Dobson DaVanzo under commission and in collaboration with Adventist HealthCare (Montgomery County, MD) developed a conceptual model of healthcare financial relationships to relieve a myriad of concerns about today’s healthcare billing system, including surprise balance billing. This conceptual piece called “Consumer Protection Realignment: Shifting Consumer Billing from Providers to Health Plans” was published in the Health Affairs Blog dated May 1, 2020.
The Consumer Protection Realignment (CPR) model is a novel approach that refocuses attention on the financial interaction of patients, providers and health plans. Today’s healthcare billing system frustrates consumers and it is nearly impossible for consumers to anticipate and understand out-of-pocket medical costs, even when receiving simple procedures. Healthcare providers struggle to recoup and manage the complexity of a health insurance market that is facing market pressures that have led to higher out-of-pockets costs in order to control healthcare expenses and premiums. This dynamic has produced a system that is unfavorable to consumers, as they bear the brunt of unaffordable costs, an increased presence of surprise balance billing, a lack of price transparency and a multitude of often complex and unexpected bills.
To solve this issue, the CPR model realigns the billing and collection of deductibles, coinsurance and copayments from health care providers to health insurance plans via proposed federal legislation requiring all providers, whether in- or out-of- network, to bill patient out-of-pocket costs through the insurer. While CPR is an overarching reform approach, the system uses operational mechanisms currently in place. Health plans would still negotiate rates with providers, but would take on the added responsibility and risk of billing patients. In turn, providers would be required to return the resulting savings to plans in the form of reduced charges for services. In so doing, CPR creates a system where consumers enjoy increased price transparency, protection from surprise balance billing, consolidated and simpler billing, and, in the long-term, more progressive and integrated healthcare delivery mechanisms. To read more about CPR visit the Health Affairs blog.