A model commissioned by Adventist HealthCare proposes a realignment of how deductibles, coinsurance and copayments are billed and collected. The realignment would require all providers, regardless of network affiliation, to bill through insurers.
The model is explained in a May article published in Health Affairs that is co-written by John Sackett, Adventist HealthCare's COO and executive vice president.
Five things to know about the model:
1. The consumer protection realignment model, or CPR, was developed by Dobson DaVanzo, a health economics and policy consulting firm, under commission from Montgomery County, Md.-based Adventist HealthCare.
2. The model puts health plans at the center of the billing process. They would become the primary point of contact for billing and collection of premiums, as well as patient out-of-pocket costs. The article states that this setup would allow providers to focus on clinical services.
3. The CPR model would provide a better billing experience for patients, according to the article. Ideally, patients would no longer receive multiple invoices for the same procedure from insurers and providers. This, the article argues, would reduce providers' administrative costs and bad debt.
4. While health plans would take on added risk for billing patients, any cost savings from improved administrative costs and bad debt on the hospital side would be legislatively required to be passed to health plans through lower negotiated payment rates, according to the article.
5. The article notes that no side would receive a "financial windfall."
"CPR would bring sweeping changes to our healthcare billing systems, including considerable benefits but also many questions that would need to be addressed," the article says. "CPR would alter the balance of responsibility between plans and providers — plans would have an increased incentive to manage population health, and providers could enjoy lower costs and less consumer 'collection' hassle."
View the full article here.