This document summarizes the results of a survey conducted by Navicure and HIMSS Analytics on patient payment behaviors and attitudes. The key findings were: 1) While most providers say they can provide cost estimates, less than 25% of patients request one, though over two-thirds of patients found estimates within 10% of the actual cost to be helpful. 2) Half of patients prefer electronic billing over paper, but most providers still use mail, and providers underestimate patients' comfort providing email addresses. 3) Providers and patients disagree on how long it takes for patients to pay their bills in full. 4) Most patients are comfortable providing credit card information for charges up to $200, and providers

1. 2017 Patient
Payment Check-up
February 20, 2017
Phil Dolan
Chief Marketing Officer
Navicure®
Bryan Fiekers
Sr. Director, Research Services
HIMSS Analytics

2. What Are We Going to Cover
© 2016 Navicure, Inc. All Rights Reserved. 2
 About Navicure
 Importance of Research
 Research Methodology
 Attitudes around Cost Estimates
 Attitudes around Bill Payment
 Opportunities for Improvement
 Key Takeaways

3. Who is Navicure®
© 2016 Navicure, Inc. All Rights Reserved.
Navicure is a provider of cloud-based revenue
cycle management solutions, each designed to:
Increase Revenue
Accelerate Cash Flow
Reduce the Cost and Effort of Staff
Integrated on a Single Platform

4. Who is Navicure®
© 2016 Navicure, Inc. All Rights Reserved.
Headquartered in Atlanta, GA
300+ Employees, all US-based
8,000+ Clients, 100,000+ Providers, 350+ Facilities
All Care Settings, including Hospitals, & Practices
Award-Winning Solutions and Service
Best in KLAS, Black Book, Stevie Awards
30+ Leading EMR, PMS, HIS Partners
Allscripts, eClinicalWorks, Epic, Greenway, Nextgen
Healthcare Management Partners
MGMA, HIMSS, AMGA, HFMA, RBMA, HBMA
Partnered with Leading Investment Firm
Bain Capital Private Equity

5. The Healthcare Landscape is Shifting
© 2016 Navicure, Inc. All Rights Reserved. 5
• The care delivery paradigm is starting to shift from Volume to Value
• EMRAM shows that organizations are becoming increasingly
sophisticated related to technology
• Access to data is driving a trend toward consumerism
• Patient financial obligations and patient choice are at the heart of
consumerism
This research focused on what patients and providers are expecting
from each other related to payments, and how the attitudes and
expectations are changing

6. Data Collection and Analysis
© 2016 Navicure, Inc. All Rights Reserved. 6
To provide insights into behavioral
trends among providers and patients
Through a blinded, web-based, voice-
of-customer quantitative study with
personnel at provider facilities and
patients
In order to create content around
billing and payment challenges
uncovered

7. Demographics
© 2016 Navicure, Inc. All Rights Reserved. 7
 Targeted: Executives, C-Suite, business
office, financial, revenue cycle and IT
leaders at hospitals and healthcare
systems; providers, office managers and
practice managers at outpatient facilities
– Contacts via:
 Recruitment: Web survey link open
between January 6 and January 30, 2017
 Targeted: Individuals that visited a provider
setting (inpatient or outpatient) in the last
12 months
 Qualifying criteria:
– 18 year old or older
– Not covered by parent or guardian insurance
policy
– Does not work for healthcare technology
company
 Recruitment: Web survey link open
between January 16 and January 20, 2017
1,000 Respondents
Patient Provider
553 Respondents

8. Generally, Patients Feel the Same Responsibility to Pay
Healthcare Expenses as Other Professional Services
© 2016 Navicure, Inc. All Rights Reserved. 8
86.1%
13.9%
Do you feel the same responsibility to pay for healthcare services
as you do other professional services, e.g. lawyer, accountant,
child care, home contractor, dry cleaners, etc.?
Yes
No
Are patients starting
to expect the same
ability to compare
healthcare services
as they do when they
are shopping for a
vehicle?

9. Current State: Three Quarters of Organizations are Able to
Provide a Cost Estimate, but Patients Do Not Ask
9
25.3%
74.7%
Is your organization able to provide patients a
cost estimate upon request?
No
Yes
1.2%
3.7%
3.8%
5.3%
9.8%
76.2%
0% 10% 20% 30% 40% 50% 60% 70% 80%
After I left; before I was
billed
After seeing the provider,
but still in the office
When I checked in
After scheduling appt
Prior to scheduling appt
Never
N = 861
Did you request a cost estimate for your last
visit or procedure, and if so, when?
N = 553

10. Future State: 56% of Patient Respondents Would Request a
Cost Estimate in the Future
© 2016 Navicure, Inc. All Rights Reserved. 10
27.9%
16.1%
2.8%
4.6%
5.1%
13.3%
30.2%
0% 5% 10% 15% 20% 25% 30% 35%
No, an explanation of costs with my bill is fine
Sometimes but not always, depending on the
purpose of seeing my provider
Yes, after I leave the office but before I receive my bill
Yes, after seeing the provider, but in the office before
I left
Yes, when I check in before seeing my provider
Yes, between scheduling my appointment and seeing
my provider
Yes, before scheduling my appointment
N = 1,000
Would you plan to request a cost estimate from your healthcare providers in the future,
and if so, when would you find it most useful?

11. Two out of Three Participants Say an Estimate Within 10% of
the Actual Cost is Adequate
© 2016 Navicure, Inc. All Rights Reserved. 11
1.7%
4.1%
11.5%
64.0%
18.9%
0% 10% 20% 30% 40% 50% 60% 70%
Other
Within 30%
Within 20%
Within 10%
Any estimate is helpful
N = 1,000
If you were to receive a patient cost estimate for a procedure or office visit, how close to
your actual cost would the estimate need to be considered a good estimate?

12. Patients Tend to NOT Compare Prices; When They Do it is
Impactful
© 2016 Navicure, Inc. All Rights Reserved. 12
No,
86.2%
Yes,
13.8%
Did you compare healthcare prices between potential providers
related to your last healthcare experience?
75% Of those that compared prices are between 18 and 34
17.3%
10.8%
26.6%
18.7%
26.6%
0%
5%
10%
15%
20%
25%
30%
<6 7 8 9 10
N = 139
How much influence did your price
comparison have?

13. Of the 25% of Providers Not Providing Cost Estimates, 44%
Have No Plans to Provide
13
7.1%
7.1%
7.9%
34.3%
43.6%
0% 10% 20% 30% 40% 50%
Yes, within the next 6 months
Yes, within the next two years
Yes, within the next year
Unsure
No current plan
N = 140
Do you currently have plans to offer cost estimates to improve your
organization’s patient experience?
Why not?

14. Providers Believe Patients are Less Comfortable Submitting
Their eMail Address than Patients Report to Be
14
3.6%
1.3% 1.6% 5.4%
9.5%
19.9%
58.7%
3.8% 2.9%
4.9% 12.7%
19.2%
24.4%
32.2%
0%
10%
20%
30%
40%
50%
60%
70%
1 2 3 4 5 6 7
How comfortable are you with submitting your email address to your providers when
requested?
Patients (N = 1,000) Providers (N = 553)
Very ComfortableUncomfortable

15. If we can accurately predict
costs, how do patients
want to pay for services?
15

16. Current State: 90% of Organizations Send Paper Bills Through
the Mail; Half of Patients Would Prefer Some Form of eBilling
16
1.8%
0.9%
12.7%
89.2%
4.2%
12.7%
17.2%
17.5%
48.4%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Electronically via text with link to view
bill on a mobile device
Electronically via e-mail and text to
view bill wherever I am
Electronically via e-mail linked to
patient portal
Electronically via e-mail with
attachment to view bill
Paper bills via the mail
How do you (would you) prefer to receive bills from your providers?
How does your organization send bills to patients? (select all that apply)
Patient Preference (N = 1,000)
Provider Billing (N = 553)
40.8%

17. Patients Report Paying Their Full Balance Much Faster than
Provider Organizations Report Receiving Full Payment
17
5.2%
51.4%
22.8%
15.9%
4.7%
1.0%
4.2%
14.6%
17.7%
20.8%
18.8%
22.9%
0% 10% 20% 30% 40% 50% 60%
Never paid any of what is owed
Never paid some of what is owed
I have not been billed yet
More than 3 months
Between 2-3 months
Between 1-2 months
Less than one month
How long did you take to pay the full balance of what you owed?
On average how long do your patients take to pay the full balance of what they owe?
Patients (N = 96)
Provider (N = 553)

18. 78% of Participants Would Authorize a Credit Card Payment
of $200 or Less
18
22.3%
31.7%
46.0%
0% 10% 20% 30% 40% 50%
I would refuse to provide my healthcare provider with my debit
or credit card to be charged one time for what I owe, up to
$200, even if it meant that I could not see my provider
I would provide my card to be charged one time for what I owe
up to $200 if required to see my provider; however, I would not
feel comfortable doing it
I would feel comfortable submitting my debit or credit card to be
charged one time for what I owe, up to $200, after my
insurance company pays its portion. The rest would be billed or
paid via an automated payment plan.
N = 1,000
In order to see the provider, if the office required you to securely store your debit/credit card in its system and
charged your card for actual charges up to $200 one time only after insurance pays its responsibility, how
comfortable would you feel?

19. Providers: Online Bill Pay and Securely Storing Patient Card
Information would Reductions in Cost of Collections
19
1.8%
20.2%
22.0%
14.6%
10.2%
12.2%
0% 5% 10% 15% 20% 25%
Other
Secure credit card on file, charging one time up
to $200 once patient responsibility is known
Online bill pay
Electronic statements
Consumer credit line, e.g. CareCredit
Automated payment plans
What payment option do you think would be the most likely to create reductions in
Cost of Collections?
N = 549

20. Key Takeaways
20
Patient Cost Estimates
• Provider organizations claim to be able to provide a cost estimate upon request, yet less than 25% of
patients requested one
• Over two-thirds of patients would find an estimate within 10% or more of their actual cost helpful.
Patient Billing
• Providers believe patients are less comfortable providing email addresses than patients report to be.
• Over half of all patients (52%) surveyed would prefer to be billed electronically vs. paper.
• Providers and patients disagree on how long it takes patients to pay.
Patient Payments
• Among payment methods that a provider organization can provide its patients, patients view credit card-on-
file (CCOF) as their preferred method for charges of $200 or less.
• Over three-quarters (78%) of patients say they would provide their debit or credit card number to be charged
one time up to $200 after claim adjudication if asked by their provider.
• Credit card-on-file (CCOF) is viewed by providers as the best way to improve patient collections.

21. Thank you!
Phil Dolan, Navicure: 770.342.0271/ pdolan@Navicure.com
Bryan Fiekers, HIMSS Analytics: 312-497.6617/ bryan.fiekers@himssanalytics.org