An easier way to think about health care

CEO Q&A

Tom Policelli
Tom Policelli

BizTimes: Why is the health care payment system so complicated? 

Tom Policelli: Providers are terrified that they will not get paid. They do not cover their costs with Medicare and Medicaid, so getting every possible dollar from commercial plan members is critical.  As each provider organization tries to optimize its collections, consumers become more confused and disengaged. Patients are absolutely buried in a blizzard of paper, with the average American family expecting to receive 125 pieces of mail each year related to healthcare billing. After a routine surgery, a patient may receive a bill from the hospital, the surgeon, the anesthesiologist, the radiologist … The sheer number of participants—doctors, hospitals, insurance companies, patients, and clinics—only add to the complexity of the healthcare payment system.

BizTimes: How can we simplify medical billing for all stakeholders? 

Policelli: The answer to fixing a broken system is not to add more complexity but to simplify. In order to do that, we need to focus not on transactions and payments but on the consumer. 

We can focus on getting people what they need by stripping out the complexity. Instead of receiving countless pieces of paperwork, patients can receive a simple monthly statement that they can pay via their preferred payment method. Most importantly, built-in financing means they can get the care they need while becoming more savvy shoppers since they now understand what is going on with their benefits.

BizTimes:  How do out-of-pocket healthcare payments impact patient access and care? 

Policelli: The trend in healthcare has been to shift the cost burden to patients as employers increasingly move to higher deductible health plans. With out-of-pocket costs skyrocketing for consumers, the risk of avoiding care due to cost reasons is significant. For many people, they would rather avoid getting the care they need than risk the negative impact medical debt can have on their lives. The disturbing trend is that people not only avoid seeking care, but they also cut back on medications to treat chronic conditions like diabetes or put off critical life-saving screenings like colonoscopies or mammograms. Our company was founded to help patients get the care they need when they need it and to find manageable ways to pay their bills. We will cover their medical bills up to their full out-of-pocket maximum and then work out a low to no interest repayment plan that is flexible and fits their budget. We want people to have access to the care they need.

BizTimes: What is the PayMedix “SuperEOB” and why is it important? 

Policelli: The “SuperEOB” is a simple consolidated statement that gives a patient the essential information they need to determine how much they owe. In today’s world, patients are confused by a flurry of multiple ‘explanation of benefits’ (which don’t explain much), bills that don’t line up with EOB, and collection notices about unpaid items and other notices. By putting everything in one place, consumers can feel more comfortable knowing what they owe and are more likely to pay it. Since we started using the “SuperEOB”, we’ve reduced the amount of paper going into patients’ homes by six-fold. And our satisfaction levels are three times higher than the industry average. People love simplicity, and that is what we provide.  

1000 N. Water St, Suite 1100    Milwaukee, WI 53202-3197

(844) 392-1652    paymedix.com

Tom Policelli joined the HPS/PayMedix leadership team as CEO in February 2021. Previously, Mr. Policelli was a co-founder and CEO of Minuteman Health, an HMO in Massachusetts and New Hampshire. Prior to that, he was co-founder and CEO of Averde Health. Mr. Policelli also ran United Health Group’s consumer-directed health business and founded a new business unit within the company. He began his career at CIGNA Healthcare, and while at Monitor Company consulted with several leading healthcare companies.