In this Business Profile, Stuart Hanson, director of business development (healthcare solutions) at Citi Retail Services, discusses how improving the payment experience can benefit consumers and healthcare providers.

Stuart Hanson Citi Retail ServicesTell me a little about your organization.

Citi's mission is to enhance people's lives through innovations that harness the breadth and depth of our information, networks, and products. With massive financial computing power and digital expertise, we are able to integrate data from many sources in a secure, scaled fashion. In addition, Citi knows how to deliver a high-quality customer service experience at a very large scale, serving tens of millions of people. Leveraging these strengths, we've developed Money2SM for Health, a digital payment platform that helps simplify the healthcare payment process for U.S. consumers. We launched the platform in collaboration with HCA/Parallon and Aetna in June 2013. Over the past 18 months, we've expanded access to the payment solution to most Aetna members across the United States through the insurer’s member portal. We also are preparing to integrate additional health plans in 2015 and beyond.

What are you noticing with respect to consumer payment trends and expectations, and how is this affecting a provider’s ability to manage collections?

Especially with the implementation of the Affordable Care Act, there continues to be huge growth in the number of consumers choosing high-deductible health plans, with many of these individuals getting coverage through the health insurance marketplaces.1 Other consumers are still seeing their healthcare responsibilities growing due to increased out-of-pocket costs under more traditional plans. Direct annual payments from consumers to healthcare providers are growing at about 8 to 10 percent per year.2

Such growth is putting increased pressure on the financial performance of hospitals and health systems, as direct payments from individuals have often been more difficult and costly to collect than commercial payments. Ten years ago, it was not uncommon for a healthcare provider to collect very little of its revenue directly from consumers. By 2019, based on our analysis and government projections, we expect to see providers' level of patient direct pay to grow by at least 50 percent, on average, and up to 30 percent of these outstanding balances could be written off—amounting to nearly $200 billion.3 Providers simply can’t afford to continue taking on bad debt at these levels.

At the same time, patients are demanding a better payment experience. When it comes to consumers purchasing health care, there is a significant gap between their expectations and services typically provided today. I think back to the keynote address at a large healthcare conference last year where an industry executive compared his consumer experience when buying a sweater online with that of trying to obtain lab results. With his sweater purchase, he could receive email and text notifications on the order’s status, including when it had left the warehouse and when it was delivered. To follow up on his lab results, however, he needed to repeatedly make phone calls to the provider. He also expressed frustration at the lack of price transparency and payment options for the lab tests. Increasingly, consumers expect the same level of digitized integration they experience in online retail settings when they shop and pay for their healthcare services.

How does Citi’s Money2 for Health address these issues?

Citi built its solution from the consumer's perspective, focusing on what patients need and want with respect to billing and payment for health care. Typically, consumers are frustrated by the tedious and confusing process of matching provider statements to paper bills. Money2 for Health gives them one place to view, pay, and archive their healthcare bills and explanation of benefits forms via desktop, mobile, or tablet devices. It also allows them to pay using a personal healthcare digital wallet, which can connect to a consumer’s checking account, most health savings and flexible spending accounts, and most credit or debit cards from any U.S.-based bank. The patient views the amount owed, selects the desired payment mechanism, and the transaction is completed through simple "click and pay."

Such convenience isn't just serving the consumer. Providers that are able to ease the payment process may benefit from reduced bad debt, lower billing and collection costs, and fewer resources devoted to addressing patients' payment or billing questions. Perhaps most important, integrating billing and payment information this way may dramatically improve the provider's ability to enhance the overall patient financial experience, which supports brand loyalty and ultimately market share. We expect that these factors may produce a strong value proposition for providers that receive payments through our platform—potentially processing consumer payments faster and reducing collection communications and follow-up.

How Consumers, Providers & Health Plans Interact with the Money2 for Health Platform

What’s involved for healthcare organizations that want to use Money2 for Health?

Consumers already can pay most providers through the platform. Organizations that are not yet enrolled with Money2 for Health receive patient payments via paper checks. And it's easy to become a registered provider. Our express set-up option requires little or no IT support and quickly enables provider organizations not only to receive payments electronically, but also to research payments through our online portal, download posting information, and issue refunds (if needed) within a short period of time. We also offer a guided enrollment process where our team members will walk providers through the steps to become enrolled, if needed.

Once enrolled, some providers may also request deeper integration with Money2 for Health to enable automated posting of patient payments through the system. With this approach, they first go through the express set-up option. They then assess the need for expanded functionality and reporting capabilities, depending on the number of their patients using the service and their own internal priorities and IT resource availability. We offer these providers two options for the level of data integration preferred, and we work with these providers on developing a joint implementation project.

Regardless of the approach pursued, it's important to understand that Money2 for Health simply augments an organization's existing billing procedures; it doesn't replace or interfere with the organization's billing or become the organization’s only payment delivery option. Existing online website payment capabilities or paper statements can remain in place.

Any other tips for how organizations can be most successful as they integrate the solution into daily operations?

Two suggestions: First, we encourage providers to keep it simple and enroll using our express set-up option. This allows providers to receive consumer payments through Money2 for Health electronically and begin using our system. Second, we recommend providers consider system integration projects to automate the payment posting function only as volumes merit and resources allow. This is why we've structured our system to be flexible for the varying needs of different providers and over time.

Additionally, we suggest that providers look for other, broader ways their revenue cycle efforts can support consumer needs through process change and technology. A key question to consider is: 'How well are you positioning your processes for pricing transparency, and effectively providing consumers with information about payment options available?' Even organizations that have invested substantially in electronic health records have often made only marginal changes in their revenue cycle systems or processes, often relying on different types of bolt-ons to what may be antiquated systems. Increasingly, we are seeing CFOs begin to seek more integrated approaches to their processes and systems, strategically revamping the whole billing and collection process as they retool for consumerism more broadly and work to factor in more consumer-centric digital payment solutions, such as Money2 for Health.

Where can readers learn more?

Readers should log on to learn more about how Money2 for Health works and view a short video clip that features insights from industry leaders about patient payment challenges and solutions. Readers also can learn more about Citi's collaboration with Aetna and additional health plans we will be rolling out in the future, as well as how this innovative solution is changing the payment landscape for patients and healthcare providers.

1 Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–March 2014, National Center for Health Statistics.
2 National Health Expenditure Projections 2012–2022, Centers for Medicare & Medicaid Services.
3 Ibid. 

Citi Money2 for Health: Your All-in-One Healthcare Payment SolutionHFMA is the nation’s leading membership organization for more than 40,000 healthcare financial management professionals. Business Profiles are funded through advertising with leading solution providers. Learn more. 

Content for this Business Profile is supplied by Citi's Money2 for Health. This published piece is provided for advertisement purposes. HFMA does not endorse the published material or warrant or guarantee its accuracy. The statements and opinions of those profiled are those of the individual and not those of HFMA. References to commercial manufacturers, vendors, products, or services that appear do not constitute endorsement by HFMA.


Publication Date: Thursday, January 01, 2015