THE HEALTHCARE PAYMENTS REPORT: The strategies payments leaders are using to take advantage of the $3.7 trillion opportunity in US healthcare

The US healthcare payments market is enormous: Healthcare expenditure hit $3.65 trillion in 2018, per projections from CMS, and this spending is only expected to accelerate.

bii HP Healthcare Expenditure ForecastBusiness Insider Intelligence

But the industry is at a tipping point. Better-informed and more critical customers, along with a push to combat the complex and opaque medical billing process, are creating demand for innovation in the healthcare payments space.

Despite a titanic market size and room for innovation, digital transformation is occurring incrementally at best. In fact, 90% of healthcare providers still leverage paper and manual processes for collections, according to data from a report commissioned by InstaMed and compiled by Qualtrics.

And even when healthcare providers offer digital solutions like online portals to customers (which 60% do), they seem to be falling short: While the majority of consumers claim they want to make appointments (68%), fill out registration forms (68%), and pay healthcare bills (61%) online, the share of consumers who actually do so hovers around 30% for those use cases. Discrepancies like these make healthcare payments a greenfield for lucrative digital innovation.

In The Healthcare Payments Report, Business Insider Intelligence looks at the healthcare payments process, including the types of healthcare payments, the stakeholders making them, where those payments are going, and what's driving change in the market. We then examine payments companies' innovations from the past year that address healthcare payments' most pressing challenges, analyze why they're lucrative, and discuss how other payments companies can learn from the innovations to furnish their own solutions.

The companies mentioned in this report are: InstaMed, JPMorgan, Liquid Payments, Patientco, Waystar

Here are some of the key takeaways from the report:

  • The US healthcare payments market is massive: Total US healthcare expenditure hit $3.65 trillion in 2018, per projections from The Office of the Actuary in the Centers for Medicare & Medicaid Services. For reference, consumers spent slightly less on retail purchases - $3.63 trillion - in 2018, per Internet Retailer.
  • But healthcare payments innovation has failed to keep up with consumer demands due to providers' reliance on legacy processes, and this may be hurting providers' bottom lines.
  • Healthcare payments are complicated by the different stakeholders - providers, payers, and patients - that have a role in each transaction. These stakeholders' needs are shifting as the market changes: Consumers are taking a more active role in paying for their healthcare while states are pivoting toward a model that compensates providers based on the quality of their services rendered rather than the quantity.
  • Some payments firms are successfully adapting to the shifting market by creating digital solutions that balance the evolving needs of the entire healthcare payment value chain.

In full, the report:

  • Outlines the structure of the current healthcare payments market.
  • Analyzes the forces and stakeholders driving change in the market.
  • Highlights companies that are implementing innovative solutions in the healthcare payments space, and offers key takeaways that other players can apply to their own approaches.
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