A mobile application to offer upfront healthcare prices and automated medical billing for socioeconomically disadvantaged Americans

Project Summary/Abstract This SBIR Phase I project will develop a novel healthcare cost estimator and billing management mobile application to assist minority health and disparity populations in America find affordable healthcare and accurately pay medical bills. America has the largest per capita health expenditure in the world, and Americans bear the significant burden of this with medical debt reaching US $81 billion in 2016 [1][2]. Over a quarter of Americans have challenges paying for medical care and this disproportionately impacts those minority health and disparity populations, leading to disparities in access and ultimately health outcomes. For example, Blacks/African Americans are 25% more likely to have challenges paying for medical care than the average American, Hispanics/Latinos - 30% higher and socioeconomically disadvantaged populations - 60% higher for those who earn less than $50,000 [3]. To make fully informed decisions about their healthcare and be protected from surprise billing, patients must know the price and quality of a good or service in advance. Approximately 73% of inpatient care and 90% of outpatient care with the highest-spending are offered by multiple providers through the market, meaning if patients researched and compared these before making informed choices they could see significant savings opportunities, with figures of up to 19% shown in literature [4]. However, the evidence for this is conflicting [5]. On January 1st 2021, hospital pricing data for services and procedures became available for the first time, and while this data is accessible, powerful players in the healthcare market are incented to keep this commercially sensitive data opaque to the public [4]. Access to intuitive tools that simplify the research and comparison process would make the effort minimal and incentives high to find low-cost, high quality care. The ability to save pricing information related to the providers and services a patient may need, and the out-of-pocket costs they may incur will avoid surprise bills and allow for reconciliation when bills are received. This can help avoid excessive charges and empowers patients to inquire about discrepancies. The scope of science proposed in this SBIR project is to develop a novel cost estimator search tool fed by an aggregated database of hospital pricing information combined with an automated billing reconciliation tool run on a smart device or laptop for a dynamic, user friendly experience completely free to the public. Digital products of this nature are available for businesses today and have been shown to improve employee engagement with, and accessibility and affordability of, healthcare services. However, those unable to afford medical care are 3.4 times more likely to be uninsured (28.9M Americans), and part of families with incomes below 400% of the poverty level (24.5M Americans) [6]. These individuals often don’t have the support of employer-sponsored insurance and benefits, further widening the inequalities across the population. Approximately 70% of socioeconomically disadvantaged populations do, however, own a smart device [7]. The mobile health, cost estimator and billing management application developed through this project will offer for the first time a direct-to-consumer solution agnostic of employer and health insurer, dedicated to socioeconomically disadvantaged populations and their needs. The benefit of this pioneering work will be meaningful pricing information and billing tools becoming more universally available, protecting patients, reducing the cost of care and ultimately bridging the gap in accessibility and affordability of healthcare in America. In Phase 1, we will evaluate the technical feasibility and validity of the mobile application. In subsequent phases we will evaluate the usability and effectiveness through human subjects research, while building the required partnerships and sales channels to develop a commercially viable product.