摩根大通 -医疗保健支付趋势 Trends in Healthcare Payments

Trendsin

HealthcarePayments

SixteenthAnnualReport

2TrendsinHealthcarePayments

TableofContents

ALetterFromtheCEO3

About

4

AIandtheEmpoweredConsumer:TheTwinForcesRedefiningHealthcarePayments

5

FromOvercollectiontoUnderpayment:TheFullPictureofHealthcare’sPaymentChallenge

10

RealSavings,RealThreats:AClearCaseforChange

14

Conclusion

19

Methodology

20

Sources21

3TrendsinHealthcarePayments

ALetterFromtheCEO

AswereleasethesixteentheditionoftheTrendsinHealthcarePaymentsAnnualReport,onemessageisclear:healthcarepaymentsarebeingreshapedbytwopowerfulforces—AIandanincreasinglyempoweredconsumer.

AIisalreadyshowingearlyvalueinworkflow-heavyareasofRevenueCycleManagementwhere

agentscanbedeployedtoincreaseautomation,anditsimpactwillcontinuetoscaleasitdevelopsasaservicecapableofcomplexprocessesacrossmultiplesystems.

Consumersarebringingretail-gradeexpectationsintohealthcarepayments,makingconvenience,transparency,andchoiceastrategicpriority,notanice-to-have.Refundshavebecomeavisible

symptomofpaymentfriction,addingtothefrustrationconsumersreportaspartoftheirpaymentexperiences.

Asmarginpressurerises,someorganizationslooktoaddedfeestooffsetcosts,butthereportunderscoresthatconsumersareincreasinglyfee-sensitiveanddemandtransparency,whichcandirectlychangepaymentbehavior.

Thepathforwardistomodernize—movingfrommanual,paper-basedworkflowstoscalable,

interoperableelectronicpaymentsthatstrengthenefficiency,resiliencyandsecuritywhilebuildingtrustacrosstheecosystem.

Thankyouforyourpartnershipasweworktogethertoreducefriction,improveexperiencesandhelphealthcarepaymentsmeetthemoment.

Sincerely,

JeffLin

ChiefExecutiveOfficer,InstaMed

GlobalHead,J.P.MorganHealthcarePayments

4TrendsinHealthcarePayments

About

TrendsinHealthcarePaymentsAnnualReport

EachyeartheTrendsinHealthcarePaymentsAnnualReportispublishedbyJ.P.MorganHealthcare

Paymentsforthepurposeofeducatingthemarketandpromotingawareness,changeandgreaterefficiency.

Nowinitssixteenthyear,themissionofthereport

hasnotchanged.Thereportusesquantitativedata

derivedfromtheInstaMedNetworkandqualitative,

independentlygathereddatafromtheInstaMed

HealthcarePaymentsSurveysofconsumers,providersandpayersnationwide.Third-partysourcesarealsousedtoanalyzethemarketfromtheperspectiveofallstakeholders.

J.P.MorganHealthcarePayments

J.P.MorganHealthcarePaymentsdrivessimple,safe,andintelligentpaymentexperiencesfororganizationsacrossthehealthcareecosystem—including

providers,payers,andhealthtechcompanies.

HealthcarePaymentsbringstogetherindustry

expertisewithpaymentsandtreasurycapabilities

tosupportsecure,reliableflowsofmoneyanddata.Weofferacomprehensiveportfolioofsolutions

designedtomeetthediverseneedsofhealthcare

organizations,servingasacenterofexcellenceforfraudriskawarenessandcompliance,andadvancingcross-paymentssolutionstailoredtotheunique

requirementsofhealthcare.

Wehelpourclientsmodernizetheiroperations,

increaseelectronicpaymentadoption,streamlinereconciliationandcashapplication,andreduce

frictionforconsumers—empoweringorganizationstostrengthenfinancialperformance,unlocknewrevenuestreams,anddeliverabetterpayment

experienceacrosshealthcare.

AIandthe

EmpoweredConsumer:

TheTwinForcesRedefiningHealthcarePayments

Artificialintelligence(AI)promisestoreshapethefutureofhealthcare,yetconsumerexpectationsarepushingagreatresetinhealthcarepayments.

5

6TrendsinHealthcarePayments

Healthcare’sAIMoment:

Revolution,RebrandorBoth

Artificialintelligence(AI)hasbecomethemostvisibleinnovation

positionedtoreshapehealthcare.However,healthcareisnotatypicalautomationenvironment:decisionsarehigh-stakes,dataishighly

sensitive,and“faster”onlyhelpsifitisalsosafe,explainable,andgoverned.

AI’spromiseisoftenframedasautomationofworkactivitiesthat

absorb60to70percentofemployees’time.1Inpractice,AIspans

machine-learningmodelsthatpredictriskandoutcomes,generativeAIthatdraftsandsummarizeslanguage,andagentsthatautomateworkflowsbyhandlingcomplexmulti-stepprocesses.

EarlyvalueisshowingupinRevenueCycleManagementworkflowswhereautomationisapplied:verifyingpatienteligibilityinreal-time,handlingdeniedclaims,andflaggingauthorizationrequirements.

Forexample,agentscanreviewdocumentationandsubmitrequestsautomatically,handlingrepetitivetasksthattypicallyrequiremanualeffortandsignificantstaffing.Astheseprocessesscale,staffcan

redirectfocusfromrepetitiveadministrativeworktostrategicinitiatives.

7TrendsinHealthcarePayments

InasurveyofUShospitals,65percentreportedusingAImodels,and79percentofthoseusedanAImodelthatwasintegratedintotheirEHR.2Adoptionisalsorisingacrossproviders,with34percentalreadyusingAIforadministrativesupport,3andconsumerssignalinginterestas68percentofAmericansareinterestedinusingAIforhealthconcerns.4

ThesetrendshighlighttheopportunityforAItomergeclinicaland

revenuecycleacrossahealthcareorganization,drivingefficiencyandalleviatingoperationalconstraints.

Yet,theultimateimpactofAIremainsunansweredbecausescaling

requiresmorethanpilots.Modelsmustfitrealworkflows,beevaluatedforsafetyandbias,andoperateunderstrongprivacy,security,and

accountabilitycontrols.Thesametoolsthatspeedworkcanintroduce

newrisks—hallucinatedfacts,automationbias,PHIleakageandmodel

drift—andAIissometimesusedtorebrandestablishedautomationratherthandelivermeasurableimprovements.Forhealthcareleaders,thekeyquestionisnotwhetherAIwillbeadopted,butwhereitcanbetrusted,howitwillbegovernedandhowoutcomeswillbeproven.

with

34%

reportingthattheyarealreadyusingAIfor

administrativesupport

65%

ofUShospitalsreportedusingAImodels

8TrendsinHealthcarePayments

DigitalWallets,Subscriptions,Surcharges:

IsHealthcareReadyfortheConsumerItAlreadyHas?

5erswouldswitch

providersforabetterpaymentexperience

AsAIiscontinuallytoutedforitspotentialtotransformhealthcare,theindustry’snext“reset”islikelytocomefromamorepracticalplace:

innovatingtosolverealproblemsthatdirectlyimpactpatients.Oneofthebiggestisthattheyincreasinglybringretail-gradeexpectationsintothehealthcarepaymentexperience.

Evenasconsumershaveconsistentlyowedmoreforhealthcare,the

industryhasnotprioritizedadaptingtomeettheseexpectations.

82%

ofconsumersreportactivesubscriptionswithautomated

payments

amongthem

6a

cardonfile

Consumersincreasinglyvaluethepaymentexperience,andmanywouldswitchprovidersforabetterone:58percentofconsumerswouldswitchprovidersforabetterpaymentexperience,a16percentincreasefromthepreviousyear.5

Retailandconsumerpaymentnormscontinuetoshapewhatconsumersviewas“good”payments.Digitalwalletshavebecomemainstream,with64percentnowusingadigitalwallettopayfortheirregularexpenses.6Automatedpaymentsandsavedcredentialsarealsonowstandard

behavior:82percentofconsumersreportactivesubscriptionswith

automatedpayments;amongthem,65percentuseasavedcardonfile.7

9TrendsinHealthcarePayments

Atthesametime,noteveryretailpaymentoptiontranslatescleanly

tohealthcare.Buynow,paylater(BNPL)hasexpandedrapidly—BNPL

spendingincreasedto$75billionin2023fromroughly$2billionin2019,8andaboutoneinfiveconsumersusedBNPLatleastoncein2022alone.9However,BNPLisprimarilydesignedtodriveretailecommercesalesandisnotnecessarilybuiltfortheconsumerjourneyinhealthcare,especiallyasthefeescanincreasethecostofcare.10

Finally,retailcheckouttrendsaremakingconsumersmoresensitive

tofeesandtransparency.Asmoremerchantsapplycardsurchargesatcheckout,consumersarebecomingmoresensitivetoaddedcostsand

moredemandingoffeetransparencywith83percentofconsumers

sayingtheywouldabandontheircartifunexpectedfeesappearat

checkout.11Ashealthcareorganizationslookforwaystoalleviatemarginpressurebyincreasingrevenue,theymustbemindfuloftheimpact

addedfeescanhaveonconsumerbehavior.

FromOvercollectiontoUnderpayment:TheFullPictureofHealthcare’sPaymentChallenge

Legacy,fragmentedworkflowscollidewithrisingpatientbalances,slowingcash,patientrefundsandrisk.

10

11TrendsinHealthcarePayments

Collect,Refund,Repeat:Healthcare’sCostlyPaymentLoop

46%

werefrustratedbytheslowprocess

ofprovidersissuepatientrefunds

86%

Ofconsumerswhoreceivedrefunds

Patientrefundsexemplifythedeepdisconnectbetweenlegacycollectioneffortsthatarepropelledbylargepatientbalancesandthesubsequentproviderinefficiencies.Themajorityofproviders(86percent)issue

patientrefunds,with14percentofproviderssayingtheyissuepatientrefundsoften.12Oftheproviderswhoissuerefunds,only4percentissuethepatientrefundsasACH.13

Patientrefundsareasymptomofthelargertrendofincreasingpatientbalanceswithoutthenecessarypaymentinfrastructure.Astheyowe

more,providersaretryingtofindwaystomaintaintheirfinancialmargins.

Thisincludescollectingupfrontorduringthepatientencounter.However,duetothecomplexityofcareandhealthplanintricacies,upfront

collectionsoftendonotmatchthefinalpatientresponsibility.

Patientrefundsmaybeanecessarystrategyforproviderstocapturepaymentsfrompatients.However,refundsaddfrictiontothepatientexperience.Ofthethosewhoreceivedrefunds,46percentwere

frustratedbytheslowprocessand28percentwerefrustratedbynothavingachoiceinhowtheirrefundswerereceived.14

Additionally,refundsarecostlytoproviderorganizationsrepresentingadditionalcallvolume,paperandmailcosts,andtheaddedburdenofescheatmentiftherefundgoesunclaimed.

12TrendsinHealthcarePayments

Healthcare’sAffordabilityCrisisIsNowaConsumerPaymentCrisis

55%

receivingamedicalbillformorethan$400inthelastyear

ofconsumersreported

Risingconsumercostresponsibilityisreshapinghealthcarepaymentsandexposingtherealityofconsumerexperiencesinhealthcare.Employer-

sponsoredhealthplanpremiumsareprojectedtorise6.7percentin2026,averagingabove$18,500percoveredworker.15Thisamountincludesbothworkerandemployercontributionsforhealthplanpremiums.

Healthcarecostsaretakingupalargershareofannualhousehold

budgets.In2024,thetypicalworkingfamilyspentnearly$4,000acrosspremiumcontributionsandout-of-pocketmedicalexpenses.16

Theamountdueonmedicalbillscanbeamajorcontributortothesecosts.Increasing43percentoverthelastdecade,theaveragedeductiblefor

singlecoveragewas$1,886in2025.17Thiscontributestothe55percentofconsumerswhoreportedreceivingamedicalbillformorethan$400in

thelastyear.18

Trendsshowthathealthcarecostsdirectlyimpactconsumersandtheir

care.Aboutone-thirdofconsumersskippedorpostponedcaredueto

costs.19Foryoungerconsumers,thisisevenmoreofaconsideration.In

fact,75percentoftheseconsumerswentwithoutcareduetocosts.20Thiscouldbewhy29percentofconsumerssaidthathealthcarecostsarethemosturgentnationalhealthproblem.21

13TrendsinHealthcarePayments

TheCollectionCycleisBroken:andBurningOutStaffintheProcess

63

$

%

Consumersarenottheonlyonesgrapplingwithrisinghealthcarecosts.Providersfaceagrowingburdenfrompatientcollections.Amajorityofproviders(63percent)saylargepatientbalancesareatopchallenge.22Additionally,41percentreportrisingbaddebtfromuncollected

ofprovidersprimarilycollectwithmanual,

paper-basedprocesses

balances.23

Patientcollectionsoftenrelyonlegacypaymentmethodsthatarestaff-dependentandpaper-based.Infact,63percentofprovidersprimarily

70%

collectwithmanual,paper-basedprocesses.24Thisincludesmailedpaperstatements,which41percentofprovidersprimarilyleveragetocollectfrompatients.25Yet,thesepaymentmethodsdonotalignwiththese

expectations,andtakeconsiderabletimeandresources.

ofproviderstaketwoor

morestatementstocollectapatientbalanceinfull

Thisisquantifiedbyjusthowlongittakestocollectapatientbalanceinfull.For66percentofproviders,collectingapatientbalanceinfulltakesmorethan30days.26For27percentofproviders,ittakesmorethan60

days.27Additionally,70percentofproviderstaketwoormorestatementstocollectapatientbalanceinfull.28For32percentofproviders,thistakesmorethanthreestatements.29

Theadministrativeburdencreatedbylegacypaymentsystemsonlyaddstothestaffingchallengesandemployeeburnoutalreadyfeltinhealthcare.Nearlyhalfofproviders(44percent)areprioritizingdecreasing

administrativetasksandmanualworkfornon-clinicalstaff.30

RealSavings,RealThreats:

AClearCaseforChange

Whyaligningwithstakeholderneedsandpreferences,eliminatingpaymentfriction,andembracinginnovationcanacceleratecashflowandimproveexperiences

acrossthehealthcareecosystem.

14

15TrendsinHealthcarePayments

AutomationIsn’tTheoretical:It’sa$21BillionOpportunity

$21billion

eStatementtransactions

increasedby

growingby33%onaverageeachyearfrom2022to2025

savingspotentialwithfullyautomatedmanualtransactionsacrossallof

healthcarepayments

136%

Persistentadministrativeburden,fragmentedsystemsandmanual

processescreatecost,delayanderroracrosshealthcarepayments.

Recognitionofthechallengeandthedesiretochangeseemstobe

increasingas44percentofproviderswanttodecreaseadministrativetasksandmanualworkfornon-clinicalstaff.31

Acrossallofhealthcarepayments,thereisa$21billionsavingspotentialwithfullyautomatedmanualtransactions.32Theseresultsareonly

possiblewheninnovationisimplementedinawaytosuittheindustry’suniqueneeds,whilemeetingconsumerexpectations.

Thefirststeptothatgoalismovingfromtheslow,costlypaper-based

statementprocesstoeStatements,whicharemoreconsumerfriendly

andefficient.From2022to2025,thenumberofeStatementtransactionsincreasedby136percent,growingby33percentonaverageeachyear.33

Additionally,cardssavedonfilearefrequentlyusedforconsumers’

subscriptions.Inhealthcarepayments,providerscanusethistoolto

offerconsumersautomatedpaymentsoptionsincludingpaymentplans.Paymentplanswithoutfeeshelptoensurepatienttrustandloyalty,whilecapturinglargerbalanceswithfewerresources.From2022to2025,thenumberofcardssavedonfileincreasedby360percent,growingby66

percentonaverageeachyear.34

16TrendsinHealthcarePayments

ProvidersWantFasterPayments:FeesAreSendingThemBacktoPaper

Wheninnovationisembraced,measurableresultsarefeltacrossan

$

payers

86%

industry.Forpaymentsinparticular,innovationhasasignificantimpact.In2025,morethan30percentoffinancialprofessionalsreportfaster

paymentsarehavingapositiveimpactontheirorganizations.35

ofproviderspreferEFTforfreefrom

Payersareinauniquepositiontoacceleratepaymentmodernization

acrosstheindustrybyshiftingclaimpaymentstoprovidersfrompaperchecksandfee-basedACHtofreeERA/EFT.Payerscanimproveprovidercashflow,reduceadministrativeburdenanddeliverpaymentvisibilitytohelpunlockworkingcapitalacrosshealthcare.

75%

ofpayersareprioritizingmanagingandimprovingrelationswithprovider

networks

b

Providersoperateinafragmentedpaymentenvironmentthatdrivesunnecessarycostandfriction,onlycomplicatedbyclaimpayments

frompayers.Asignificantshareofproviders(41percent)reportbeingchallengedbytheadministrativecostsassociatedwithpaymentsfrompayers.36Thesecostsshowupinmanualreconciliation,exception

handlinganddelayscreatedbymixedpaymentmodes.

ProvidersoverwhelminglypreferEFTforfree(86percent)andonly2

percentpreferACHwithfees.37Notably,61percentwouldratherreceivepaperchecksthanacceptACHwithfees.38Thisisacriticalinsight:fee-basedoptionsmoverecipientsfromfaster,moreefficientpayments

towardslower,costliermethods.

Thetimingisfavorableforchangeas75percentofpayersareprioritizingmanagingandimprovingrelationswithprovidernetworks.39Aligning

paymentpolicieswithproviderpreferencesoffersatangiblewaytostrengthenthoserelationshipswhileloweringcosts.

17TrendsinHealthcarePayments

ModernizingPaymentsIsn’tJustAboutSpeed:It’sAboutSurvivingtheNextDisruption

84%

ofprovidersreportcybersecurityis

apriorityattheir

Modernizationofpaymentsislongoverdueinhealthcare.Thestatusquoreliesonhandoffs,exceptionsandmanualworkaroundsinthebestcasescenario.Inadisruption,thosesamemanualstepsbecomechokepoints,slowingrecoveryandincreasingrisktothehealthcareorganization.

organization

Cybersecurityraisesthesestakesevenfurther.Fragmentedandlegacypaymentenvironmentscanexposetheorganizationtoransomware,

breachesandotherthreatsincreasinglyaimedathealthcare.Infact,93percentofhealthcareorganizationsreportedtheyhadexperiencedacyberattackinthetwelvemonthsprior.40

Thefinancialandoperationalimpactsofcyberattacksaresubstantial.

Theaveragehealthcaredatabreachcostsnearly$11millionandgoes

undetectedfor213days.41Thismayexplainwhy84percentofprovidersreportcybersecurityisapriorityattheirorganizationand42percentareincreasingcybersecurityandsafetyprotocolstominimizerisksforadatabreach.42

18TrendsinHealthcarePayments

Inthisenvironment,businessresiliencymustbebuiltintothedesignofpaymentworkflows,controlsandtechnologychoices.Thisisachieved

bymovingtowardaninteroperable,scalableelectronicpayments

infrastructurethatsupportsreliabilityandsecuritybydesign.This

includesclearincidentresponserolesandprocedures,regularemployeetrainingandtestingtobuildacultureofawarenessandreporting,andcontinuousassessmentandimprovementthroughstress-testingsecuritycontrolsandresponseplans.

Ultimately,modernizingpaymentoperationsisapracticalpathto

reducingmanualeffort,limitingdisruption,andstrengtheningtrustwhilepositioningorganizationstowithstandanincreasinglycomplexthreat

landscape.

19TrendsinHealthcarePayments

Conclusion

Healthcarepaymenttrendsrevealanindustryontheprecipiceoftransformation,drivenbytheconvergenceoftechnologicalinnovationandshiftingconsumer

expectations.AIisnolongeradistantpromisebutanactiveforcereshapinghowhealthcareorganizationsoperate,interactwithpatientsandmanagepayments.

AI’simpactismultifaceted.TheadoptionratesamongprovidersandconsumersalikesignalagrowingtrustinAI’sabilitytoenhancehealthcaredelivery.However,thejourneyfrompilotprojectstoscalable,reliable

solutionsiscomplex.Healthcare’suniqueenvironmentmeansthatAImustbeimplementedwithcareful

attentiontosafety,explainabilityandgovernance.

ParalleltotheriseofAI,consumerexpectationsarefundamentallyalteringthepaymentlandscape.Digitalwallets,automatedpaymentsandsavedcredentials

havebecomestandardinretail,andconsumers

increasinglyexpectthesameinhealthcare.Yet,notallretailpaymentinnovationstranslateseamlesslytohealthcare.

Legacypaymentsystemsremainapersistentpainpointforbothconsumersandproviders.

Fragmentedworkflows,manualprocessesandpaper-basedstatementsslowdowncashflow,increase

administrativeburden,andfrustrateconsumers.Mostprovidersstillrelyonmanual,paper-basedmethods,whichareoutofstepwithconsumerpreferencesandcontributetodelaysandinefficiencies.

Modernizationistheclearpathforward.Thetransitiontoscalable,digitalpaymentinfrastructuresoffers

substantialbenefits.Paymentinnovationcanreducemanualeffort,acceleratecashflowandimprove

theoverallpatientexperience.Payersalsoplaya

criticalroleinthistransformation,withopportunitiestostreamlineclaimpaymentsandalignpolicies

withproviderpreferences,therebystrengthening

relationshipsandunlockingworkingcapitalacrosstheindustry.

Businessresiliencyismoreimportantthanever,

especiallyinthefaceofrisingcybersecuritythreats.Thefinancialandoperationalimpactsofcyberattacksaresubstantial,andfragmented,legacypayment

environmentsonlyincreasevulnerability.Buildingresiliencyintopaymentworkflows,controlsandtechnologychoicesisessential.

Byembracinginnovation,prioritizingconsumerand

providerneeds,andstrengtheningsecurity,healthcareorganizationscanreducefriction,improveoutcomesandbuildlastingtrust.Thefutureofhealthcare

paymentswillbedefinedbythosewhoarewillingtoadapt,investinscalablesolutionsanddeliverbetterexperiences.

20TrendsinHealthcarePayments

Methodology

TheTrendsinHealthcarePaymentsSixteenthAnnual

Reportincludesquantitativedatafrom$656billionin

healthcarepaymentsvolumeprocessedontheInstaMedNetwork.Thedatarepresentedwasprocessedbetween2022and2025.

Thereportincludesqualitativemarketdatabasedon

ananalysisofthreeInstaMedcommissionedonline

surveysconductedbyQualtrics,LLC(“Qualtrics”),an

independentexperiencemanagementandmarket

researchcompany,tobetterunderstandtheexperiencesofthekeystakeholdersinthehealthcarepayments

process.

ThedatacompiledbyQualtricsfortheProvider

HealthcarePaymentsSurvey2025comesfrom

respondentscomprisedof64%medicalpractices

orclinics,6%hospital,healthsystemorintegrated

deliverynetworks(“IDNs”),4%billingservice,

2%durable,medicalequipmentorhomemedical

equipmentsuppliersand21%othertypesofproviders.

ThedatacompiledbyQualtricsforthePayer

HealthcarePaymentsSurvey2025comesfrom

respondentscomprisedof16%nationalpayers,32%regionalpayers,32%IDNswhereahealthplanownsaproviderorganization,4%IDNswhereaproviderownsahealthplan,8%TPAs,4%Bluesplan,and4%othertypesofpayers.

ThedatacompiledbyQualtricsfortheConsumer

HealthcarePaymentsSurvey2025comesfrom

respondentswhoarearepresentativesampleofthe

UnitedStatespopulationbygender,agegroupand

race/ethnicitywhopaidamedicalbillforthemselvesoradependentandhadhealthinsurancein2025.

Forquestionswiththeoptiontoselectmorethan

oneresponse,eachanswerchoiceiscalculatedasa

standalonemetric.Thecalloutisthencalculatedbasedontheuniquenumberofrespondentswhoselectedatleastoneoftheanswerchoicesinthecallout.

21TrendsinHealthcarePayments

SOURCES

1McKinsey,TheeconomicpotentialofgenerativeAI:Thenextproductivityfrontier,June2023

2HealthAffairs,CurrentUseAndEvaluationOfArtificialIntelligenceAndPredictiveModelsInUSHospitals,January2025

3InstaMedProviderHealthcarePaymentsSurvey2025

4Aflac,WellnessMattersSurvey,January2025

5InstaMedProviderHealthcarePaymentsSurvey20