InstaMed Blog

A previous post covered how consumerism is impacting the healthcare payments industry and detailed how payers and providers can work together to take advantage of this trend.

However, the rise of consumerism in the healthcare industry presents unique challenges for payers to engage their members, which they must adequately prepare for – or risk consumer dissatisfaction and lost revenue.

Risks and Opportunities of Healthcare Consumerism for Payers
A decade ago, payers and employers managed almost all of the health benefit decisions for patients.  As a result, patients were relatively insensitive to costs as they took care of their healthcare needs.  However, today, patients have higher deductibles (over 15.5 million have high-deductible health plans, AHIP) and have become consumers who are sensitive to their healthcare costs.

Increasing confusion around healthcare costs results in a high volume of calls from members with questions about their explanation of benefits (EOBs), deductible limits and more.  In fact, 75% of consumers surveyed said they were confused by the U.S. healthcare system.

Three Areas to Address Healthcare Consumerism
To meet the challenges of healthcare consumerism, payers must focus on three key aspects of consumerism: clinical, administrative and financial.  In recent years, payers have begun to achieve significant progress in the clinical and administrative aspects, especially through their member portals.  However, there is a great deal of work that must be done to cater to consumers on the financial side.

CLINICAL
Payers have made efforts to engage with their members by educating them on preventative care and healthy lifestyles, which can help drive lower out-of-pocket costs and gain member trust.  An example of this is UnitedHealthcare’s Health in Numbers.

ADMINISTRATIVE
Health plan information is increasingly accessed by members through member portals – websites that allow members to view benefit information, including deductible amounts and network providers.  Payers are making efforts to help members understand this information through various communication methods.  For example, Wellmark Blue Cross and Blue Shield wrote a blog post titled, “Explanation of Benefits. If it’s not a bill, then what is it?

FINANCIAL
Although members can view benefit information in these member portals, the functionality of the portal frequently ends there.  Members want to manage, pay and understand their healthcare bills in one convenient portal – as they do in consumer-focused industries.  In a recent survey, 72 percent of consumers said they were interested in paying their healthcare bills online.  Yet, this expectation set by consumer industries has gone widely unmet in healthcare.

Broadening the Focus of Healthcare Consumerism
To address this gap in the financial side of healthcare consumerism, payers can enable members to simplify their healthcare finances by integrating payment functionality within their member portals.  As a best practice, payers should enable their members to view payments owed to all providers across multiple family members, make a payment, securely save payment information for future payments, and view how payments affect their deductibles, all in one place.

To enable payments, payers must ensure that they meet the compliance and regulatory requirements for both healthcare and payment processing, including PCI, EHNAC, HIPAA and money transfer laws regulated by FinCEN. It is also important to note that the unique regulations related to consumer payments are under harsh scrutiny and strict enforcement, not only by FinCEN and the CFPB, but also each state’s treasury and attorney general.  Significant fines and even criminal felony charges can be the result of unlicensed money transmission and improper treatment of consumer funds while in transit.

However, by integrating payment functionality within member portals, payers will ultimately streamline a confusing process to increase member satisfaction and differentiate offerings to employer groups.

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