Process upgrade solves consumer cash questions

December 1, 2006

Often when a patient walks into a provider's office, he or she might not have any idea about the total cost of the visit-except what the copay might be.

Often when a patient walks into a provider's office, he or she might not have any idea about the total cost of the visit-except what the copay might be.

"In today's world there is a lot of confusion related to consumers understanding their obligation, in that they do not pay for their out-of-pocket costs in a consistent, timely or an efficient manner," says Bill Fandrich, HealthePass Product Executive, for Bloomfield, Conn.-based CIGNA Healthcare. He projects that patients' payments to providers will more than double in the next five years. "The healthcare payment process still operates under the traditional managed-care model, which is a copay patient obligation model that does not effectively address deductible and co-insurance payment obligation," he adds.

To fulfill that need, CIGNA plans to launch its HealthePass solution in 2007 with some of the largest hospital systems and physician groups in the United States. At its core, HealthePass consists of a robust, comprehensive cost calculator that will supply accurate, personalized estimates of patient liability and is intended to be an easily adopted tool for providers that will clearly set financial expectations, shorten providers' revenue cycles and significantly reduce the potential for patient bad debt.

PROVIDER PERSPECTIVE

HealthePass is the product of a thorough reassessment of the healthcare marketplace by CIGNA. While many in the industry might have explored real-time claims adjudication and debit cards, CIGNA also sought input from providers, physician groups, hospitals, employers and others to see the industry from a provider's perspective, according to Fandrich.

"We took a step back and did several months of detailed market analysis, including hundreds of hours of interviews with providers," Fandrich says. "As a byproduct of that, we saw the need to introduce a different kind of solution, one that could work across the various provider business models. We needed to provide a solution that could cross products-PPO plans, consumer-directed plans and other plans with a wide variety of benefit options. We needed to provide a very simple way for both the consumer and provider to understand the patient's financial obligation."

Significant among its multiple functions, HealthePass ensures there is a shared understanding of the patient obligation during the healthcare delivery cycle-before, during or after treatment. Whereas most cost calculators today use the "charge" information to make non-specific cost estimates, HealthePass's calculator generates an estimate based on the specific treatment, provider contract, and a real-time snapshot of the patient's covered benefits.