It should come as no surprise that healthcare in the United States is unaffordable. As patients struggle to pay for care, many healthcare organizations are also struggling to keep their doors open due to labor shortages, supply costs, and other factors. Overburdened staff often lack the time and resources to help patients navigate their costs of care.
So, how do we tackle this issue? By utilizing technology to reduce the administrative burden and maximize patient savings, providers and pharmacies can play an important role. Aligning stakeholders across the healthcare continuum is also critical to removing financial barriers—and supporting healthcare organizations’ bottom lines.
To shed light on this important topic, we spoke to Srulik Dvorsky, co-founder and CEO of TailorMed, a leading technology company offering the nation’s largest network of patients, providers, pharmacies, and life science companies dedicated to improving healthcare affordability.
Gary Drenik: What is the current state of healthcare affordability and medical debt in the U.S.?
Srulik Dvorsky: Due to soaring expenses and the rise of high deductible health plans, today’s patients shoulder more financial responsibility for their care. Out-of-pocket costs have skyrocketed. Consequently, an estimated 1 in 10—or 23 million U.S. adults—owe at least $250 in medical debt, while 3 million owe over $10,000.
In a recent Prosper Insights & Analytics survey, 31% of U.S. adults 18 or older said that healthcare costs were “somewhat” or “very likely” to affect their ability to spend and save in other areas.
In the same survey, 83% of respondents had some form of health coverage, whether through an employer or a government plan, suggesting that financial barriers affect both insured and uninsured Americans.
When faced with a decision between necessary living expenses and lifesaving care, many patients do not adhere to prescribed treatment. According to the Kaiser Family Foundation (KFF), 25% of adults say they or a family member have not filled a prescription, cut pills in half, or skipped doses in the last year due to costs.
Drenik: How does affordability impact healthcare organizations’ financial stability?
Dvorsky: As patients are increasingly unable to pay for treatment, hospitals and health systems have found it harder to collect patients’ bills. Hospitals have historically failed to collect 65 cents for every dollar they bill; since 2000, they have provided almost $745 billion in uncompensated care.
For pharmacies, prescription abandonment leads to significant loss of revenue. Skipping or delaying treatment also leads to worse outcomes and higher costs for more extensive care down the line. Medication nonadherence is estimated to cost the healthcare system over $672 billion annually.
The pandemic and inflation compounded these challenges for patients and the organizations that serve them. For example, 2022 saw well over $1 billion in net losses for some of America’s largest not-for-profit health systems. While hospital financial performance has stabilized in 2023 compared to last year, margins are still below historical levels.
Drenik: What can be done to tackle this growing issue?
Dvorsky: To address affordability and boost financial performance, healthcare organizations should focus on expanding access to financial assistance. Numerous resources exist, from drug manufacturer copay assistance to foundation grants. However, utilization remains low.
This is often because providers and pharmacies lack the people and processes to make the most of these cost-saving opportunities. Without a centralized, systemwide approach and dedicated teams, financial navigation efforts fail to maximize patient savings.
Fortunately, technology platforms can help streamline the process. Using data and predictive analytics, these solutions enable providers and pharmacies to proactively identify financially at-risk patients—before they receive a bill they can’t afford. Based on the patient’s diagnosis, insurance, and other factors, the technology then produces a comprehensive list of funding opportunities as well as expedited enrollment options.
Healthcare leaders largely recognize that financial experience is a critical component of a patient’s overall satisfaction with a provider or pharmacy. To improve financial experience, healthcare organizations must find innovative ways to connect patients with the resources they need.
Drenik: How does assisting patients with their costly healthcare needs improve healthcare organizations’ financial performance?
Dvorsky: Improving affordability creates a win-win for patients and healthcare organizations. In addition to benefiting patients, technology-supported financial navigation helps providers and pharmacies avoid unnecessary costs and increase revenue. When patients can afford care, they’re more likely to pay their medical bills, reducing uncompensated care and bad debt. In addition, they’re less likely to abandon their prescriptions at the pharmacy.
By utilizing technology to optimize financial navigation, healthcare organizations can also increase efficiencies. It’s no secret that healthcare workers are experiencing heightened levels of burnout. For financial navigators, pharmacy technicians, and other professionals tasked with helping patients find assistance, cumbersome, manual processes only add to this burden. Technology empowers staff to find assistance opportunities and complete enrollments in one centralized space, rather than relying on spreadsheets and web searches. As labor challenges continue to plague the industry, this approach allows teams to do more with the resources they have.
Drenik: What does the future hold for healthcare affordability in the U.S.? What improvements need to be made?
Dvorsky: Healthcare costs in the U.S. are projected to continue rising. This complex challenge demands a comprehensive solution—one that unites stakeholders across the healthcare ecosystem. This means patients, providers, pharmacies, life science companies, and other entities coming together to tackle this pressing issue. Technology can play a key role by creating a cohesive digital network of partners collaborating to alleviate financial hardship. Just as it takes a village to solve any major challenge, solving America’s affordability crisis will require all impacted parties to join forces.
Drenik: I appreciate your sharing your insights, Srulik, and eager to see how technology will help combat affordability in the months and years to come.
Dvorsky: Me too. Thank you for having me.
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