Healthcare affordability has become one of the defining challenges in today’s market. Rising costs are not new—but the growing burden on patients is reshaping how, when, and whether care is accessed at all.
For health system–owned health plans, this moment represents both a critical challenge and a strategic opportunity.
The Pressures Facing Health System–Owned Plans
Health system–owned plans operate at the intersection of three competing financial realities:
- Managing employer expectations around cost control
- Protecting provider system revenue and utilization
- Delivering a seamless, positive member experience
Balancing these priorities has always been complex, but the pressure is intensifying. Employer healthcare costs are projected to rise by 9–10% this year, with 1–1.5% increasingly shifted to employees through higher out-of-pocket costs.
At the same time:
- Patient responsibility now accounts for 24% of allowed amounts, rising sharply year after year
- 63% of providers cite large patient balances as a top operational challenge
- 41% report increasing bad debt from uncollected balances
- More hospitals are including upfront payment requirements which creates a barrier to patient access
These dynamics point to a fundamental breakdown in how healthcare is paid for. Solutions like PayMedix directly address this by restructuring the payment model—guaranteeing providers receive payment in full for the plan and patient portion of a claim which removes the burden of point-of-service collections and cumbersome post-care patient billing and collections.
The Hidden Impact: When Patients Don’t Access Care
While cost-shifting strategies may balance plan economics in the short term, they often create unintended consequences.
The reality is the average annual out-of-pocket spend is about $1,100 per person, yet 53% of Americans cannot cover a $1,000 expense in full.
When financial barriers rise, care utilization falls. Patients delay or skip necessary care—or seek alternatives outside the system. In many cases, they ultimately re-enter the system later needing higher-cost treatment.
PayMedix helps break this cycle by eliminating upfront payment requirements and giving members a clear, pre-established path to pay over time with no interest charges or fees. By removing uncertainty at the point of care, it increases the likelihood that patients move forward with necessary treatment.
Member Experience Is Financial Experience
Health plans often focus heavily on clinical quality and access—but members don’t separate clinical care from financial experience.
A positive clinical interaction can be quickly negated by confusing billing statements, unexpected out-of-pocket costs, and lack of clarity around what is owed and why. When both affordability and clarity are lacking, member satisfaction drops—even if care quality remains high.
PayMedix simplifies this experience by replacing fragmented provider billing with a single, consolidated statement and a consistent payment experience. This removes confusion, builds trust, and aligns the financial experience with the quality of care delivered.
Affordability Is Also a Health Equity Issue
Affordability challenges disproportionately affect vulnerable populations, making this more than just a financial concern.
Consider this: Around 40% of individuals overall delay or avoid care due to cost. That number jumps to 67% for individuals earning under $90,000 annually.
Traditional financing solutions can unintentionally reinforce inequities. Many programs are offered only after care is delivered, depend on creditworthiness, and may include deferred interest or penalty structures.
PayMedix addresses these inequities through a group-based financing model that does not rely on individual credit approval. All eligible members receive the same access to interest-free payment options, ensuring affordability support is available before care decisions are made—not after.
The Employer Perspective: When Benefits Fail to Deliver
Employers are caught in the middle.
They are striving to control rising costs while ensuring employees actually use the benefits they provide. When employees delay care due to affordability concerns, productivity declines, absenteeism increases, and preventable conditions worsen
In these cases, the health plan may be functioning as designed from a cost standpoint—but failing both the member and the employer.
A Strategic Opportunity: Redesigning the Payment Experience
For health system–owned plans, affordability is not just a challenge—it’s an opportunity to differentiate.
Unlike traditional insurers, HSOHPs have influence across plan design, provider payment models and member billing and experience. This creates a unique ability to rethink how healthcare is financed and delivered.
What Leading Organizations Are Prioritizing
Forward-thinking plans are beginning to focus on:
1. Upfront, Transparent Financial Experiences
Giving members clear, predictable understanding of their financial responsibility.
PayMedix operationalizes this by eliminating uncertainty—members know they will not face point-of-care payment demands and can access a defined, interest-free payment plan.
2. Interest-Free, Group-Based Patient Financing
Moving away from individual, credit-based lending models.
This is a core component of the PayMedix model—interest-free financing that is universally accessible for all members.
3. Consolidated Billing and Navigation Support
Reducing confusion and friction by simplifying how patients receive and understand bills—and helping them navigate the system.
PayMedix delivers a single, unified billing relationship for the member, reducing administrative complexity and improving engagement.
Why Payment Innovation Is a Competitive Advantage
When payment is reimagined, the benefits extend across stakeholders:
For Health Plans
- Increased membership growth and retention
- Improved member satisfaction scores
- Stronger employer relationships
PayMedix enhances these outcomes by embedding affordability directly into the plan design, creating a differentiated and member-centric offering.
For Provider Systems
- Reduced bad debt tied to patient responsibility
- Improved cash flow and revenue predictability
- Less billing friction with patients
PayMedix pays providers in full for all allowed claims and assumes responsibility for patient collections, significantly improving cash flow and reducing administrative burden.
For Employers and Communities
- Lower long-term medical cost trends
- Increased utilization of preventive and necessary care
- Reduced financial barriers for patients
By enabling earlier access to care and reducing delays, PayMedix contributes to healthier populations and more sustainable cost trends.
What It Takes to Succeed
Implementing an effective affordability strategy requires more than new tools—it requires alignment.
The most successful organizations share key characteristics:
- Executive alignment across health plan and provider leadership
- Recognition that affordability is a core strategic priority, not just a back-office issue
- Willingness to rethink traditional approaches to patient financial responsibility
The Path Forward
Healthcare affordability is now a system-wide challenge affecting growth, equity, and sustainability.
PayMedix represents a practical and scalable path forward—removing financial barriers at the point of care, simplifying the member experience, and aligning incentives across the ecosystem.
By adopting solutions like this, health system–owned plans can move beyond managing affordability challenges to solving them—while strengthening their competitive position and delivering meaningful value to members, employers, and communities.
