Supporting Patients With Medical Debt Through Improved Consumer Experience

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I'm Mark Spinner, president and CEO of AccessOne. I am in the Charlotte, North Carolina area, where our company is headquartered. I'm here today to talk about the health care consumer and what we're trying to do to help the affordability crisis. 

I've been here at AccessOne for about 6 years. I partnered with our founder, Dr Salton, to expand the company. We're really a mission-driven organization that is about patient advocacy. 

Can you comment on the current state of medical debt in America? What factors contribute to patients not paying their bills?

We see an affordability crisis for the health care consumer. It is a changing landscape. Certainly, over the last 10 to 12 years, the cost burden has shifted significantly to the consumer. We, in our normal lives, are handling bigger and bigger portions of health care costs.

Having twins that end up in the NICU, like my wife and I did, is a whole different ballgame today than it was back 14 years ago. I don't remember a bill that I had outstanding at that time. It wasn't that significant at all. Today, that's potentially a financial catastrophe, even if you do have insurance. 

I think that's a dynamic at play. At the heart of the matter, there is a lot of space between the consumers who are covered by the safety nets we have in place in American health care, whether it's Medicaid or other programs, or Medicare for our older adult population; and then those consumers who must pay any health care bill in full when due. The space between those two has grown larger, and that's the core issue.

The other piece on the provider side is there's still a lot of legacy thinking, technology, and processes that have been in place for decades that are out of date with the reality consumers are getting used to everywhere else in the economy. Three bills and a collection agency—it doesn't toe the line anymore. It's just not enough. 

How does medical debt impact providers?

It's tough. Most of our clients are mission-driven organizations. They're large health systems, they're university health systems, they're faith-based organizations. By and large, they really care about their mission. They care about their communities, and they're trying to deliver health care in a very complex environment. It is expensive. It's difficult. 

The cost shift away from their traditional source of revenue, which was payers and government programs, is a huge burden. A lot of times, these revenue systems aren't set up with that consumer in mind in the beginning. That consumer was an afterthought for a long time because 95% or more of the system’s revenue didn't come from that consumer. It came from an insurance company, government program, or employer program. 

Now, they see 10%, 12%, or 15% of their revenue coming from the consumer, and their tools are generally geared toward either medical record management or institutional reimbursement. They're doing work and spending a lot of money in technology and effort trying to meet that consumer, but the legacy pulls them back over to these other areas. 

When you think about how to meet the consumer where they are, we consider: Who is she? Who is our consumer? What is that persona?

We've studied it quite a bit. We've handled millions of families in terms of financial advocacy and helping them with flexible repayment plans. Our persona for our primary consumer is: She's the mother. She's the health care head of household. She's in her mid-40s. She's incredibly busy, and now she's more often working from home or trying to manage a lot of things at once. She's on her phone; she's not necessarily in a place where she can always grab a bill, answer a phone call, wait on hold, remember a login for one of the 4 or 5 different providers that she's managing to deliver care to her family. 

When you think about who she is and what she needs, from a health care perspective, it's pretty complex. But in the rest of her consumer life, look what she can do on her phone. She can go on her phone, shop for a new or used car, get a financing offer for that car, pay for it, apply for financing, and set it all up at the tip of her finger. She can get that car delivered to her door without ever having to leave her phone. She can take out a large loan for that car without ever leaving her couch. 

Whether she's on Amazon, one-click shopping and enjoying that experience and service, or completing a big purchase, she's trained to expect seamless mobile-first experiences that bake in easy ways to pay in full, pay in a few months, or get financing to pay for big-ticket items. Her expectations have gone way up in the last several years, but her experience with most health care systems hasn't changed a whole lot. The gap for health care providers continues to grow in terms of what consumer experience they're delivering vs what she expects from the vendors she deals with in her normal consumer life.

How can technology be used to address these challenges?

That is such a challenge for providers. They get inundated with vendors and offers, and other things they can spend money on to help these issues. 

I think what providers can do first is put themselves in the shoes of that consumer. I mean really go the extra mile to think through what she's experiencing, what she is used to, what she needs, and try to match the level of excellent user experience with that expectation. The closer you can get to that standard being set by these other industries, the better outcomes you will get. And we've proven it.

Over the last couple years, we've revamped our technology platform to feature text-first engagement protocols in mobile-first and mobile-native experiences for consumers. When we first started to use text-based enrollment and application campaigns, the percentage of consumers engaging with us and activating in a 100% self-service environment through their phone or PC without having to speak to a human, make a phone call, or have a letter sent—it went from less than 10% to over 80%. 

If you can get close to that bar for the consumer and meet them where they want to be, you can create a major change in behavior that'll have not only a positive impact on their user experience, but could meaningfully change your cost structure with respect to print, mail, customer service coverage, inbound phone call volumes, etc. You can make a large difference in a very short period of time if you get that user experience just right.

Is there anything else you would like to add?

Health care is going to change so much when we can prove in a few markets that payers and providers can get on the same page for their member/consumer. I think that common ground is out there. Obviously, there's better traction in some markets than others. But we see this consumer who just wants to understand and have some transparency around what their benefits are delivering and what they owe. The more that we can put that member, consumer, and patient at the center of how we're solutioning, it will drive great benefits for all constituents in the ecosystem. 

Finding that win-win-win is something we do with our patient consumers and our provider clients. I just think there's a bigger opportunity there. I look forward to working with health care systems, health plans, and payers that are looking for that same win.

This transcript has been edited for clarity