Price Transparency

Two years after the No Surprises Act was signed into law, healthcare price transparency and billing remain trending topics in the healthcare world. Together with the CMS final rule on price transparency, new regulations aimed at helping consumers better understand and plan for healthcare expenses have the potential to reshape the patient experience. Patients, providers, and politicians share an interest in improving price transparency. But developing and implementing the necessary processes has proven to be a challenge for providers. Meanwhile, the regulatory landscape continues to evolve, creating new challenges and expectations across the board. Where does price transparency stand today? Experian Health caught up with Riley Matthews, Senior Product Manager at Experian Health, to talk about the future of patient estimates and healthcare price transparency. Q1: As regulations have taken effect, how are patient perceptions changing when it comes to price transparency? “Patients are definitely here for these mandates,” Matthews says. “Most consumers have had the challenge of going to a hospital for care and finding out the bill is not what they expected. Maybe they didn’t even know what services they were getting in advance, or what the price for those services would be.” Now that price estimates and online pricing information are increasingly available, the consumer mindset is changing. Armed with greater access to information, patients feel empowered: “It’s changing the marketplace,” says Matthews. “Until now, healthcare hasn't truly been a free market: Pricing information has been kept very close to the chest and, often, patients didn’t see pricing until services were about to be rendered. At that point, they didn’t have time to evaluate. Patients can now see what the price of a radiology visit is at different facilities and compare.” As price transparency gains traction, consumers can be more proactive about the cost of care and managing their financial responsibility. Q2: What are the incentives for providers to comply with regulations and provide greater price transparency? “If someone is buying a car, they can search multiple dealerships online and compare pricing. Now, because of these mandates, patients can do the same for knee surgery,” Matthews explains. “If providers and hospitals aren't complying—if they’re not giving patients tools to help them understand and meet their financial obligations—they’re taking a risk.” In a study from Experian and PYMNTS, six in 10 patients who paid out-of-pocket for healthcare costs and received either an inaccurate estimate or a surprise bill said they would switch providers for a better payment experience. Separately, the regulatory consequences for failing to meet mandated requirements could escalate if the industry fails to comply. “CMS is likely to do more audits to enforce these mandates,” says Matthews. “The mandates themselves aren’t necessarily changing, but the amount of financial impact to providers and hospitals who don't comply is increasing. Price transparency violation fines start at $300 per day for a breach in the mandate, but they can go up to $5,500 a day or just over $2 million per year.” Q3: Have regulations been effective at motivating providers to get up to speed on implementation? “Implementation is accelerating but it hasn’t been quick,” Matthews says. “Compliance is on everybody's list of priorities but bringing systems up to speed has been a challenge: Technology takes time. Experian Health offers two solutions to help providers meet the core mandate for the CMS final rule. The first is Patient Estimates, a self-service portal patients can use to generate price estimates, make payments, and more. “Our self-service payment estimates portal provides a searchable list of prices for 300 common services, so patients can go to their hospital’s website and get a quote or view pricing,” Matthews says. “We’ve checked the box on that part of the CMS rule.” To meet the second part of the CMS mandate, Experian Health is partnering with Cleverley + Associates to create a downloadable, machine-readable pricing file for providers that can be digested and used across the organization. “Because there’s no standardization, providers haven’t been sure how to build this file,” Matthews says. “Many don’t have the tools or capability to do it themselves. “Combined with our self-service patient estimates, our partnership with Cleverley means Experian now has a full end-to-end solution that can solve for price transparency,” says Matthews. “And now that clients have a solution they can purchase and use, we expect to see an acceleration in adoption and compliance.” Q4: How are price transparency regulations evolving? What’s ahead for 2023? Both the CMS price transparency rules and the No Surprises Act are already having an impact on patients, who can now expect to receive a cost estimate prior to treatment. New online tools are on the way to help them understand their upfront costs. “Both of these regulations are meant to ensure that—there’s no better way to describe it—there are no surprises when a patient gets their bill, especially in self-pay scenarios,” says Matthews. “We already see providers moving in this direction.” But there are changes ahead. “The No Surprises Act isn’t fully fleshed out,” Matthews says. “Additional rules are going into effect January 1, 2023, and the industry is waiting on future regulations for insured patients that haven’t even been seen yet. Existing regulations will continue to evolve.” States are enacting additional mandates as well. According to Matthews, New York, Florida, and Colorado have all started to refine or expand their state regulations. Mandates in Colorado, for example, will allow patients to get price comparisons or dispute charges in advance of service. Q5: What actions should providers be thinking about as we move into 2023? Providers need to find the strategy that best fits their organization: “If a provider lacks a solution for both parts of the CMS mandate, they may want to reach out to a partner who can help support both, like Experian Health and Cleverley,” Matthews advises. “And if providers already meet half the mandate—if they currently have a portal like ours where those services are listed but lack the machine-readable file—they can identify whether it makes sense to partner to meet that other half. Providers can consider their costs and risks in each area and identify what works best.” At the same time, providers and their partners need to keep the patient experience top of mind. Although patients welcome greater price transparency, offering up-front cost estimates and pricing tools are only half the equation. Patients may also need financial help in the form of easy online and mobile payment options, payment plans, or charity assistance. “Philosophically and culturally, patients have been conditioned to approach healthcare without focusing on price,” Matthews says. “If they need specialized care, their doctor refers them to a specialist and they go. They don't see who's in or out of network or research what the prices will be. This has been the accepted process for many patients, including me. But perceptions are changing, especially as high-deductible health plans have become common now. Patients are becoming a little bit more skeptical.” Price transparency has the potential to make patients better consumers by empowering them to take charge of their own healthcare and their financial well-being. “Regulations are giving providers greater responsibility for price transparency, but a change in the consumer mindset is creating an equally compelling need for improvement,” says Matthews. “The game is definitely changing.” Discover how Experian Health can help healthcare organizations comply with healthcare price transparency and create better patient experiences.

Can greater clarity and providing patient estimates at the beginning of the patient's financial journey set the stage for better access to care and a smoother path to payment? Millions of Americans struggle to pay for healthcare. A 2022 survey conducted by West Health and Gallup found four in 10 Americans, or roughly 112 million people, are cost insecure or cost desperate when it comes to healthcare. The issue is not just affordability; it’s also anxiety. Patients who fear they won’t be able to cover their out-of-pocket healthcare expenses may postpone or avoid treatment. At a minimum, anticipated medical expenses are a source of stress, especially for the growing number of patients who have high-deductible health plans. Pre-treatment patient estimates can help alleviate the stress. By taking some of the mystery out of medical bills, accurate estimates help patients understand and plan for costs. By opening a dialogue about treatment costs early in the process, patient estimates pave the way for further discussions about insurance coverage, payment plans, charity help, and more. As inflation wreaks havoc with household finances and talk of recession turns up the volume on financial stress, patient estimates and other tools that ease the payment process offer a bit of welcome relief for patients. A better patient financial journey offers benefits to providers as well. For healthcare organizations that are thinking about adding or improving pre-treatment patient estimates, here are 4 key benefits to consider: 1. Patients are more likely to forgo care if they can’t see how much it will cost. According to Experian Health and PYMNTS data published in July 2022, nearly half of consumers who canceled appointments last year did so because they were concerned about costs. Their concerns were not unfounded: the same survey revealed that one in five respondents spent more on healthcare than they could afford. Especially in uncertain economic times, the ability to understand and plan for out-of-pocket medical expenses is critical to patients. A Commonwealth survey found that deductibles were equal to 5% or more of household income in some cases; out-of-pocket costs were equal to 10% of household income in others. Add in concerns about the rising cost of living and the prospect of lost jobs, and the anxiety level surrounding healthcare costs only intensifies. Patient Payment Estimates help alleviate patient fears by providing clear, easy-to-understand estimates prior to treatment. Armed with this information, patients can make clear-eyed decisions about their care and ask about payment options if they’re needed. 2. Price transparency regulation is helping to create a new competitive environment. The No Surprises Act and CMS price transparency final rule are bringing price transparency into focus for patients and providers alike. These regulations require providers to offer accurate estimates in advance of treatment and disclose their pricing for common procedures. Although these regulations continue to evolve and providers are still working toward full compliance, patients are beginning to see more access to pricing information and a greater likelihood of receiving pre-treatment estimates. That’s creating a new competitive environment—and new choices for patients who are contemplating care. “In this new world, patients have the ability to branch out and research their own options,” says Riley Matthews, Senior Product Manager at Experian Health. “Patients have the pricing information to make informed decisions about healthcare and can shop between different providers based on price.” As a result, patient perceptions around transparency and trust are changing: “If providers want patients to keep walking through the door, they need to provide tools to help patients understand their financial obligations and feel that they’re being treated honestly and fairly.” Price transparency may have an additional benefit. According to Experian Health’s State of Patient Access: 2021 survey, eight in ten providers believe price transparency correlates with patients being more likely to pay bills on time. By simplifying pricing and payments, providers literally make it easier to pay. 3. Patients who know out-of-pocket costs in advance are more satisfied with care. In a March 2022 survey from Experian Health and PYMNTS, 88% of patients who received pre-treatment estimates were satisfied with the care they received from their family doctor, compared to 78% of patients who did not get an advance notice of costs. “Our ideas about patient satisfaction and care are changing,” says Matthews. “Healthcare is about more than physical health: It also encompasses mental, emotional, and financial health, all of which are affected by the patient payment experience. When healthcare costs or confusion stand in the way of patients getting treatment, or when healthcare bills create real financial challenges and stress, a transparent and compassionate billing process can make a crucial difference.” 4. Providing clear and accurate patient estimates is the first step to a better payment experience. Helping patients anticipate their healthcare bills with pre-treatment estimates is only the beginning of the journey. The same patient-centered payment tools that make the healthcare billing and payment process easier for patients also make it easier for providers. PatientSimple, Experian Health’s secure online patient portal, lets patients generate price estimates, apply for charity care, set up payment plans, update insurance information, make payments to hospitals and physicians, and even schedule appointments. Patient Financial Advisor delivers personalized estimates and payment options using the patient’s mobile device. Estimates are based on real-time benefits information and the payer’s contracted rates and pricing. Giving patients access to a range of information, using channels they prefer, helps them navigate the process at their convenience. Collections Optimization Manager helps providers target their collections, so they can direct resources where they’re most likely to succeed. Altogether, digital solutions that help improve the payment experience for patients can also help optimize the payment process for providers by making cost and payment information easily accessible to patients. It also creates behind-the-scenes efficiencies that streamline billing and collections for providers. Providing patient estimates is just the start.  Improving the patient payment experience at every step is a win for both patients and providers. Patients need clear information about treatment costs, insurance, and payment options to proactively plan their treatment and finances. But when providers put the systems in place to improve the patient's financial journey, they benefit too, by making these processes easier and more efficient. An improved patient payment experience may also reduce the need for difficult conversations with patients who are surprised by their medical bills and unsure how to pay them. More information, upfront, sets the stage for a healthier process overall. Learn more about Patient Payment Estimates and the full suite of Experian Health solutions to bring your patient payment experience up to speed.

Healthcare can be a serious expense. Around half of U.S. adults find it difficult to keep up with the costs, according to research from the Kaiser Family Foundation. As a result, roughly 4 in 10 have delayed medical care or gone without it over the last year. That’s where patient payment estimates and price transparency come in. When discussed at the outset of care, it can help patients prepare their budgets and understand their payment options. Consider it a built-in opportunity for healthcare providers to increase patient satisfaction and collections. “We’re all patients, so we all know the struggles,” said Riley Matthews, Senior Product Manager at Experian Health. “There is real frustration when faced with personal health challenges. On top of that, you’re burdened with meeting financial responsibilities. There’s no upfront explanation or seamless user experience to guide you through the cost of those services.” How to approach patient payment estimates The best time to share cost estimates is before the patient receives care. Healthcare providers can frame it as a two-way conversation, where the patient can ask questions and understand their projected out-of-pocket costs. When pricing is unclear, the patient might forgo care altogether. That’s a lose-lose for both the patient and the provider. Price transparency tends to lead to a better patient experience. According to a recent study conducted by PYMNTS and Experian Health, those who aren’t aware of their financial responsibility beforehand are less satisfied than patients who are. It then comes down to calculating patient estimates that are accurate and reliable. Patient Payment Estimates from Experian Health provide a clear breakdown of their out-of-pocket costs for the recommended services. It’s a simple but empowering thing that can help patients feel more in control. When patients are engaged and know what to expect financially, providers are more likely to collect payments in a timely manner. The Patient Payment Estimates platform offers: Price transparency, including financial assistance options An improved patient experience that allows for mobile payments Increased point-of-service collections Helping patients understand their payment options Once patients have a clear cost estimate, you can shift the conversation toward their payment options. Some may prefer to pay their bill in full beforehand. Others may need a more flexible arrangement — otherwise, they could opt out altogether and seek better payment options elsewhere. According to the PYMNTS and Experian Health study mentioned earlier, nearly one in 10 patients used a payment plan for their most recent doctor’s visit. What’s more, many patients who use payment plans are highly interested in switching providers if it means a better payment experience. Payment plans are valuable because they bend to fit patients’ unique financial situations. They can also increase the collections rate for healthcare providers. Experian Health’s Collections Optimization Manager can help providers be more intentional with their collections strategy. It scores and segments patient accounts based on which ones are most likely to be paid. From there, it directs them to the right resources to make payments. It essentially uses account data to bump up collections. Giving patients what they want Experian Health’s State of Patient Access 2.0 survey drove home an important point for healthcare providers — patients want clear, transparent pricing, along with payment plans and easier ways to pay. It’s precisely why patient-centered payments are so important. The idea is to give patients realistic financial expectations and fast, convenient payment options. Doing so can increase patient loyalty and revenue. Online patient payment software answers the call. This type of patient-first digital solution can optimize communication between patients and providers and allow for simple online bill pay. Patients are managing much of their finances online these days, from their bank accounts and student loans to their mortgages and credit cards. PatientSimple is a secure online portal where patients can set up payment plans, update their insurance information, schedule appointments and more. As the healthcare industry evolves, the patient experience is growing right along with it. Digital solutions, which make room for transparent pricing, are part of that journey. Patient Financial Advisor is a prime example. It provides an accurate snapshot of costs and payment options in advance. Patients receive a personalized estimate based on their benefits information and the provider’s payer contracted rates and pricing. Patients are also directed toward secure payment options. When all is said and done, healthcare providers want to deliver excellent care while also hitting their revenue goals. Patient payment estimates can be a driving force in getting there. Discover how Experian Health can help healthcare organizations provide price estimates and create better patient experiences.

Healthcare consumers should find it easier to access information about how much their care will cost, with the Government’s twin price transparency final rules both now in effect. The Transparency in Coverage Final Rule came into effect on July 1, 2022, placing new requirements on health insurers to disclose rates for specific items and services. This follows the similar Hospital Price Transparency Final Rule, which came into effect in January 2022. Taken together, the regulations are a significant step toward helping Americans understand and plan for the cost of care. However, this means that providers will need to implement healthcare price transparency tools to help them follow these regulations. While it remains to be seen how health insurers will fare, implementation has not been straightforward for many hospitals: only 16% achieved full compliance as of August 10, 2022. No fines have been issued yet, but with the maximum penalty increasing from $300 per day to $5500 per day in 2022 (up to $2 million per year), providers are under pressure to resolve compliance issues. To support this, Experian Health and Cleverley + Associates have joined forces to introduce new healthcare price transparency tools that providers can implement now. Bridging the price transparency gap When consumers don’t know how much their care will cost, they’re more likely to delay or default on payments, avoid care, or consider switching to a different provider. Transparent pricing should help consumers shop around for affordable, high-quality services and estimate the cost of care in advance. However, there’s still some work to do to close the gap between expectations and reality. Despite the legislative changes, patients continue to receive inaccurate estimates and unexpected medical bills. Survey data from Experian Health and PYMNTS found that of these patients, 4 in 10 ended up paying more for healthcare than they could afford. Even where the required pricing information is available, it’s often too complex to meaningfully inform patients’ healthcare decisions and financial planning. Experian Health and Cleverley + Associates have partnered together to offer providers a solution for the list of 300 shoppable services and a machine-readable file for items and services offered. This can help providers deliver better patient experiences with accessible pricing information. Healthcare price transparency tools are the key to compliance Under the Hospital Price Transparency Final Rule providers must display payer-specific rates for 300 shoppable services in a consumer-friendly format. Experian Health’s Self-Service Patient Estimates solution facilitates the first requirement, by enabling providers to list shoppable services and deliver accurate estimates to patients. It draws in current chargemaster data, payer-negotiated rates and patient benefits data so estimates are as accurate as possible. Patients receive a personalized estimate with links to convenient payment methods. Providers can deliver a better patient experience and increase upfront collection rates while minimizing the admin burden associated with manually uploading price lists. Similarly, Patient Financial Advisor gives patients a pre-service estimate of their financial responsibility straight to their mobile device, again connected to payment options. It’s designed to arm patients with a clearer understanding of their costs and payment options, so they’re better prepared to manage their financial responsibility. The price transparency mandate also requires providers to make available a machine-readable file for items and services offered by the hospital, including gross charges, cash prices for self-pay patients, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges. Under the new partnership, these machine-readable files are powered by Cleverley + Associates. The files incorporate standardized payer-specific negotiated charge formats and providers can access consultancy support to manage price changes. These files are created using the following process: Model the payer-specific contract terms and rates Apply those terms and rates to patient claims to determine the amount to be paid Assign a Medicare Severity Diagnosis-Related Group (MSDRG) and Ambulatory Payment Classification (APC) to each claim Calculate the median expected payment for items and services by MSDRG, APC and the relevant payer Disclose payer-specific negotiated charge on machine-readable file. An enhanced option is available which allows hospitals to benchmark prices, evaluate different pricing scenarios, and select the most appropriate pricing strategy. That strategy can then be incorporated immediately into the transparency file, so the output is based on the most current data. With this model, Experian Health and Cleverley + Associates can help providers meet both parts of the price transparency mandate. Leverage price transparency investments to improve consumer satisfaction While upfront estimates and clear pricing information are essential for compliance with the Final Rule, providers can further assist patients to manage payments by offering swift support to those who are entitled to financial assistance. Patient Financial Clearance automatically screens patients before or at the point of care to see if they’re eligible for financial assistance, Medicaid or other financial support. Experian’s proprietary Healthcare Payment Risk ScoreSM predicts propensity to pay, so patients can be assigned to the most fitting financial pathway. The final piece of the patient-friendly pricing puzzle is offering clear and convenient ways to pay. Patients welcome a choice of payment methods, including access to the same digital payment tools they use in other purchasing experiences. Experian Health’s Patient Payment Solutions enable providers to securely accept multiple payment types, including eChecking, credit cards (which can be kept on file), and recurring billing. PatientSimple brings all of this together to allow patients to pay balances, see payment plans and apply for charity care via a single self-service portal. Find out more about how Experian Health and Cleverley + Associates are supporting healthcare organizations to implement price transparency tools, comply with regulations and deliver outstanding patient experiences.

Paying for healthcare has long been a complex experience for patients. Inflation means more families are tightening their wallets, so the demand for clarity and flexibility is increasing. At the same time, the pandemic’s digital legacy means patients have had a taste of contactless and online payment methods – and they want more. This means that providers will have to focus on creating a better patient payment experience. Could a modern financial experience that benefits patients and providers finally become the norm? Experian Health President Tom Cox addresses this question in a recent PYMNTS publication of healthcare leaders’ predictions for the second half of 2022. Concerns about economic uncertainty, along with a desire for more financial predictability, means that providers can benefit from delivering a better patient payment experience. How? These 3 emerging trends could guide the way: 1. Patients expect a frictionless payments experience As patients bear more financial responsibility, they expect paying for healthcare to be as easy as buying a new sweater. Experian Health and PYMNTS data found that one-quarter of consumers used digital methods to pay for their most recent healthcare visits, with patient portals being the most common at 14%. Contactless and mobile payments are also becoming more popular. To eliminate friction, providers must start by identifying the pain points in their payment processes. Do patients know in advance how much their bills will be? Are they given advice and options to spread out payments if they can’t afford to pay the entire bill in one shot? When it comes time to pay, can they find a familiar and convenient payment method? Providers that can answer yes to these questions will have the edge when it comes to delivering a satisfying patient payment experience. When it takes an average of more than 30 days for providers to get paid, any strategies to make it easier for patients to pay sooner and in full will help provider cash flow. Offering quick and convenient digital payment methods that patients can access anywhere, pre-and post-service, will be the key to delivering a better patient payment experience and accelerating collections. 2. Amidst concerns about cost, patients want transparent pricing New research by Experian Health and PYMNTS found that consumers who were under financial pressure were more likely to cancel appointments out of concerns about costs. More than 2 in 5 patients who received inaccurate estimates ended up spending more on healthcare than they could afford. It’s no wonder that 6 in 10 patients who received an unexpected bill or inaccurate estimate say they would switch healthcare providers for a better experience. Cox notes that alongside consumer demand for a better patient payment experience, regulatory change is giving providers a further nudge toward price transparency: “The Hospital Price Transparency Final Rule and the No Surprises Act have put accurate data at the forefront of efforts to transform the patient’s financial experience. Together, these regulations can create the same pricing experience that consumers enjoy in other verticals, namely knowing the cost before making a purchase.” To date, implementation has been patchy. In August 2022, only 16% of hospitals were found to be compliant with the federal price transparency rule. In a recent conversation with Healthcare Finance News, Experian Health’s Chief Commercial Officer, Jason Considine, acknowledges that providing accurate estimates takes work: “Getting these estimates involves having information about the patient's benefits and insurance plan to create an accurate estimate… On top of mind for most provider organizations is an expectation of spending to increase for technology as regulations expand.” Investing in the right technology can help providers deliver financial clarity to patients. For example, Patient Estimates is a web-based price transparency tool that generates accurate estimates for patients before and at the point of service. It can also direct patients to payment plans and charity care, to help them plan and spread out the cost of care. Similarly, Patient Financial Advisor gives patients a pre-service estimate of their expected financial responsibility delivered straight to their mobile devices, and offers methods to make a secure payment. 3. Digitalized patient payments require better data and analytics Maximizing the impact of the above strategies relies on having the right data and technology in place. For example, in Accessing Healthcare: Easing Digital Frictions in the Patient Journey, Experian and PYMNTS found that patients may pay in person most often, but at least a quarter would prefer to pay online. Some may want to pay in full while others want to spread the cost. How can providers tailor their approach if they don’t know which patients want which option? Considine says that “Providers have to figure out the right financial pathway. It takes leveraging data to know the right financial experience." Achieving this requires a combination of consumer data, financial information and demographic details to create a complete picture of each patient’s needs and preferences. Patient Financial Clearance leverages Experian’s unrivaled datasets to calculate an optimal payment plan for each patient, based on their unique situation. Patients are guided to the right plan, giving them a sense of confidence about what to expect. It automatically screens those who can afford to pay upfront and those who may need more time. It’s a more supportive experience for patients and increases point-of-service collections for providers. Another option is PatientSimple®, which identifies the optimal financial pathway for consumers and makes that pathway available through its consumer-friendly, mobile-compatible, self-service portal. In short, patients want better payment methods, upfront price estimates and personalized payment plans. Data and technology can bring these to life. Find out more about how Experian Health can help healthcare organizations deliver a payments experience that meets and exceeds patient expectations, complies with regulatory change, and accelerates collections to help providers ride out financial uncertainty.

Does a patient’s age influence their experiences with rising healthcare costs? A recent report from Experian Health and PYMNTS points to a generational gap when it comes to the impact of and responses to medical bills. The study takes a deep dive into how Gen Z, millennials, Gen X and seniors are reacting to the growing cost of care. From canceling appointments to being surprised by out-of-pocket expenses, this article looks at the key differences in generations and healthcare costs, and the tools and solutions providers can implement to support their patients. Millennials are most likely to cancel appointments due to high-cost estimates A worrying proportion of patients are choosing to delay or forego care because of concerns about cost. This seems to be felt most acutely among younger patients. According to the new data, 74% of millennials and 56% of Gen Z patients have canceled a healthcare appointment after receiving a cost estimate that was higher than they could afford, compared to 13% of baby boomers and seniors. Gen X patients fell in the middle, with just over half canceling appointments after receiving high estimates. That said, healthcare costs affect all generations. While older patients seem less likely to cancel appointments due to cost, the “Medicare Effect” suggests that many hold off seeking care in the first place, until their costs are covered at age 65. Many households, regardless of demographic, are walking a financial tightrope as inflation continues to climb and patients bear responsibility for a greater portion of healthcare costs. Providers can help minimize the number of patients forgoing essential care by helping to track down any available coverage, so patients aren’t inadvertently billed for care that could have been covered by a forgotten health plan. Coverage Discovery continuously scans commercial and government coverage using multiple proprietary data repositories, advanced search heuristics, and machine learning matching algorithms. Finding missing coverage means upfront estimates will be more accurate, and patients will be likely to see a lower co-pay amount. In 2021, Coverage Discovery tracked down previously unknown billable coverage in more than 27.5% of self-pay accounts and found more than $66 billion in corresponding charges, removing a huge burden for patients and providers alike. Gen Z patients are most surprised by out-of-pocket expenses Overall, 19% of patients found they spent more on healthcare than they could afford in the last 12 months. As would be expected, those who received inaccurate estimates (43%) experienced more financial distress than those who received accurate estimates (26%). Among those who paid out-of-pocket expenses for their most recent healthcare visit, Gen Z patients were the least aware that they would be required to make a payment, with 32% not knowing that they’d need to make co-payments. Only 20% of Gen X and 10% of baby boomers and senior patients were unaware. One way to alleviate the strain of unexpected bills is to issue cost estimates automatically, before the patient’s visit. Only 34% of surveyed patients received estimates automatically before their visit, so it’s no surprise that many are caught unaware when the final bill arrives. With Patient Estimates, patients get a breakdown of their expected costs based on real-time provider and payer data. The estimates are delivered automatically to the patient’s mobile device (along with links to convenient payment methods. An earlier report by Experian Health and PYMNTS found that patient satisfaction rose by 10% when billing estimates were provided, underscoring their value. Millennials pay the highest out-of-pocket expenses Millennials appear to have been hardest hit by out-of-pocket bills. The average across all respondents was $363, but millennials paid an average of $619. This could explain why millennials were more likely to cancel appointments. Providers can help patients manage balance bills by providing tools that make it easier to plan and pay their bills. For example, Patient Financial Clearance screens and segments patients so providers can help guide them to the most suitable financial pathway. PatientSimple and Patient Financial Advisor help patients access cost estimates, identify best-fit payment plans, apply for financial assistance and make payments, via their patient portal or mobile device. Baby boomers and seniors are most satisfied with the healthcare payment process Most patients were generally satisfied with the payment process for their medical bills. Older patients appeared to be slightly more content, with 77% of baby boomers and seniors saying they were satisfied, compared to just under 70% of Gen X and millennial patients. Gen Z was the least satisfied, at 60%. With 22% of unsatisfied patients saying they’d consider switching providers, getting the payment experience right is high stakes for providers. So, how can providers improve the payment experience for those who are less than completely satisfied? Accurate estimates, tailored payment plans, clear communication and convenient payment methods will all be in the mix. For most healthcare organizations, this will mean embracing digital tools and automation. Experian Health’s State of Patient Access 2.0 survey revealed that while younger patients may be especially receptive to a digital patient payment experience, it crosses generational lines. Members of “Gen C” – digitally-connected consumers of all ages – are looking for a streamlined payment experience. When patient loyalty and decisions about when to receive care are so heavily influenced by the financial journey, it makes sense to offer digital estimates, billing and payments where possible. The good news for providers is that prioritizing patient satisfaction doesn’t mean sacrificing efficiency. Automation and digitalization can facilitate greater choice and convenience for patients, without requiring additional staff input. In fact, it’s likely to yield productivity gains and free up staff to focus on delivering an even better patient experience, and support patients to get the care they need. Find out more about how Experian Health’s suite of patient payment solutions can help providers deliver a financial experience that satisfies patients of all generations and healthcare costs.

As inflation puts the squeeze on families and individuals, healthcare providers have an opportunity to reimagine the patient financial experience so that medical bills put less stress on a household’s finances. Consumer-friendly changes might include providing estimates, clarifying benefits statements, offering payment plans, providing digital tools to make payments more convenient and offering more payment options. Not only would this help patients manage their medical bills so they feel more in control of their finances, but it would also help ensure that healthcare providers get paid faster and more reliably. Treating patients more like customers might actually boost the bottom line. In fact, a recent study from Experian and PYMNTS revealed that 6 out of 10 patients who paid out-of-pocket healthcare costs and received either an inaccurate cost estimate or an unexpected bill would switch healthcare providers for a better payment experience. “The Healthcare Conundrum: The Impact of Unexpected Patient Costs on Care,” a new report by Experian Health and PYMNTS, surveyed 2,483 consumers to learn about the effects of rising healthcare costs and unexpected medical bills on patient care and satisfaction. The financial challenges for patients Patients have been forced to assume a greater financial burden for healthcare payments through the prevalence of high-deductible healthcare plans. One benefits survey found that 58% of covered workers have at least a $1,000 deductible for single coverage. And due to limited payment options for managing medical costs, many consumers get strapped with large medical debt. More than half of Americans have at least $1,000 in medical debt and more than two-thirds of Americans under 65 report that they struggle with the cost of healthcare. Some consumers even opt to delay or forego medical care because of the cost. The healthcare industry has invested billions of dollars in technology and services that empower patients to play a more active role in the clinical side of their health journeys. Now, providers have an opportunity to do the same with the financial side of healthcare, so patients are empowered to better manage their health costs. 3 investments for a better patient financial experience Experian Health’s State of Patient Access 2.0 survey showed that patients want transparent healthcare pricing, payment plans and support, and faster and more convenient ways to pay their medical bills. “Giving patients transparency and payment options can improve the patient experience,” says Liz Serie, Senior Director of Product Management at Experian Health. She explains that it’s important for providers to improve the financial experience because it will benefit each patient’s overall health journey, increase the likelihood that patients will pay their medical bills, and help build patient loyalty as consumers prefer providers that offer convenient financial tools for patient payments. Experian Health has a suite of tools and services that can help providers improve these aspects of the financial side of healthcare. If providers make these strategic investments in the patient financial experience, they can both grow revenue and increase patient satisfaction. Investment 1: Price transparency Financial transparency is a major issue in healthcare, which results in unexpected or unexpectedly large medical bills. Data from Experian and PYMNTS revealed that in the past 12 months, 43% of patients who received inaccurate cost estimates and 40% of those who received an unexpected bill spent more than they could afford. If providers can offer more price transparency, it will help patients avoid getting stuck with inaccurate, confusing, or nonexistent estimates for their health costs. Tools like Patient Payment Estimates and Patient Financial Advisor can deliver clear estimates to a patient’s mobile device so they can be better informed about their health costs – and be better prepared to manage them. Patient Estimates uses real-time insurance status, contract rates, and provider pricing so the patient gets an accurate breakdown of a pricing estimate on the front-end of their care. This will allow patients to focus on the care they need instead of stressing about price uncertainty. These tools also offer convenient ways for patients to pay their medical bills so they can manage their financial obligations. Investment 2: Customized payment options Consumers expect financing options for larger purchases like cars and appliances, so healthcare providers should consider offering the same.  Personalized payment plans can help patients manage and pay their health bills. PatientSimple identifies the best financial pathway for each individual patient and offers an easy-to-use, self-service portal that helps them navigate that path. Patients can also use this tool to store payment information, set up payment plans, and apply for charity care. Consumers also want digital payment options that give them a fast, flexible, and secure way to make payments. Many consumers report that the pandemic has changed how they prefer to pay for goods and services. They want more contactless options, online portals, and mobile-friendly systems. Experian’s Patient Payment Solutions modernize patient payments through mobile-optimized, self-service options that make it easier and simpler for patients to pay their health bills in whichever way they prefer. Investment 3: Data-driven financial insights Healthcare providers can use data-driven tools like Patient Financial Clearance and Collections Optimization Manager to determine which patients have the financial capacity to pay their medical bills – and which patients might need financial assistance. By tailoring payment plans to each individual patient, providers can improve the financial experience and increase the efficiency and productivity of collections. Consumers have shown that they want convenient and customized payment options for all their purchases – healthcare included. To meet that expectation, providers can leverage technology, data, and analytics, creating the best possible patient payment experiences and improving their own bottom lines. Learn more about Experian Health can help healthcare organizations reimagine the patient financial experience with digital tools and solutions.

Nearly a quarter of patients have received a surprise medical bill, according to new data from Experian Health and PYMNTS. 4 in 10 patients said they ended up spending more on healthcare than they could afford, with the average surprise bill amounting to $675. Even insurance-savvy patients fall foul of surprise billing: 31% of patients who were familiar with the coverage landscape ended up paying more than their estimates suggested. Healthcare providers will need to implement solutions that can generate accurate price estimates before patients seek care, and prevent surprise billing. Without accurate cost estimates, patients are more likely to cancel appointments, which could cause their health conditions to get worse and eventually cost more to treat. This also creates avoidable and expensive administrative work for providers, who must chase payments from growing numbers of anxious, self-pay patients. To prevent surprise billing, healthcare organizations can look to data and digital tools. Advanced analytics provide greater clarity about each patient's financial situation, generate more accurate estimates and improve the patient payment experience. Inaccurate estimates persist despite the No Surprises Act Consumer demand and legislative action on surprise billing have led to an escalation in the push for more accurate estimates. But estimating patient liability is far from simple. It requires complicated calculations based on the patient's coverage, provider charges, payer contracts and potential discounts. Undertaking this manually can be time-consuming and error-prone, so many providers are turning to automated solutions. In a recent conversation with Healthcare Finance News, Jason Considine, Experian Health's Chief Commercial Officer, notes that providers expect to invest more in digital patient estimates solutions, particularly as the regulations expand. Those investments are likely to include technology to deliver accurate estimates and patient-friendly payment methods, and increased use of advanced data analytics to optimize collections. Surprise billing is at odds with a high-quality patient payment experience Beyond compliance, accurate estimates are essential for a positive patient experience. A poor financial experience can leave a bad taste in the patient's mouth, even if the clinical care was outstanding. So, what does that positive experience look like? The key is to think like a consumer: make the billing process as clear, convenient and compassionate as possible. Patients are looking for accurate and up-to-date pricing to be available before they receive care. And clear, and communication around the billing process can help eliminate the shock factor and improve patient collections. For example, providers could integrate a tool such as Patient Estimates, to give patients an accessible, personalized cost breakdown based on real-time pricing and benefit information. Patient Financial Clearance assesses a patient's individual financial circumstances to provide accurate estimates and recommend appropriate payment plans. And pricing information, payment plans and links to secure payment methods can be offered via a range of self-service, mobile-optimized patient payment solutions. El Camino Hospital in California used Patient Estimates to improve price transparency. The Senior Director (Revenue Cycle) said: “We decided to do a soft launch of a patient estimator tool, and the very next day, even without advertising it yet, our patients found the tool on the website and started using it. The feedback was excellent. We're providing a lot more estimates than we could before because it's 24/7 and patients can use it on their mobile device, their laptop or their desktop. Some advice I'd give other hospitals is to think of the patient when you're deciding what to do to best communicate your prices. What would the patient want?” Data-driven technology can prevent surprise billing Tom Cox, President at Experian Health, is optimistic about how the patient payment experience might evolve in the second half of 2022, as shared in a recent PYMNTS publication. He believes improvements come down to having the right data in place: “Payment options are increasingly digital and more convenient, payment plans are more common, and price estimates have become less of a rarity. There is also greater use of non-clinical data to get a broader view of patients and their unique financial solutions. Data, coupled with the right technology, can help providers make sense of it all and enhance the patient journey.” Data-driven technology can help simplify the payment process for patients, from accurate estimates to convenient payment methods. With PatientSimple, providers can leverage Experian's unmatched data and advanced analytics to identify the optimal financial pathway for consumers. It then guides patients toward that pathway through a user-friendly self-service portal. Patient Financial Advisor offers a similar experience via mobile. Patients can avoid the stress of surprise medical billing and plan for upcoming expenses. With tools that allow them to pay medical bills from anywhere, at any time, many patients will pay upfront, speeding up the collections process. Working with a partner such as Experian Health lets providers combine what they already know about their patients with industry-leading technical expertise and payment tools. With support to implement the right data-driven technology, providers can prevent surprise billing, resulting in regulatory compliance, greater revenue opportunities and customer loyalty.

COVID-19 provided an unexpected use case for patient portals. In a matter of weeks, the benefits of remote patient access were undeniable. Patient portals allowed patients to schedule, register and pay for care from the comfort and safety of home. Now, as the latest omicron sub-variant triggers another surge in case numbers, providers are again reminded of the value in making digital channels available to minimize face-to-face interaction. With staffing shortages continuing and patient numbers rising, it’s worth recapping the benefits of patient portals. Why should healthcare providers prioritize patient portals? Here are 7 reasons: 1. Patient portals can be used to communicate safely with patients as Covid-19 cases rise Health officials may be cautious about reinstating extreme measures in response to the latest wave of infections. However, they can’t afford to be complacent about an uptick in hospital admissions. Patient portals can mitigate the risks associated with increasing foot traffic by allowing patients to schedule and register for care without attending in person. Completing paperwork from home eliminates the need for patients to share clipboards or sit in stuffy waiting rooms, while online scheduling platforms enable staff to manage the flow of patients safely and efficiently. Remote patient monitoring, secure messaging and online prescription refill requests can also be managed via portals, further reducing the need for in-person visits. 2. They can ease pressure on understaffed teams Providers need to find efficient ways to handle the administrative workload that comes with higher patient volumes. It’s even tougher given increasing retirement and resignation figures. More nurses are embracing the occupational benefits of remote and virtual care and are opting to switch from high-stress facilities to telehealth positions. While this speaks to the growth and impact of remote healthcare, it leaves a gap to be filled in hospitals. Patient portals can alleviate some of the burdens by reducing the need for staff input at various points in the patient journey. For example, online scheduling reduces the number of calls to call centers. Pre-filled data and automated registration can reduce the risk of errors during patient intake, which are time-consuming to fix. Portals can also be used to help patients navigate the payments process, speeding up collections and reducing the time staff spend chasing payments. 3. Patient portals can address inefficient patient access workflows Because patient portals are tethered to the patient’s electronic health record (EHR), they provide a hub for every piece of data relating to the patient. Patients can access that golden record at any time. They get an engaging and transparent experience, and are less likely to call up to ask questions – they already have the answers. They can also check data to make sure that it's accurate, which helps avoid the delays and misunderstandings that cause friction for patient access teams. It's important to ensure that the portal itself doesn’t introduce friction. Patients need to be able to enroll in the portal without too much trouble. Automating the patient enrollment process and implementing a multi-layered identity-proofing solution can create a secure and efficient way for patients to get the most out of their portal, without compromising safety or efficiency. 4. To improve patient engagement and meet consumer expectations One of the biggest reasons to invest in patient portals is because patients say they want them. Research from Experian Health and PYMNTS found that 44.1% of patients have obtained test results through patient portals, while 18% used patient portals to fill out forms for their most recent healthcare visit. Overall, two-thirds said they use patient portals. Beyond offering a convenient patient experience, this is also a matter of patient loyalty and retention: 61% of patients say they’d consider switching providers to one that offered a patient portal, which could have a significant impact on revenue. 5. They can boost revenue by offering easy ways to pay Experian and PYMNTS research shows that around a fifth of patients uses their portal to make payments. Unfortunately, 16% of those patients said they’d faced difficulty viewing invoices, setting up payment plans and making payments through their portal, which suggests some room for improvement. Experian Health’s Patient Payment Solutions solves these challenges. A range of self-service, mobile-optimized tools simplify the patient financial journey by giving patients upfront pricing estimates, personalized payment plans and easy ways to pay. 6. Using patient portals can improve health outcomes (especially for “frequent flyers”) Patient portals also play an important role in promoting better health outcomes for patients. Research shows that when patients have access to their medical information, they feel empowered and prepared to speak to their doctor and adhere to care strategies. Multiple providers can engage with the patient through the same platform, and see what other treatments are being prescribed. This helps improve communication between the patient and provider and helps improve care management. It’s especially useful for older patients and those with chronic conditions. In this way, portals support effective care coordination, helping value-based care providers achieve their goals of reducing healthcare costs, promoting population health and closing the gaps in care that have widened over the last few years. 7. Patient portals can support compliance with price transparency regulations Finally, portals offer a route to ensuring compliance with new regulatory requirements around price transparency. The No Surprises Act and hospital price transparency rule call on providers to give patients accurate, upfront cost estimates so they can plan for their financial responsibility more easily. Patient Payment Estimates can be delivered in several ways, including through patient portals. And as noted, once the patient has their estimate, they can also be directed to easy and convenient payment methods, including through their portal. Whether it’s a surge in COVID-19 cases, rising inflation, or labor shortages, providers must find ways to build resilience, stay competitive, and continue to offer patients the flexible and transparent healthcare experience they desire. Patient portals should be part of the plan to open the digital front door. Contact us to find out how Experian Health helps healthcare organizations deliver a reliable and secure patient portal experience.