Jul 29, 2019

Health care's billing service boom

Before you get in that wheelchair, how about you fill out some forms? Photo: Michael Stravato/For the Washington Post via Getty Images

Health care's administrative back end — services like verifying patients' insurance, putting patients on payment plans and collecting patient debt — is bigger than ever.

The big picture: The U.S.' fractured insurance system leads hospitals and doctors to spend tens of billions of dollars annually on billing software and services — none of which are tied to actual health care.

Driving the news: For-profit hospital system Tenet Healthcare decided to spin off its billing services unit, Conifer, into its own publicly traded entity in 2021.

Between the lines: Conifer and hundreds of other companies sell their administrative services at a profitable rate. And many hospital systems that send out the bills have ownership stakes in these companies.

  • Tenet controls 76% of Conifer, which registered $1.5 billion of revenue last year. Catholic Health Initiatives owns the remaining 24%. They both use Conifer.
  • Catholic health system Ascension and private equity firm TowerBrook hold a majority stake in R1 RCM, which used to be named Accretive Health and was prohibited from doing business in Minnesota due to its aggressive collections practices. Two Ascension executives sit on R1's board.
  • Bon Secours Mercy Health recently sold off a majority stake in its billing firm, Ensemble Health Partners, for $1.2 billion, the Wall Street Journal reported.

The bottom line: Researchers have cited administrative costs as a sizable source of health care waste. Some startups are trying to address this issue, but traditional billing and service firms are only getting larger and have providers as investors.

Go deeper

The health care debate Democrats aren't having

Candidates at the Democratic debate in Detroit. Photo: Justin Sullivan/Getty Images

Tuesday night's field of presidential candidates fought in 30-second soundbites over the merits of single payer Medicare for All versus a public option.

Yes, but: None of the candidates moved beyond sparring over insurance reforms to address the underlying reason why people are having so much trouble affording their health care, which is that health care services keep getting more expensive.

Go deeperArrowJul 31, 2019

Health Care Vitals: Nashville

The Axios roundtable last Thursday morning in Nashville. Photo: Adam Sanner for Axios

Last Thursday, Axios' Sam Baker hosted an Expert Voices Live roundtable in Nashville, TN on health care access and affordability in the state.

Government officials, academic experts and local leaders discussed the challenges faced by care providers in delivering equitable, high-quality care, and the lasting impact this has on local communities.

Centralizing services

A significant portion of the conversation was dedicated to discussing the potential of centralizing health services and applying the community health center model on a larger scale.

  • Mary Bufwack, CEO Emeritus at Neighborhood Health, discussed the legal obstacles for health centers that provide different types of care under one roof: "[There are] licensing issues for centers that specialize in different things...It's hard to have a centralized place for a range of services with these licensing issues."
  • Katina Beard, CEO at the Matthew Walker Health Center highlighted the positive impact of more broadly applying the community health center model: "There are a lot of lessons from the community health center world that can be applied to broader health systems...[We want] to look at how we can co-locate services better, and cobble services together, especially in rural areas. How do we get [patients] to the dentist and other care providers?"
  • Stu Clark, CEO at Premise Health on the significance of more equitable health coverage: "[We need to get off] the fee-for-service treadmill and translate this to rural areas and underserved areas...[Health care] is an issue of courage and this country doesn’t have it."
Effectively allocating funding

Structural inefficiencies in the financing of health care coverage featured prominently in the discussion.

  • Dr. Stacie B. Dusetzina, Associate Professor of Health Policy and Associate Professor of Cancer Research at Vanderbilt University School of Medicine on the distribution of resources in health: "A big piece of the puzzle is how we pay for services...Our current system incentivizes inefficiency; we’re overspending and getting less comprehensive health benefits...Lots of people are making money for the current system so don’t want to change it. [But we need to] look at centers that are trying to do more with less, lots of lessons to take from there."
  • Dr. Sayeh Nikpay, Assistant Professor of Health Policy at Vanderbilt University School of Medicine highlighted the disparities in the current system: "There’s money there, but it doesn’t get deployed to the places where it will make the most impact...[For health providers] Where is the blockage? How do we get those resources to you?"
  • Dr. Melinda Buntin, Chair of the Department of Health Policy at Vanderbilt University School of Medicine on those who neither have the money for large care expenses nor qualify for free or low-income clinics: "The middle class has extraordinarily expensive care...and [they're] doing things on a shoestring."
Designing policy and creating political will

The importance of creating change at the policy level was a significant part of the wider conversation and drew the most debate over how to address both the causes and impact of health inequity.

  • Senator Bo Watson, District-11 of Tennessee on the governance challenges from his perspective: "We’re constrained by the financial reality of what we have. Should I focus my resources on social determinants? Or care? What do we do with the dollar we have? The legislature has had a conversation about a Block Grant...[and will be] submitting an application for this grant in the next month."
  • Tene Franklin, Vice President of Diversity Equity and Inclusion at Health Leads on finding common ground: "Tennessee is 42nd in overall health on a national scale. What do we value? What are opportunities to learn from progress?"

Thank you Delta Dental Institute for sponsoring this event.

Keep ReadingArrowAug 26, 2019

Hospitals winning big state battles

Illustration: Aïda Amer/Axios

Several states have made ambitious attempts to address health care costs, only to be thwarted by the hospital industry.

Why it matters: States' failures provide a warning to Washington: Even policies with bipartisan support — like ending surprise medical bills — could die at the hand of the all-powerful hospital lobby.

Go deeperArrowAug 15, 2019