This article is sponsored by FinPay. This article is based on a presentation that took place during the BHB Value conference with Christopher Wolfington, Founder & Chief Revenue & Strategy Officer at FinPay. The presentation took place on April 26, 2022.
Billions of dollars currently are lost across the health care payment landscape, with value-based care making inroads to help address the problems surrounding care providers’ reimbursements and health insurance member outcomes.
But the system still needs financial solutions that help the patient, said Christopher Wolfington, Founder & Chief Revenue & Strategy Officer at FinPay, during a discussion at the recent Value conference hosted by Behavioral Health Business.
“Out of $460 billion a year of [patient] out-of-pocket expenses, only 19% gets paid…This means that $340 billion in the healthcare ecosystem goes unpaid,” Wolfington said.
Establishing Roles: the Payer, the Provider, the Employer & the Patient
In value-based care, there are many decisions to be made. These decisions include choosing from various health plans, what kind of treatment to receive and the length of stay. During the decision-making process, some roles have more power over others. The health insurance payer is very interested in their member health care utilization, as well as controlling cost.
“Then the employer actually has two interests. One is they want a healthy employee that’s productive, but if they’re self-insured, they also have a cost-containment motive. In the traditional healthcare setting, there are four stakeholders,” says Wolfington.
Payer vs. Provider
Frequently, the stakeholders are looking to do what’s best for their organizations, rather than the patients’ well-being.
“The patient’s left outside the conversation to manage the care and the cost of that care all by themselves between the stakeholders,” says Wolfington.
This leads to conflict between the payer and the provider. The provider is concerned about getting paid quickly. The patient is concerned about out-of-pocket costs they may face for using their insurance.
“The correct answer is the patient deserves a fair, honest, and transparent conversation about the cost before they admit,” says Wolfington… “The patient’s also a consumer when it comes to costs, yet they’re supposed to navigate the cost of care, deductibles, co-pays, coinsurance all by themselves.”
Solutions
Under a shared risk model, where payers and providers agree upon a set budget and quality performance thresholds, everyone wins.
“In a shared risk value-based model, the payer is incentivized to give you accurate information so that there’s a better outcome both clinically and financially. That’s low-hanging fruit. Getting that information is not that difficult,” says Wolfington.
FinPay offers a solution-focused on transparency to make for a better experience both for patients and providers.
“You want the provider to behave better. I have an idea, motivate them to behave better. That’s what they care about, pay me, pay me fast and give me some opportunity for additional upside if I do things to help you out. If I’m the payer, what do I care about? I care about cost containment. I care about my members’ well-being and proper utilization of the health benefits. Payers don’t want them to be going too overboard,” says Wolfington.
By educating the patient and giving them affordable payment options so that any household can afford treatment, they are allowing transparency so that there are no surprises. A patient financial experience that prioritizes the patient’s access to affordable care helps avoid an abrasive financial experience that can disrupt a patient’s care plan in treatment.
With financial stress being one of the leading causes of relapse in substance use and mental health treatment, a better patient financial experience will help providers control the financial risk around patient out-of-pocket expenses and prevent a poor financial experience from harming clinical outcomes.
FinPay enhances the patient’s financial experience by providing the education, transparency, and payment options that make patient financial responsibility digestible and affordable to the patient. To learn more visit: www.FinPay.com.
Companies featured in this article:
