Launched at Mad*Pow's annual HXR conference, The ‘A Bill You Can Understand’ design and innovation challenge demonstrates that ‘collaboration is the new innovation.’ Public and private players leveraged their respective platforms, expertise, and perspective to accelerate progress toward solving a key consumer pain point with our health care system. Two challenge winners were selected from 84 submissions and were announced at the Health 2.0 conference on September 28, 2016. There were also 10 submissions who received an honorable mention. A big thanks goes out to all who were involved in the challenge. This webinar shares lessons learned from the challenge from Mad*Pow's Paul Kahn.

1. PREPARED BYPREPARED BY
Lessons Learned from
A Bill You Can Understand
DATE
Paul Kahn, Experience Design Director November 9, 2016

3. Project Timeline
February
Concept collaboration with Health
and Human Services
March
Pilot Partners & AARP sponsorship
April
Announcement at HxR
Research Report and Website
May 10: Launch at Health Datapalooza
June-July: Webinar + Social Media
campaign
Aug 10: Competition Deadline
Aug 22: Advisory panel review
Sept 7: Patient focus group review
Sept 15: Federal panel review
Sept 21: Winners/Honorable Mentions
chosen
Sept 28: Winners/Honorable Mentions
announced at Health 2.0

4. Our Pilot Partners

5. Mad*Pow Research Report
• Identify major issues in the current
medical billing system facing
patients today from the point of
view of
• Healthcare systems
• Insurance companies
• Patients
Seven Top Concerns:
• Patients Don’t Know What They Don’t
Know
• Volume of Communication
• Understandability
• Terminology
• Timing
• Financial Planning
• Trust

6. Patients Don’t Know What They Don’t Know
• Providers don’t inform Patients about how their medical care and
related costs are distributed among providers.
• Patients don’t know when and where to ask questions about
decisions that affect their medical care and related costs.
• Patients don’t know when a denied claim will be resubmitted,
processed and accepted.

7. Volume of Communication
• Patient typically receive a large number of documents from payers,
multiple providers and third-party benefits manager for a single
medical event.
• “Going paperless” can result in a large volume of emails from
multiple sources with links to multiple patient portals, each requiring
its own credentials, containing PDF copies of the same documents
that arrived in the mail.

8. Understandability
• These diverse documents do not provide a clear indication of how they
relate to one another or how they define the patient’s healthcare costs.
• The same charge may be described differently in a bill and in a benefit
statement.
• The name the physician treating the patient may not appear on the bill,
while the name of physicians’ unknown to the patient do appear.
• Hospitalization charges are divided into categories incomprehensible to
the patient, professional and facility services defined by the provider’s
contract with the payer.

9. Terminology
• Treatments are described in unfamiliar terms.
• Payment options are difficult to find and written in legal jargon.

10. Timing
• The time needed to reconcile claims to determine actual patient
charges separates the patient’s experience of care from their
experience of cost.
• The unpredictability and distance in time makes the entire
experience unreal, followed by bad surprises.

11. Financial Planning
• The lack of awareness of cost before and during care leads to patients
unprepared for managing final cost.
• Faced with bills that far exceed their available resource to pay,
patients don’t know their options for managing long-term payments.

12. Trust
Many factors undermine patient trust of the charges on the bill
• The contentious provider-payer relationship that generates denial
and resubmission of claims
• The enormous difference between charge master and allowed
charges.
• The patients’ experiences of duplicate bills and unrecognizable
charges.

13. Problems Are Closely Inter-related
• Providers struggle to manage their revenue flow.
• Negotiating payment contracts with a variety of payers makes it challenging to
estimate the cost for a patient at the point of care.
• Large payers operating in multiple states are faced with enormous variations in
data reporting practices.
• A significant amount of communication in the healthcare business is done by fax
and copies of paper forms, then re-entered into data processing systems.
• Inter-system communication in the healthcare billing world between providers,
insurers and pharmacies is one of the last bastion of non-digital communication.

14. Real Estate is
based on
Location
Location
Location
Medical Billing is
based on
Surprise
Confusion
Delay

15. What we heard from Patients
RATED THEIR MEDICAL
BILLS AS CONFUSING
OR VERY CONFUSING.
DIDN’T DO ANY
RESEARCH ABOUT
COST PRIOR TO THEIR
MEDICAL VISIT

16. What we heard from Providers

17. Bills and Benefit Statements

18. Bills and Benefit Statements

19. Guidelines and Literature

20. Medical Billing Ecosystem

21. Medical Billing Ecosystem

22. Medical Billing Ecosystem

23. Medical Billing Ecosystem

25. Patient Journey Map

26. Patient Journey Map
(3-7)
Being presented with
enormous differences
between Charge master
fees and adjusted fees
challenges
understandability of
charges and undermines
trust in Providers
(5)
Timing delays for
medical bills are unlike
any other retail or
service experience
(7)
Incomplete or
inaccurate cost
estimates undermines
trust in both Insurer
and Provider
PAIN POINTS
Medical Billing Top Concerns:
(1) Patients Don’t Know What
They Don’t Know
(2) Volume of Communication
(3) Understandability
(4) Terminology
(5) Timing
(6) Financial Planning
(7) Trust
(3-5-7)
Introducing Third Party
payers complicates the
process and further
undermines trust
(2)
Maintaining accounts
on multiple Patient
Portals for access and
payment of bills from
different Providers
Multiple sites makes it
difficult to keep track of
what has been paid

27. Patient Journey Map
(6)
Insurer could estimate the
total cost of procedure at
the time it is recommended
and prepare Patient for
total cost.
Hospital could estimate
when costs will be due and
explain payment options
OPPORTUNITIES
Medical Billing Top Concerns:
(1) Patients Don’t Know What
They Don’t Know
(2) Volume of Communication
(3) Understandability
(4) Terminology
(5) Timing
(6) Financial Planning
(7) Trust(2)
Coordinated statements
or a unified portal to
review Provider claims
to Insurer, bills from all
providers, and the
Patient’s FSA/ HRA/
Deductible status would
reduce concern about
volume of
communication
(5-6-7)
Patient will be able to
pay the bill and plan
for the financial
consequences
knowing that all
pending claims have
been resolved, that
the bills all agree with
expected cost
estimates, that no
further adjustments
will change their cost.

28. Who submitted entries?
• Healthcare organizations
• Non-profits working in the healthcare sector
• Doctors and healthcare workers
• Interaction design companies
• Health information and financial services software companies
• Graduate student teams from public health and design schools
• Ad hoc groups of people passionate about the topic

29. Prize 1: Easiest Bill to Understand
• Winner
• RadNet
• Honorable Mentions
• A Better Health System
• Change Healthcare
• Renown Health
• Up To 11

30. Prize 1 Winner:

31. Prize 2: Transformational Approach
• Winner
• Sequence
• Honorable Mentions
• Business Innovation Factory
• EveryBill
• FAIR Health
• gravitytank
• Health Payment Systems
• iVinci

32. Prize 2 Winner:

33. What about the EoB?
Charlotte UX

34. Offer multiple payment options

35. Include patient’s insurance status

36. Omit un-discounted charges from statement

37. Cost estimate before the bill

38. Separate amount owed from detail of charges

39. Image of provider or institution

40. Three Approaches
Entries demonstrated three approaches for unifying the billing
experience
• Provider Network becomes the single source managing all charges
from in-network and out-of-network providers
• Insurer becomes the single source of payments to be redistributed to
all providers
• A new Third-Party Service Platform manages claims and payment
between providers, payers and patients

41. Current Medical Billing System

42. Provider Model

43. Insurer Model

44. Service Model

45. Conclusion: Shore Up the Fragments
• Alleviate the current fragmentation of financial relationships
• Transform the stream of invoices from unrelated providers and
interpretations of unconnected payer benefits into a single financial
relationship
• Create a coherent service for managing patient’s experience of
healthcare providers and their associated cost