Americans experience healthcare affordability in different ways. Often, affordability is first considered in terms of health insurance premiums that fit within an individual or family’s monthly budget. However, healthcare affordability is much more — it also means being able to find care without worrying about deductibles, co-pays or unexpected bills that a patient cannot pay. It means not facing complicated and illogical prior authorization barriers that sometimes drive patients to choose to pay out-of-pocket rather than continue fighting with their health plan.
Unacceptably, millions of Americans are struggling with healthcare costs. Many have chosen to skip prescriptions or other needed care because of concerns about costs; 4 in 10 Americans have medical debt. And while avoiding care in the short-term may save some immediate expenses, this approach often results in illness and injury worsening, resulting in costlier care later.
Making Care More Affordable for Patients Is Paramount
The healthcare system writ large must do more to address patients’ concerns with the cost of care. In the AHA’s “Making Health Care More Affordable: A Blueprint to Lower Costs, Improve Access and Enhance Quality,” America’s hospitals and health systems put forward several concrete ideas to reduce premiums and cost-sharing, as well as help patients avoid more complex and costly care in the future.
- Further Limit How Much Patients Owe in Cost-sharing. One of our proposals would directly limit the amount health plans could impose in co-pays, deductibles and coinsurance. Lower out-of-pocket costs can make it easier for individuals and families to seek care when they need it rather than delaying treatment because of financial concerns.
- Simplify Healthcare Bills. Another proposal would substantially simplify patients’ billing experience. Today, patients often receive multiple bills from different providers and facilities following a single episode of care, for example, from the physician, lab and hospital. Consolidating healthcare bills into a single monthly statement managed by the patient’s health plan would make it easier for patients to understand what they owe, track payments and manage household budgets.
- Scale Back and Streamline Prior Authorization Requirements. Patients also would benefit from our proposal to reduce the number of approvals required by health plans and, when they do apply, make the process as streamlined and fast as possible. More efficient approval processes can protect patients from seeking care options outside of their coverage, which are often much more costly.
- Increase Access to Primary and Preventive Care. Improving access to primary care and preventive services is another key component of our recommendations. Strong primary care relationships help patients manage chronic conditions, receive preventive screenings and address health concerns before they become more serious — and expensive — to treat.
- Improve Access to Cheaper, High Quality Drug Therapies. Many Americans rely on prescription drugs to help manage their health. Unfortunately, the cost of drug therapies has skyrocketed in recent years. We support a number of proposals to increase access to safe, effective, lower-cost drugs, with a specific focus on high-quality generic medications that provide the same clinical benefits as brand-name products at a fraction of the cost.
- Lower the Overall Cost of Care to Lower Premiums. The AHA’s blueprint includes dozens of recommendations to reduce system costs, with a heavy emphasis on eliminating unnecessary administrative costs and investing in improving individuals’ health to lessen the need for costly healthcare services. Taken together, these proposals are intended to lower the overall cost of care, which would translate into lower premiums.
Better Value and Better Experience
When it comes to affordability, patients must come first. Our recommendations recognize that affordability cannot be about cutting benefits or simply sifting costs from premiums into cost-sharing. The best approach to affordability is helping people stay healthy, eliminating unnecessary costs, simplifying the billing experience and preserving access to essential services. These recommendations, as well as the dozens of others included in our blueprint, offer practical steps toward a healthcare system that delivers better value and a better experience for everyone.
Making Healthcare More Affordable
Prior Authorization
Billing & Collections
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