New Approach to Consumer Experience: The Key Role of Healthcare Payments

Updated on February 26, 2016

Jeff Lin Headshot-BWBy Jeff Lin, Senior Vice President of Product Management at InstaMed

Centers for Medicare & Medicaid Services (CMS) released the final enrollment numbers for Open Enrollment 2016. In just three months, 12.7 million individuals enrolled in a health plan through the public and private exchanges this year which is an increase of one million over the previous year. Now in its third year, Open Enrollment presents particular challenges for the healthcare industry with this annual flood of new consumers, including:

  • 90% of consumers have purchased the Bronze and Silver plans which have higher overall patient responsibility. (CMS)
  • The amount a consumer must pay before a health plan covers any portion has increased 67%. (The Kaiser Family Foundation)
  • The average health plan premium is expected to increase by 7.5%. (

As demonstrated by these statistics, consumers have a rapidly growing role in healthcare which is under particular scrutiny during an Open Enrollment period. However, consumers, especially new participants, are still confused and frustrated by the process of managing their healthcare finances. 

Adapting to the New Metal Plans and Higher Payments
The trend of high out-of-pocket costs has been spurred on by the introduction of the “metal plans” in Open Enrollment. The most popular plans are the Silver and Bronze plans that offer the lowest premiums yet have the highest out-of-pocket expenses.

Despite selecting a metal plan, these consumers do not necessarily understand the most common healthcare payment terms such as premium, deductible, coinsurance, or co-payment. This lack of understanding results in frustration, confusion, and a poor experience – often without any payment made. Consumers need to know how much they owe and how to pay. Healthcare organizations can eliminate consumer confusion and dissatisfaction with a simple and secure payment experience and clear patient communications.

Make Healthcare Payments Simple

Payers and providers have the opportunity to work together to simplify healthcare payments for consumers by leveraging industry-proven solutions and best practices:

Set Expectations Upfront and Guarantee Payments

Providers can look to best practices from other industries to guarantee their revenue while making it simple for consumers to pay their responsibility. Just like reserving a hotel room, providers can require that all consumers present a payment method before the time of service to ensure the responsibility is automatically paid with low staff intervention. Consumers are familiar with this process from their experiences in other industries and often prefer automated, simple payments.

Add Healthcare Payments to Member Portals

Many health plans offer member portals where consumers can manage claims and view benefit amounts. Health plans can simplify the consumer experience by integrating payment functionality in their member portal for both premium and provider payments. In fact, a consumer survey by Melior Group found that 84% said they want to make payments through their health plan’s website.

Enabling payment through a member portal allows consumers to manage all of their healthcare payments all in one place and immediately understand how it affects their payment responsibility – especially deductible amounts.


The consumer experience in healthcare has changed dramatically and, in large part, been driven by high deductible health plans and increasing consumer payment responsibility. Healthcare organizations can adapt to the new role of consumers with innovative ways to eliminate the frustration and confusion of healthcare payments and ultimately enhance the consumer experience.

Before joining InstaMed, Jeff was an executive at Accenture, where he led multiple enterprise projects for multiple Fortune 100 companies. Jeff’s experience and expertise include a deep focus in the areas of product management, product strategy, product marketing and developing strategic partnerships.

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