Navigating the healthcare system and understanding benefits are major pain points for patients, especially as costs continue to rise.
With that backdrop, Aetna has rolled out SimplePay Health, a new alternative insurance plan that seeks to add simplicity and transparency to the member experience. SimplePay plans have no deductibles or co-insurance, and patients are billed through combined, easy-to-understand statements modeled after those a person may receive for a credit card.
Members will also be able to understand their costs in advance of a medical appointment and can more readily schedule visits with high-quality providers.
Amie Benedict, president of diversified commercial solutions at Aetna, told Fierce Healthcare in an interview that the complexity and fragmentation in the healthcare system make it difficult for people to readily understand what their care will cost.
For example, an outpatient surgical procedure requires separate payments to the surgeon or facility, the anesthesiologist and any rehabilitation that is provided post-op, she said. Making all of those individual charges clear in advance as well as on a simple statement for payment afterward clears up some of that confusion.
"I think consumers are really still challenged by understanding what the cost of a service is going to be. Even months later, they might get a bill from their provider," Benedict said. "The thing that's most exciting for me is it covers the whole bundle of services."
Another example Benedict offered is a visit to the cardiologist. In that scenario, there are costs associated with the visit itself as well as any tests provided by the physician. The patient's bill would spell all of those expenses out in one place, she said.
The plan is also app-driven, she said, so that when members are seeking out services it's simple for them to identify the costs associated with certain providers. Providers are split into three categories: green, yellow and red, according to Benedict.
When a member boots up the app to find an appointment, providers with the lowest costs and highest quality are labeled as green. Meanwhile, providers with slightly higher prices are labeled as yellow, while those labeled red are the most expensive options.
Once they schedule and have the intended visit, they don't pay at the site of care. They instead pay down the line once they receive the statement, Benedict said. If they're not able to pay the full amount, there are options for 0% interest financing to make payments over time.
Beyond making costs clear to the member, Benedict said it takes some of the billing pressure off of providers, too.
"The provider is benefiting from this in terms of not having to collect from the member upfront or afterwards," she said. "That whole member-provider experience is radically improved, because there's no collection component there."
In its early data, SimplePay Health has been able to drive a 60% increase in the use of high-quality providers and generate 12% savings on total cost of care for members and plan sponsors.
Benedict said employers who selected SimplePay as their plan offering initially had about 20% of members using high-quality providers, and, after making the switch, that number jumped to 60% to 80%.
"So having sort of that red, yellow, green guidance and the cost certainty component up front really helped the member make a much different decision and navigate to the more cost-effective solution, which is really what we're striving for," she said.