Direct-Pay for Healthcare

Michael T. Havig MD

Tech Brief

Our superpower: Making the complex simple. As a physician founder, I understand there are few industries more complex than healthcare. While the actual provision of care - procedures, testing, surgeries, therapeutics - is by default complex, access to, and payment for that care, should be simple. Unfortunately, it is not. CPT, ICD-10, HCPCS mean nothing to the patient, confuse doctors and their staff, and add significant administrative burden to all involved in patient care. Studies show greater than 50% of the time spent during patient care was consumed on administrative tasks. At HealthMe we are making the complex simple by connecting patients and payers directly with doctors by transforming medical practices into eCommerce storefronts. Patients shop for healthcare digitally: view transparent pricing, select a service, and checkout. To accomplish this, we condensed tens of thousands of disparate CPT/ICD codes into a functional library of 400 hundred transparently priced healthcare bundles covering the entire patient care cycle into easy-to-understand consumer centric offerings. Our growing, proprietary database of pricing information makes it easy for doctors to fairly price these bundles based on regional and national data. Our pricing data is unique in that it reflects what a consumer actually pays for a specific healthcare bundle, not what someone charges, or an insurance company pays to a specific provider for a stand-alone CPT or HCPCS code. This simplification enables a digital retail ecosystem for patients, payers, and providers. When we win, transparent prices inform patients and payers, and healthcare becomes shoppable like everything else.

Problem Tech Solves

HealthMe has bridged the gap to healthcare price transparency and plain language payment models suited to today’s health consumer. In order for a buyer/patient to purchase from a seller/provider they must be able to communicate, like in any other industry. One reason for the lack of a consumer-centric retail payment model in healthcare is that doctors, patients, and payers don’t speak the same language. To define a knee injury patients might say ”my knee hurts”, doctors speak in technical terms like “unstable meniscal root injury”, and payers speak in ICD and CPT codes. HealthMe improves current payment models via consumer centric transparently priced healthcare bundles that are understandable to patients, doctors, and payers. Our “Knee Care” bundle includes “a doctor visit, x-rays, and a plan to get you feeling better”. Our surgery bundles are all inclusive of surgeon, facility, and anesthesia fees allowing patients/payers to know costs in advance and get absolutely no surprise bills. Additionally, the growing direct-payer ecosystem needs modern rails to run on. Nearly 100 million Americans work for self-insured employers. There is a huge gap between the patient/payer and provider with a reported average of 18 intermediaries between them to navigate and pay for care. Surgeries are often “one-off” deals requiring travel, inconvenience, and expense due to the lack of providers offering transparent bundles. Faxes, invoices, and checks in the mail are prevalent. HealthMe’s local transparently priced bundles, coupled with multiple inbound/outbound payment options, instantaneous split payments to bundle participants, and financing options streamline the process.


1.Access to Care: Do Orthopedic Surgeons Accommodate Self-Pay Patients? This peer reviewed study was presented by Dr. Havig at the American Academy of Orthopedic Surgeons (AAOS) 2021 Annual Meeting. Methodology: Eighty-three orthopedic groups representing 3,206 physicians in large orthopedic groups were surveyed by a prospective patient. Findings: Only 10.8 percent of orthopedic groups surveyed could offer a transparent price for an initial visit (price range $175 to $500). Only 1.2% (1 practice) had a comprehensive self-pay program. The finding that 98.8% of orthopedic groups lack a transparent pricing strategy shows most would benefit from a comprehensive platform to give access to specialty care for this growing group of patients. 2.Case Study: Improving Access to Care - Can a Digital Direct-Pay Strategy Increase Patient Access and Grow Practice Revenue? Methodology: In January 2022 large orthopedic practice instituted a digital direct-pay strategy using the HealthMe platform. Numbers of new patients, revenue generated, and staff workflows were assessed over the first 6 months on the platform and compared to data from H2 2021. Findings: In the 6 months prior to using HealthMe the practice reported turning away direct-pay patients, and accommodated fewer than 10 elective direct-pay patients, generating less than $1K of revenue. Using HealthMe the practice saw 630 elective new self-pay patients giving these people access to specialty healthcare. $210K of direct revenue was generated with an estimated $472K of additional downstream revenue through the care cycle. Greater than 90% of the staff noted improved ease of the direct-pay workflow.