Cory GainesConsumers increasingly are relying on information and insights from blogs, social media, and review sites in order to make purchasing decisions. This wealth of information has created a smarter consumer in most aspects of daily life. Although the consumer concept is relatively new in health care, patients—as the consumers of health care—are beginning to embrace this culture and becoming increasingly interested in better understanding their health information so they can make better clinical and financial decisions. By building clinical and financial information networks that take consumer preferences into account, providers can help their patients, improve their decision making, streamline clinical and financial workflows, and sustain their bottom lines.

Why Information Flow Matters

All healthcare stakeholders want information transparency. More importantly, they all want to trust the information they’re getting. For example, patients want to know that a provider’s billing statement accurately reflects what they owe. If they don’t trust the “amount due” is correct, they’ll wait until the next billing cycle to take action.

Likewise, providers and health plans have had to create entire businesses around processing billing, auditing claims, and recovering denials, all because of information that’s often inaccurate or missing. As an industry, we spend $315 billion every year on billing, claims processing, bad debt, and other aspects of the revenue cycle. A system of information sharing between providers and health plans could help reduce that expense. Such a system also would enable more meaningful communication with patients, minimizing confusion and encouraging timely payments. 

Providers can begin by taking the following key steps toward building a consumer-centric payment network.

Simplify billing statements. Use plain language that most patients will be able to understand instead of ICD-10 codes or clinical descriptions.

Modernize communication. Leverage platforms like Twitter, Facebook, and text messaging to streamline and accelerate communication flow among health plans, providers, and consumers.

Make paying bills “Amazon simple.” Most providers are still stuck in a paper-based billing model, requiring patients to mail in checks. But making payments should be easy and convenient. Providers should work with strong payment vendors capable of managing different online and mobile channels to replicate in healthcare the simplicity of one-click payment that online retail outlets have accomplished.

Health plans can contribute to the consumer-centric initiative by partnering with provider organizations in a few ways.

Help consolidate bills. A health plan is the one stakeholder who actually “sees” all the information regarding a patient visit. Health plans can use this information to help patients better understand their bills, explaining what is covered and the amount the patient owes the provider. Even better, they could work with the provider to combine the explanation of benefits with the provider bill so the patient receives one clear statement.

Offer “bill pay.” Most financial institutions have websites where customers can pay all their monthly bills like utilities, credit cards, and car payments with just a few clicks. A similar application from a health plan would be a convenience for patients and might just incentivize them the next time open enrollment comes around to stay with the plan. Such a site also could help to ensure providers get paid.

Through improved information flow, health plans and providers can promote their own financial health by avoiding unnecessary revenue cycle time and expense while at the same time enhancing the patient financial experience and increasing overall satisfaction.


Cory Gaines is senior vice president and head of product management for network solutions at Change Healthcare.

Publication Date: Tuesday, November 14, 2017