Medical bill design challenge to create simpler bill

HCPRO Website, May 13, 2016

HHS launched a challenge to redesign medical bills to make them easier for patients to read and understand. The challenge, announced May 9 at Health Datapalooza 2016, is sponsored by the AARP and administered by design agency MadPow. Winners will be awarded cash prizes of up to $10,000.

The design challenge aims to solve common complaints about medical bills, according to HHS’ statement. A patient may receive multiple bills from each department he or she received services from for the same episode of care. These bills can vary greatly in content, presentation, and the language used to describe services and payment. This makes it difficult for the patient to determine if the bills are correct, if additional charges may be pending, what they owe, and what was paid by their insurance plan.

Criteria for the redesign challenge were developed based on research and interviews with healthcare systems, insurers, other industry stakeholders, and patients. One of the top concerns expressed among all groups was that patients know very little about the procedures they receive, what to expect on medical bills, and how much procedures typically cost. Many patients do little research prior to a visit or try to estimate costs using payer websites, although this is typically not effective, according to the challenge’s research report. Other common concerns include the terminology used on bills, the timing of bills, and the volume of communications sent to patients.

Patients reported that the number of bills and statements sent is confusing and the inclusion of certain business-to-business financial details such as chargemaster prices and adjustments further muddies the water.

Providers interviewed for the report agreed that patients want a simple bill and that lines of overly detailed information are not relevant to them.

However, simply changing the appearance of the bill will not be enough to achieve the challenge’s goals. Medical billing is a complex process involving many departments and is affected by federal and state regulations. For example, some insurers send explanation of benefits (EOB) several times a month to avoid missing state-mandated deadlines, although this may mean a patient can receive multiple EOBs for the same episode of care. The inclusion of specific ICD-10 information also confuses patients who may not be able to map the care described on the bill with their experience.

The judges include Patrick Conway, MD, MSc, deputy administrator for innovation and quality and CMS chief medical officer, Karen DeSalvo, MD, MPH, MSc, acting assistant secretary of HHS, and Mary Wakefield, PhD, RN, acting deputy secretary of HHS. Winners will be announced at the Health 2.0 Annual Fall Conference in September. Winning designs will be tested or implemented by:

  • Cambia Health Solutions, Portland, Oregon
  • Geisinger Health System, Danville, Pennsylvania
  • INTEGRIS Health, Oklahoma City, Oklahoma
  • The MetroHealth System, Cleveland
  • Providence Health and Services, Seattle
  • University of Utah Health Care, Salt Lake City

Submissions will be accepted until August 10.