The healthcare payment landscape in the United States is complex and fraught with financial challenges. Despite the rise of value-based care patient financial experience—a model focused on improving patient outcomes while controlling costs—billions of dollars are lost annually due to unpaid patient expenses. This financial shortfall not only affects providers’ reimbursements but also creates a heavy burden on patients who often face confusing and unpredictable costs.
At the recent Value conference hosted by Behavioral Health Business, Christopher Wolfington, Founder and Chief Revenue & Strategy Officer at FinPay, shed light on the ongoing issues and offered insights into how financial solutions can better serve patients while supporting providers and payers alike.
The Enormous Burden of Unpaid Patient Costs
A staggering $460 billion in out-of-pocket healthcare expenses is billed to patients every year. However, Wolfington reveals that only about 19% of these costs are actually paid. This leaves roughly $340 billion in unpaid expenses floating in the healthcare system—a loss that impacts every stakeholder in the ecosystem.
This unpaid balance can be devastating for patients, many of whom struggle with mounting medical bills and financial uncertainty. At the same time, providers face cash flow issues and revenue leakage, which can hamper their ability to deliver quality care.
These financial challenges highlight the urgent need to improve the value-based care patient financial experience, ensuring patients understand their costs and can afford their care.
The Complex Roles in Value-Based Care
Value-based care requires numerous decisions by multiple stakeholders, including:
- Health Insurance Payers: Focused on managing member utilization and controlling healthcare costs, payers are driven by the need to balance expenditures with quality care outcomes.
- Providers: Healthcare providers aim to deliver effective treatment and ensure they are reimbursed in a timely manner.
- Employers: Employers, especially those who self-insure, have a dual interest: they want their employees to be healthy and productive, but they also seek to contain healthcare costs.
- Patients: Patients are at the center of care but often lack the information and support to make informed financial and treatment decisions.
Wolfington points out that these roles don’t always align smoothly, and often patients are left out of important conversations about care management and cost transparency. This gap makes improving the value-based care patient financial experience more critical than ever.
Power Imbalance: When Patients Are Left Out of the Conversation
One of the most critical issues is the gap between stakeholders, especially the power imbalance that leaves patients isolated. While payers and providers negotiate reimbursement and care parameters, patients frequently find themselves managing complex billing, deductibles, co-pays, and coinsurance on their own.
Wolfington emphasizes the need for transparency: “The patient deserves a fair, honest, and transparent conversation about the cost before they admit.” Patients, after all, are consumers in the healthcare market—they should not be expected to navigate this complicated financial terrain alone.
Addressing this gap is essential to enhancing the value-based care patient financial experience by empowering patients with the knowledge and resources they need.
The Payer-Provider Dynamic and Its Impact on Patients
The relationship between payers and providers often involves tension. Providers want to be paid quickly and in full to maintain financial health. Payers, meanwhile, want to keep costs contained and ensure members use benefits appropriately without excessive or unnecessary care.
This tug-of-war frequently results in delayed payments, unclear billing statements, and unexpected costs passed down to patients, who are then forced to manage financial stress that can interfere with their health and recovery.
Improving the value-based care patient financial experience requires breaking down these barriers so that providers and payers can align their goals to better serve patients.
Shared Risk Models: Aligning Incentives to Improve Outcomes
One promising development in healthcare finance is the shared risk model. In this framework, payers and providers agree on a budget and set quality performance benchmarks. This model encourages collaboration rather than conflict, with everyone working toward improved patient outcomes and cost efficiency.
“In a shared risk value-based model, the payer is incentivized to give you accurate information so that there’s a better outcome both clinically and financially,” explains Wolfington.
Such alignment makes the value-based care patient financial experience more transparent and manageable for patients, as providers and payers share responsibility.
How FinPay’s Transparency-Focused Solution Addresses Financial Challenges
FinPay is tackling the patient financial experience head-on by promoting transparency and improving communication between payers, providers, and patients.
Wolfington breaks down the motivations of each party:
- Providers want fast, reliable payment and opportunities for bonuses if they help control costs and improve outcomes.
- Payers aim to contain costs while ensuring members access care responsibly.
- Patients need clear, upfront information and affordable options to manage their financial obligations without undue stress.
By educating patients on what to expect and offering flexible, affordable payment plans, FinPay helps households access treatment without surprises or confusion. This transparency transforms what can be an abrasive, anxiety-inducing financial experience into one that supports ongoing care and enhances the overall value-based care patient financial experience.
Why Improving the Patient Financial Experience Is Vital for Treatment Success
Financial stress is a leading contributor to relapse in both substance use and mental health treatment. When patients struggle to pay bills or face unexpected expenses, their ability to stay engaged in treatment diminishes.
A better patient financial experience not only helps patients but also enables providers to control financial risk related to unpaid out-of-pocket expenses. Reducing the financial strain on patients helps ensure their treatment plans are not disrupted by billing challenges, thereby supporting better clinical outcomes.
Prioritizing the value-based care patient financial experience is key to fostering both financial and clinical success.
The Path Forward: Financial Solutions that Empower Patients
The future of healthcare reimbursement and value-based care depends on solutions that prioritize the patient experience without sacrificing clinical quality or financial sustainability. Transparency, education, and shared risk are essential components to realigning the system so that patients are no longer left to shoulder the burden alone.
Wolfington’s insights demonstrate that with the right financial tools—like those FinPay offers—healthcare stakeholders can work together to improve care, reduce unnecessary costs, and support patients in their recovery journeys, ultimately improving the value-based care patient financial experience for all involved.
Conclusion
Value-based care has opened new doors for improving healthcare quality and controlling costs, but it cannot succeed without addressing the financial challenges faced by patients. Billions of dollars lost to unpaid patient expenses threaten both clinical and financial outcomes.
Solutions grounded in transparency, shared risk, and patient-centered financial education are crucial. By making the cost of care clearer and more manageable, providers, payers, and employers can help ensure patients receive the treatment they need—without the stress of hidden or unaffordable bills.
Improving the value-based care patient financial experience is no longer optional—it is essential for a healthier future.
