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Measuring the Current State of Patient Pay

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It has been a year since the coronavirus pandemic hit the US. But even now, the pandemic and the fear it caused are still on people’s minds as deaths and infections are slowly coming to a halt. Amid the chaos that the pandemic started, healthcare has been one of the government’s main focuses, with payers and providers scrambling for damage control to accommodate the situation.

Although the vaccine has arrived, its rollout is slow, not to mention people are still sceptical of its effectiveness. Also, the onslaught of the pandemic was a grim reminder that the US healthcare system is inadequate and not fit to adapt to the situation. But that was last year. We should ask what the state of play is right now and how it’s predicted to shift again this year.

Accelerated value-based arrangements and insurer partnerships

Many insurance providers were also hit by the pandemic and forced to halt operations, losing a lot of money in the process to help prevent the spread of the virus. However, this also pushed them to look into more value-based arrangements instead of the usual pay-for-free services they typically offer.

It is quite ironic how the pandemic has forced us to see that staying in the usual pay-for-free insurance model is detrimental for everyone, especially during the pandemic. Not only that, but the government has also been open to looking for insurance deals and partnerships to businesses. This shift in insurance will also force the providers to keep their clients healthy instead of helping them when they are sick.

Geared up for real-time payments

Although technology has been adapted to many industries now, the healthcare industry is yet to enjoy the benefits of letting people pay in real-time. Sure, some insurers have already adapted, but not all of them, even with the apparent benefits they will have if they have done so. But the healthcare industry has been primed for this transformation long ago, and we should expect the payment process for providers to mostly be made online this year.

But as mentioned just now, some providers are still opting for the usual method of getting payments, which, as we all know, was a huge hassle. And not only that, because of the complexities that providers face with their reimbursement models, it can take almost a month or two to get their pay. 

And, of course, having errors like missing payments and delayed ones in the claim is detrimental to the predicted cash flow of the provider. This hassle is imposed more on the provider, which is why the process needs to go fully automated.

Further consumerisation of healthcare payments

Nowadays, being a consumer in healthcare takes a lot of financial responsibility. Consumers are recently becoming more meticulous and picky when it comes to shopping for healthcare insurance. However, companies are there to help you out regardless if you have your health insurance or not. Two of the main things consumers want in providers nowadays are transparency around prices and billing, and predictability. 

As we all know, America’s healthcare is complex and opaque. This puts a strain on both payers and providers alike due to the unnecessary hassle that US healthcare has. That said, providers want and deserve clarity regarding billing their patients for the service they perform. 

Payers want to know how their bills are quoted in the exact amount and full detail. There are many cases where patients are surprised by their bills once they get them. However, Waystar’s survey states that consumers nowadays have a strong interest in understanding their financial responsibility for healthcare. 

67% of these people are willing to find a quotation of the total costs before going to the doctor. However, the survey also stated that when people compute the estimate themselves, they are wrong 54% of the time, which is a sad reality.

Payer shift

As the pandemic rolled around last year, many people lost their jobs, and naturally, their insurance coverage would as well. Of course, not all employees have lost their healthcare coverage, but it’s estimated that 14.6 million people may have lost health insurance due to the massive drop in employment. Experts expected that the number of people to opt for Medicaid or self-pay could last until the following year. It’s also expected for people to seek out discounts from sites like BuzzRx and other websites.

To wrap things up

Although the number of people opting for self-pay due to the loss of insurance recently, experts believe that this might not last long as signs that things are changing for the better are happening. 

Also, due to this sudden rise of opting for self-pay, the demand for real-time payment methods and transparency has increased, which providers must meet. But until then, providers would have to struggle for a while because of the sudden shift.

Ellen Diamond did her degree in psychology at the University of Edinburgh. She has an ongoing interest in mental health and well-being.

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