By Srulik Dvorsky, CEO and Co-founder, TailorMed
It’s an unfortunate reality of our times: Healthcare in the United States has become increasingly unaffordable, challenging patients, providers, and pharmacies alike. One in 5 adults reported they can’t afford quality care. Uncompensated care hovers around $40B annually. The COVID-19 pandemic continues to strain the resources of our healthcare system. What lies ahead?
Against a backdrop of growing financial burden, these three trends tell the story of where healthcare affordability is heading in 2022 and beyond.
1.) Expect more patients to be in financial distress and needing financial assistance.
Out-of-pocket expenses and premiums are expected to rise in 2022. Coupled with rising living expenses, it’s becoming even more challenging for people with chronic conditions needing high-cost specialty treatments to afford care.
Healthcare costs continue to be a big concern for consumers and knowing out-of-pocket costs prior to receiving treatment has been top-of-mind for many. However, the lack of visibility into pricing for healthcare services has created post-treatment sticker shock. This has contributed to high rates of medical debt in the U.S. – $140 billion worth. The legislature has taken steps to create transparency and tools to help patients make educated decisions. However, they’re coming slowly. The No Surprises Act will mitigate certain unexpected out-of-network charges – 2 in 3 Americans worry about unexpected medical bills – and the Centers for Medicare & Medicaid Services’ delayed transparency bill will have more of an impact in 2023 and beyond as providers get their ducks in a row to offer upfront pricing for shoppable health services.
These challenges are compounded by the fact that the average person isn’t health insurance literate, making it more challenging for them to navigate their own financial responsibilities. For many Americans, there is no compelling event spurring them to get informed, until they’re going through a life-changing health crisis. Many don’t even know there may be financial resources available to help them reduce the cost of treatment.
What does this mean for providers? Rising costs and the lack of financially informed and engaged patients impacts their financial wellness. Health system margins are already thin enough. Providers end up incurring uncompensated care, collections that could be avoided upstream, and patients delaying or forgoing treatment.
2.) Increasing reliance on predictive analytics, digital tools for patients needing financial care
Providers have been catching up in giving people the digital consumer experience they’ve received from consumer retail, banking, travel, and other sectors. They’ve made headway in making it simpler for patients to find the right doctor and schedule an appointment. More recently, many providers have started offering an easier bill-paying experience, like Cedar and VisitPay. Together, these digital tools can lead to better access, better health, and better financial outcomes.
However, with more patients at financial risk more needs to be done. Providers are seeing the opportunity to be increasingly vigilant in engaging patients prior to treatment. Predictive analytics is playing an emerging role here. Patient data surfaced from different sources can create a single view, revealing who are the most financially vulnerable. This includes a spectrum of meaningful data points touching patient demographics, insurance benefits, treatment plans – particularly across complex episodes of care – and provider rates. By leveraging this data, providers can proactively identify which patients need the most financial care throughout the course of treatment and match them with the right funding programs. For a growing number of providers, the patient’s clinical care journey isn’t their only point of concern. Engaging patients during the financial journey matters, too.
3.) Coordinated efforts to create affordable access to high-cost treatment
One of the biggest financial pain points for patients going through high-cost care is specialty medications. The pharmaceutical industry has invested millions to develop these innovative drugs that address rare diseases or chronic conditions. However, the cost for many of these needed medications can create financial barriers for the ordinary person.
Expect to see the emergence of providers, pharmacies, and the pharmaceutical industry offering funding opportunities to patients in a coordinated way. Think of it as a connected consortium with pharma offering co-pay cards and free and replacement drug programs, providers helping ensure patients are on the optimal insurance plan, and pharmacists offering financial assistance programs to a patient filling a high-cost, specialty prescription – preventing that person walking away from a life-saving treatment.
Healthcare organizations are also gaining increased awareness of foundations that help patients offset treatment costs and everyday living expenses — such as The Pink Fund and the Multiple Sclerosis Foundation. As a result, we’re seeing growing demand for these programs. This also means these funds are closing out faster.
Getting to in-person care needs to be affordable as well. Healthcare organizations are increasingly engaging with non-emergency medical transportation (NEMT) services, like rideshare services Lyft and Uber. Expect these rideshare companies to become more embedded in care coordination — from medical appointments and vaccination transportation services to prescription deliveries and senior care.