Healthcare Finance Trends for 2022: Patient Payments Focus Report

This Focus Report offers a range of themes carrying particular importance for patient payments and financing selected from the Healthcare Finance Trends for 2022 eBook prepared by CommerceHealthcare®. The three highlighted trends are related. There is a growing need for patient financial assistance that must be addressed to ensure access to care and organizational economic recovery. (Trend 1 below) Effective expansion of patient payments programs is hoped to make substantial progress in 2022, utilizing technology to provide a highly convenient digital consumer experience. (Trend 2) Finally, that positive experience increasingly requires offering the full panoply of rapidly growing digital payment options. (Trend 3)

For each trend, a few additional data points and considerations are provided for further illumination. Leaders are encouraged to read the complete Healthcare Finance Trends for 2022 eBook, detailing 11 trends that carry significant implications for the economic and operational wellbeing of health systems, hospitals and practices.

Mounting Patient Financial Pressures a Growth Inhibitor

Recovery hinges to a significant degree on patients proceeding with elective and routine care. But, like providers, patients are challenged financially, both from the effects of the pandemic and from accelerating patient payment obligation. Statistics delineate the current state of consumer healthcare finances.

• Rising out-of-pocket expenses and insurance coverage gaps. For many years, the trend in patient expense obligation has marched steadily upward. Growth of personal outlays is projected to rise 9.9% annually through 2026.¹ Moreover, 10% of adults under 65 were uninsured in the first half of 2021.² Many lack required resources. A study of Americans over age 65 found 27% have less than $500 available for medical bills.³

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• Consumers struggling to manage care finances. A Commonwealth Fund study found that over one-third of patients — both insured and uninsured — encounter some billing problem or medical debt.⁴ (Figure 2) Another survey estimated almost 18% of individuals carry medical debt, with a mean amount of $429.⁵

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The result is lost or deferred revenue for care providers. A mid-2021 survey asking which actions consumers have taken when they could not afford medical care or medications discovered the percentages shown in Figure 3 of those who delayed, skipped or declined treatment.⁶

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Financial status may get more precarious for many as the national pause in student loan and rent obligations ends. Providers will be expected to offer more financing as well as respond to the growing consumer preference for obtaining upfront out-of-pocket cost estimates. A recent survey noted that nearly half of patients obtained an estimate, and the effect on volume was largely positive.⁷ (Figure 4) These expanded financing steps can go beyond improved satisfaction to build patient loyalty. That effort is critical to long-term provider health and is much-needed in an environment in which 36% of consumers register indifference to health system brands.⁸

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Additional Data and Takeaways

• Debt levels pose a “major problem” for 24% of employees surveyed, suggesting providers face lurking patient payment problems.⁹
• Collection agencies are holding collectively $140 billion in outstanding medical debt.¹⁰
• Equity is a major concern in patient financing. Throughout the pandemic, the burdens have been falling disproportionately on non-white patients. Medical bill/debt problems were indicated at a level 1.5 times higher for black patients than white.¹¹

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• CommerceHealthcare^® internal data suggests that the monthly payment threshold for patient financing that maximizes compliance tends to be about $200.

Bringing the Technology Strategy Together

The pandemic added fresh impetus to healthcare’s substantial multi-year investment in digital transformation. Stimulated by the crisis, 60% of providers undertook new digital projects.¹² The focus for 2022 will be on integrating the technology pieces into a coherent, comprehensive whole. Many will formulate a digital roadmap to guide investment and sequence implementation of several high-profile technologies:

• Digital front door. Providers are unifying disparate systems, apps and workflows into a single-entry pathway that enables patients to navigate their care with maximum convenience and efficiency. IDC believes that by 2023, 65% of patients will be accessing services through a digital front door.¹³ Progress is already evident in the proliferation of online appointment scheduling and bill pay tools.
• Remote/virtual care. While telehealth’s surge during the crisis has abated, usage is poised to grow. Over half (56%) of hospital and health system leaders expect increased telemedicine investment during the next two years.”¹⁴ Additional research calculates that 40% of the pandemic-related virtual care will remain.¹⁵
• Further embedding telehealth into the landscape carries two key 2022 dependencies. The first is reimbursement alignment. Providers and industry groups are strongly urging CMS to extend the public health emergency declaration that broadened coverage eligibility during COVID-19. The agency has proposed doing so through 2023. The second dependency is platform redesign. Much telehealth workflow was put in place rapidly and now must mature for long-term optimization.
• Connected Health. Remote monitoring devices, mobile apps and artificial intelligence are opening a new frontier of personalized care and enabling movements such as “hospital at home.”

Several hurdles must be jumped to execute digital transformation. A study of CFOs across industries identified the two leading barriers to effective technology deployment in finance as high investment cost (26%)¹⁶ and inadequate internal staff skill sets (23%). Clearly, health systems, hospitals and practices will need to find ways to budget appropriately.

Additional Data and Takeaways

• Telehealth appears to have some economic sensitivity that may impact future usage. A survey uncovered that only about 19% of consumers who initially preferred a video visit would still want one if the costs were higher relative to in-person. Nearly 62% would switch.¹⁷ This price sensitivity is echoed by primary care physicians, 21% of whom said they had to limit use of telemedicine when reimbursement payments were reduced.¹⁸
• Observing that reaching enterprise scale with a digital tool can average two years, several health systems recently formed a non-profit marketplace of digital health apps to help hospitals support a "plug-and-play" model that minimizes reconfiguration and deployment time.¹⁹
• Unifying technology will be essential to offering a complete and convenient patient experience. For example, on the patient financing side, integration is being pursued between EHR, patient intake, financial clearance, charity care and financing software.
• Digital front door adoption depends on providers doing “more to increase awareness of the value of these tools” for patients.²⁰

Drive for Convenience Fuels Digital Payments Adoption

A variety of digital payment modes are gaining wider B2B and B2C acceptance. Growth is being propelled by convenience, efficiencies, cash management and health safety, and is uniform across a range of payment rails, including:

• Real time payments (RTP). This mode forms a $13.5 billion worldwide market, expanding at an annual clip of 33% through 2028.²¹ Real time healthcare bill payments and disbursements are projected to reach over 70 million in 2022.²²
• Electronic Funds Transfers (EFT). Healthcare processed 108 million EFTs in the second quarter of 2021, up almost 36% from the same 2020 period.²³
• Mobile wallets. This facilitator of RTP is likewise surging. New mobile wallet users are projected to come onstream at a rate of 6.5 million per year between 2021 and 2025, with average spending reaching $4,064 annually per user.²⁴ Mobile wallets are also becoming a force in all e-commerce as the forecast in Figure 6 displays.²⁵

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Digital payments should expand in 2022 as part of e-commerce protocols necessary to support telehealth. COVID-19 concerns will provide further stimulus.

Related technologies to keep on the planning radar:

• Biometric authentication. Security is paramount in electronic payments, and research suggests that consumers prefer voice, fingerprint and other biometrics.
• Open banking APIs. These tools allow strong integration between bank and provider systems to provide patients a more seamless payment experience.
• Cryptocurrency. The future remains cloudy for this mode, but it is already being used for a number of consumer transactions.

It is important to note that effective payments innovation is about more than just processing digital payments. A “closed loop” system is needed that unites payments and data to permit complete reconciliation and tracking of fund flows.

Additional Data and Takeaways

• Offering a variety of digital payment methods supports strategies to maximize pre-service payments for out-of-pocket care costs and to efficiently provide refunds.
• A dependency to consider in promoting these forms of payment: many patients lack necessary high speed internet connections.
• A cross-industry study showed the dynamism of the payment space, with healthy majorities of companies offering more methods, boosted by consumer behavior changes from the pandemic.

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• 59% percent of consumers who have never owned cryptocurrency are interested in using it to make purchases in the future.²⁶

Conclusion

Balancing the multiple patient payments priorities discussed in this Focus report will be crucial. Fuller context for these and other high-impact trends can be gleaned from the complete Healthcare Finance Trends for 2022 eBook, provided by CommerceHealthcare^®.

CommerceHealthcare^® solutions are provided by Commerce Bank.

Disclosures:

1. Kalorama, Out-of-Pocket Healthcare Expenditures in the United States, 5th Edition, July 12, 2021.
2. S. Collins, G. Aboulafia, M. Gunja, “As the Pandemic Eases, What is the State of Health Care Coverage and Affordability in the U.S.? Findings from the Commonwealth Fund Health Care Coverage and COVID-19 Survey, March–June 2021,” Commonwealth Fund Issue Briefs, July 2021.
3. D. Grunebaum, “One in Four Seniors Lack $500 for Medical Bills: Survey,” MedicareGuide blog post, October 19, 2021.
4. S. Collins, G. Aboulafia, M. Gunja, “As the Pandemic Eases, What is the State of Health Care Coverage and Affordability in the U.S.? Findings from the Commonwealth Fund Health Care Coverage and COVID-19 Survey, March–June 2021.”
5. N. Eddy, “Medical Debt Soars To $140 Billion and is Examined as a Social Determinant by JAMA,” Healthcare Finance, July 21, 2021.
6. Accenture, “Digital Adoption in Healthcare: Reaction or Revolution?” 2021 Accenture Health and Life Sciences Experience Survey–US Findings, August 2021.
7. Waystar, Consumer Attitudes Toward Medical Bills and the Price Transparency Rule, 2021.
8. T. Macgibbon, “Why Patient Loyalty in Health Care Matters: Why Now and How to Get Started,” MedCity News, August 23, 2021.
9. Employee Benefit Research Institute, 2021 Workplace Wellness Survey, July 2021.
10. N. Eddy, “Medical Debt Soars to $140 Billion and is Examined as a Social Determinant by JAMA,” Healthcare Finance, July 21, 2021.
11. Collins et. al, Commonwealth Fund Health Care Coverage and COVID-19 Survey.
12. BDO, 2021 Healthcare Digital Transformation Survey, 2021.
13. IDC, Futurescape: Worldwide Health Industry Predictions, 2021.
14. B. Siwicki, “Most Provider Organizations Boosting Telehealth Investments, Survey Finds,” HealthcareIT News, September 30, 2021.
15. Oliver Wyman, “Five Things to Know about Consumer Sentiment and Virtual Care Adoption,” blog post, August 25, 2021.
16. McKinsey & Company, Mastering Change: The New CFO Mandate, October 2021.
17. Z. Predmore, E, Roth, J. Breslau, S. Fischer, L. Uscher-Pines, “Assessment of Patient Preferences for Telehealth in Post–COVID-19 Pandemic Health Care,” JAMA Network Open, December 2021.
18. Primary Care Collaborative and the Larry A. Green Center, Quick COVID-19 Primary Care Survey, Series 30 Fielded August 13-17, 2021, September 2021.
19. J. Cohen, “Systems to Launch App Marketplace for Digital Health Tools,” Modern Healthcare, October 5, 2021.
20. Accenture, “Digital Adoption in Healthcare: Reaction or Revolution?” 2021 Accenture Health and Life Sciences Experience Survey–US Findings, August 2021.
21. Grandview Research, Real-Time Payments Market Size, Share & Trends Analysis Report, January 2021.
22. PYMNTS.com, “Deep Dive: Giving Healthcare Payments a Real-Time Upgrade,” blog post, November 20, 2019.
23. Nacha, 2Q 2021 ACH Network Volume Totals Infographic, 2021.
24. eMarketer Insider Intelligence, “U.S. Payment Users Will Surpass 100 Million This Year,” blog post, March 30, 2021.
25. J.P. Morgan, 2020 E-commerce Payments Trends Report: US, 2020.
26. PYMNTS.com, Cryptocurrencies Payment Report, May 2021.