HFMA Research: How Did Healthcare End Up Harming the Patients It’s Meant to Heal?

Tension between providers and payers is nothing new in healthcare. What’s alarming, though, is the extent to which this conflict has permeated the core of healthcare delivery.

According to new research from the Healthcare Financial Management Association (HFMA), 87% of healthcare finance leaders believe that strained relations hinder their ability to provide optimal care to patients. Let that sink in. In an industry dedicated to healing, institutional conflicts are undermining the very mission we’ve sworn to serve.

Complicating matters further is the exponential growth of out-of-pocket patient responsibility. For the first time, most American private workers are enrolled in high-deductible health plans, exposing patients to the friction between providers and payers. As executives engage in tug-of-war over rates and denials, patients are left holding the bag—or, more accurately, the bill.

The inability to negotiate sustainable reimbursement models has resulted in unsustainable patient cost share, and the consequences are profound. Medical debt remains a leading cause of personal bankruptcies in the United States. Health outcomes suffer too: Nearly half of patients report deteriorating health due to difficulty paying medical bills, and one in four adults skip care because of cost.

Now that patients are directly impacted by payer friction alongside providers, we should feel more compelled than ever to act with urgency. Though achieving superior payer-provider collaboration has long seemed unattainable, there are actionable steps we can take today to address this broken experience.

Integrate data to empower patients

Neil Kulkarni, Vice President of Customer and Clinician solutions at Highmark Health, offers sage advice: “Start small.”

It’s why his organization partnered with Allegheny Health Network and Cedar to integrate critical health plan data, including deductible status and HSA balances, into patient bills. Now patients have a single source of truth so they can confidently resolve their financial liability. The results speak volumes: an 11% reduction in customer service requests, a 33% increase in HSA utilization, and $17 million more in patient payments in just one year.

Leverage AI for streamlined support

A connected bill pay experience that incorporates the payer is just the beginning. With rapid advances in artificial intelligence (AI) and large language models (LLMs), integrating data from providers and payers opens up exciting new possibilities in patient support.

Imagine the power of an LLM trained on this information. Want to know how a charge impacts your deductible? Need clarification on how coinsurance was calculated? These queries could be addressed instantly, whether through self-service tools, virtual AI agents, or customer service interactions. This could finally eliminate the stressful back-and-forth that patients often face when seeking answers about their bills.

Connect the dots to improve health

These solutions represent a significant step forward for reducing payer-provider friction for patients in financial interactions, introducing a new ecosystem approach. By extending collaboration to include other critical financial stakeholders, it could open up opportunities to address fundamental issues in affordability and access, not just billing.

The technology exists. The opportunity is clear. What’s needed is the courage to adopt innovative solutions because it’s the right thing to do for our patients. That, and the right partners to help connect the dots.

Seth Cohen is President at Cedar