees.” This will include the bill itself, and other materials the patient may see or tools a patient may interact with.
- A video under 3 minutes of how your submission addresses the evaluation criteria
- A journey map: You can use the backbone we’ve provided in terms of style and example journey or come up with your own.
When is the submission deadline?
August 10, 2016 by 11:59 pm.
Can I submit my design after the deadline?
No. So don’t procrastinate! We want to see your amazing work.
Can I send an updated design after the deadline?
Nope. You’ve only got one chance, so make it count.
How do I submit my design?
If you’d like to participate in the Design & Innovation Challenge, pre-registration is the first step. Once you’ve pre-registered, we’ll send a Final Application Form with more instructions by email.
How will you judge the submissions?
We’re giving out two prizes. Both will be evaluated using a scorecard against a shared set of core criteria as well as a prize-specific set of additional criteria. An advisory panel will review all the submissions and make recommendations to our Federal judges. These judges will do their own review and then select our challenge winners.
How are Prize 1 and Prize 2 different?
- Prize 1 — Bill that is Easiest to Understand —is all about incremental innovation: taking bills as they exist in the current system and improving them.
- Prize 2 — Transformational Approach — is about disruptive innovation: blowing the doors off the way things are done today and creating something completely new that improves the patient experience.
Are there only two prizes?
There are only two cash prizes. We’ll also be giving out Honorable Mentions for entries that are outstanding in specific focus areas. If you have a specific passion or area of interest, feel free to focus your efforts on that. (e.g. just the bill or the cost estimator or communication between the insurer and the provider, etc.)
How disruptive can my design be?
Forget thinking outside the box. There doesn’t even have to be a box. You can completely reinvent processes and systems, rethink collaboration, and re-envision the intersection of patients, providers, and insurers. But keep it within the realm of possibility, please.
Do I have to be part of a design team to submit my design?
No. The Challenge is open to teams and individuals. You can read more details about this in our Terms and Conditions.
I don’t know anything about healthcare billing. Where do I start?
Every human-centered design project begins with research, and this one is no different. We’ve gotten the ball rolling for you with a research report and a wealth of other other resources. Of course, to make this truly human-centered, you need to involve patients in some aspect of your design process. Make your designs with them or run your designs by them, it’s up to you. The more patient involvement, the better.
What is a "journey map" and how would it be used?
Journey maps visually demonstrate the overview of a consumer or patient's experience from initial contact through engagement process. For example, where a patient first interacts with the health system when they have a medical incident (e.g. if they have an emergency and go to the emergency room, or if they visit their primary care physician and receive a prescription) and what touch points or engagement they have as they move through the system. This would be used to show a patient's interaction with a medical bill or to show a patient's interaction with the medical billing system writ large. For some additional resources on journey maps, please see the links on the challenge website. Your journey map will be used to demonstrate the process and experience from the patient's perspective for the solution you've designed.
Where can I find out more about journey maps?
We’ve created a current state journey map based on our research. However, feel free to create whatever style of journey map or specific flow you’d like. You aren’t required to use ours. If you’re new to journey mapping, check out these articles:
- Using Customer Journey Maps to Improve Customer Experience
- All You Need To Know About Customer Journey Mapping
- Illustrating the Big Picture: Journeys, Experiences, and Illustrations
What is the difference between the content in the video and the content in the written submission? Are you looking for something different?
The video will be more brief and to the point than the written explanation. The video will focus on the story of how the submission works and how it addresses key issues and evaluation criteria. The written explanation provides more opportunity for detail.
Can the design brief include graphics or can I only use words?
The design brief provides an opportunity for you to describe the concept in detail, the design principles it follows and how it meets the evaluation criteria. It should not exceed 2,250 words and you are permitted to use graphics to supplement the written explanation.
Are all 4 submission components (written brief, video, journey map and visual composition) required for both prizes?
The same 4 submission components can be submitted for both prizes as long as it is made clear in those submission components how the submission meets the evaluation criteria for both. You could also submit different components for each prize.
If an innovation is developed that incorporates both prizes, can it be presented as one product via one submission?
While the same submission components can be submitted for both prizes, it must be made clear in those submission components how the submission meets the evaluation criteria for both. If your team feels that your solution meets all the core criteria, all the criteria for Prize 1 and all the criteria for Prize 2, you can submit the same design brief, video, visual composition and journey map entry twice to be considered for both prizes. Alternatively, when submitting your work you could modify the components for each prize to emphasize how your work meets that specific criteria. We encourage the latter approach as it will help the judges understand why they should consider your submission for both prizes.
How market-ready do solutions need to be?
Solutions for "Prize 2: Transformational Approach" do not need to be close to market ready as they are more disruptive in nature. However, the more feasible submissions for "Prize 1: Easiest Bill to Understand" are in the near term, the better as the focus there is on incremental innovation.
How will my work be used?
The purpose of this challenge is to stimulate innovation and raise consciousness in the industry on the top concerns present for medical billing and potential solutions. We’ll be creating a gallery of all the submissions. Your work will live in this gallery, where we hope it will inspire everyone who sees it. It may also be used in marketing and advertising, now and in the future.
Who owns my design after I submit it?
Upon submission, contestants warrant that they are the sole author and owner of the Challenge Submission, and that the submission completely originates with the contestant, that it does not infringe upon any copyright or any other rights of any third party of which contestant(s) is aware, and is free of malware. You can read more details about this in our Terms and Conditions.
What data and information is required on a medical bill?
There is no standard list of required data and information for the medical bill that providers send to patients after health care services are delivered. However, all insurers must send members of their health plans an Explanation of Benefits after the care has been received and associated claim have been processed. And charity hospitals have to explain options for people who can’t pay their bills.
Some things to consider:
- The State of Vermont requires medical bills to include: What was done, by whom, when, and how much it cost.
- Many/most bills include: Date of service, description of services, charge status, payments, adjustments, credits, balance, notes, amount you paid, amount you now owe, amount billed to insurance, amount covered by insurance. And, almost all have information about financial assistance.
We are providing many examples of current medical bills and benefits statements to illustrate what is commonly represented today. We are also providing a listing of the information and data that is available to be represented on the bill. It is up to challenge teams to interpret the research findings and decide what data and information to represent on your bill as well as other patient facing materials and tools you may include in your concept.
What does the patient want/need on the bill? What questions do patients have when they see their bill?
You will find answers to this question and more in the Research Report.
- What am I paying for? (An itemized list that can be reviewed and confirmed.)
- How much did the hospital bill to my insurance company? Was it the correct amount?
- How much of those charges does my insurance cover?
- How much do I have to pay?
- How do I pay my bill?
- What if I can’t pay my bill in full?
- Who do I call if there is a mistake on my bill?
- What do patients want?
- To pay as little as possible
- What do the providers who are billing want?
- To get paid as quickly as possible
- To avoid questions from confused patients
- To get high satisfaction ratings from patients
- What do insurers want?
- To ensure that they are billed according to agreements.
- To avoid questions from confused health plan members
- To get high satisfaction ratings from health plan members
How does the billing process work?
After a patient receives care, the provider sends a bill to the insurance company. The insurer decides how much of the bill it will cover. This amount is based on many factors: billing agreements between the provider and the insurer, “reasonable and customary” charges for the goods and services received, the patient’s deductible and co-insurance rates, etc. The insurance company pays the provider, and the provider bills the patient for the balance of the charges. When the insurance company processes the claim, they send an Explanation of Benefits (EOB) to the patient, detailing the charges, amount covered, and any remaining balance. In most cases, the patient does not receive the bill and EOB at the same time. The gap between date of service and date of the bill depends on how and when the claim and bill are processed and can vary. Sample bills, EOBs and other patient facing materials are available on the challenge background page.
What actions do people want to take when they get their bill?
- Understand if the bill is correct
- Wait to see if more bills arrive that may be more accurate
- Explore payment options
- Pay the bill
- Call the insurance company or healthcare provider for answers to questions about the bill
- Dispute the bill
What happens if you don’t pay a bill? What do consumers need to help them make informed decisions and avoid negative consequences?
Providers usually re-send unpaid bills every month. If they remain unpaid, the hospital notifies the consumer that the bill is being sent to collections. Many providers give consumers information about financial assistance. Some make adjustments to bills. Others allow consumers to set up very flexible payment plans. Nonpayment or underpayment of medical bills is reported to credit bureaus, affecting the patient’s credit score.
What if the patient is a minor?
If a patient is under 18, he/she likely has a parent or guardian who is the “guarantor,” responsible for paying the bill and listed on the billing document.
What literacy level should we be writing for?
Although the average American adult reads at an 8th grade level, health literacy is much lower. According to a 2015 report published in “American Family Physician,” written materials should be written at the 5th-6th grade level.
Readability-score.com offers a handy tool to help you gauge the readability/literacy level of your content.
Will this bill have insurer payment information? Negotiated rates, payments, etc that would be found on an EOB?
Choosing the appropriate content for the bill is part of the challenge, along with explaining where the data will come from.
Is this bill meant to be only a paper bill or have an electronic version? If there is to be an electronic version, are there intended to be web and/or mobile app versions?
Choosing the best formats for the bill is part of the challenge. Explain why the formats you choose are the best for the patient.
Where can I find resources on Health Literacy & Plain Language?
Are there additional resources available to better understand the current cost estimation process?
Most health systems and insurance companies provide cost estimation tools and resources. Geisinger, Providence, and Cambia for example, provide online cost estimator tools which may require membership. INTEGRIS, MetroHealth, and University of Utah have call lines to assist their patients looking for costs.
Links to partner organization cost estimation resources:
- Geisinger Cost Estimation
- INTEGRIS Cost Estimation
- MetroHealth Cost Estimation
- University of Utah Health Care Cost Estimation
- Providence: Providence Health Plan offers an online treatment cost estimator tool to their members
- Cambia: Cambia’s regional health plans offer cost estimator tools like resource 1, resource 2 and resource 3 to their members
Companies like "Castlight" also work to provide consumers with cost estimates.
I have more questions. Who can I talk to?
Feel free to send questions via email. We’ll also be holding a Q&A webinar. Stay tuned for the date and time. We’ll update the FAQs on this site based on the questions that come in during the webinar.
of Mad*Pow's patient survey respondents were hesitant about seeking additional medical care because of their experience with medical bills