Matt dives into a specific healthcare topic to help those in the industry, and those outside of it, better understand the market drivers causing today’s healthcare challenges.

Apps. Portals. Advisory boards. Patient councils. Health literacy programs. Branded support hubs. Market research. Access teams. Patient journey maps thick enough to stop a raccoon. Grand View Research pegs the global patient engagement solutions market at $27.63 billion in 2024, and pharma sits squarely inside the end-use category. Good. Fine. Necessary. Nowhere near enough.

During the same general era, hospitals and medical providers in Virginia filed 1.15 million lawsuits against patients to collect $1.4 billion in medical debt. Those lawsuits generated 812,948 judgments for providers, 403,924 garnishment filings, $45.9 million in court costs, and $87.1 million in attorney fees. Twenty law firms brought more than half of the medical debt collection lawsuits and more than half of the later garnishment orders. That sentence should send every patient centricity deck in America crawling under a table to think about what it has done.

Nonprofit hospitals brought 52.7% of the lawsuits. Hospitals even garnished their own workers, with researchers identifying 4,100 garnishment orders against hospitals’ own employees. Sit with that. A person clocks in to care for patients, gets sick, receives a bill she cannot verify, falls behind, and the institution that signs her paycheck reaches back through a court order to take part of it. That takes a special kind of institutional rot.

The system delivers the outcome its architects built. The question for every pharma and biotech leader sounds painfully simple. Do you have the nerve to confront what patients actually experience, or do you prefer the clean little part of the story where your brand support program looks useful?

Stanford and George Washington researchers found the pressure builds long before the courthouse. Since 2000, employer-sponsored family health insurance premiums climbed 321%. Wages climbed 123%. Hospital services climbed 276%. CPI climbed 88%. Families ran uphill while the cost machine tied cinder blocks to their ankles.

KFF reports that medical debt persists despite more than 90% of the U.S. population carrying some form of health insurance. High deductibles and other cost sharing produce bills that insured people still cannot pay. KFF also estimates 20 million adults owe medical debt, with total debt reaching at least $220 billion. Coverage without affordability hands patients a plastic card and a trapdoor.

Now the part nobody wants in the workshop breakout. A patient walks in sick. She signs paperwork under stress. She receives care without a real price. Weeks later, a bill arrives with a number she cannot verify and cannot afford. Her plan collected premiums. The provider sent the bill. The court summons names her.

That story shreds trust across the whole ecosystem. Patients rarely separate the hospital, the plan, the PBM, the drugmaker, the hub, the copay program, and the advocacy partner into clean swim lanes. Patients experience one healthcare machine. When one part of that machine takes their wages, every company standing near the machine absorbs the stink.

ELAVAY captures the stink in numbers. The 2025 report shows the industry scores well on ethics and patient commitment but stumbles on stakeholder engagement, leadership visibility, and payer alignment. Pfizer/Seagen led corporate image and reputation with a 5.92 average rating. Johnson & Johnson I.M. followed at 5.89. Bristol-Myers Squibb earned the highest average rating at 6.23 but lagged on recognition. That gap matters. Doing good work quietly helps. Doing good work visibly, consistently, and in partnership builds trust.

Virginia lawmakers passed the Medical Debt Protection Act, effective July 1, 2026. The law blocks interest and late fees for 90 days after the final invoice due date. After that, interest caps at 3% per year. The law also prohibits arrest, body attachment, foreclosure on real property, liens on personal property, and wage garnishment against patients who qualify for financial assistance. Good. Needed. Late.

The law attacks the collection machinery after the debt appears. It leaves too much of the engine running. Researchers tied many of the lawsuits to hidden prices, opaque billing, and predatory contracts, with the same procedures varying by as much as 77 times between hospitals. The law does little to fix the price confusion and billing errors at the point of care that trigger harmful debt collection in the first place. We bandage the bruise while the bat stays in the room.

Where do insurers fit? Researchers warn that rising garnishment among employed patients points to shortcomings in employer insurance products. Employers need fuller transparency across health plan spend and claims data so they can manage benefits with real prudence. Patients end up in court. The benefit design that exposed them often survives clean enough for another renewal meeting.

Now widen the lens. Pharma and biotech companies invest in patient advocacy partnerships while operating inside a system that financially wrecks the same people those partnerships claim to serve. Nobody gets to say, “We only control our molecule,” and call that a strategy. The line might survive legal review. It dies in a patient’s kitchen when a garnishment letter lands next to a grocery bill.

ELAVAY sees the same tension around payer dynamics. In 2025, advocacy organizations showed strong interest in payer engagement support while industry support lagged. The report flags a gap between organizational interest and support around payer engagement, formulary access, reimbursement pathways, and payer-specific messaging. Advocacy organizations want help where patients actually bleed time, money, and energy.

The best companies stop treating patient centricity like a campaign theme. They run it like an operating discipline.

In the 2025 ELAVAY topline results, Janssen and Pfizer/Seagen jointly led with 76 points each. Bristol-Myers Squibb followed with 52.5 points. Merck with 48. Eli Lilly with 44.5. Those scores reflect cumulative contributions across patient programs, health equity, health literacy, corporate image and reputation, and other domains. The leaders win because advocates can see the work, not because somebody sponsored a lunch and said the word community six times.

In partnerships and programs support, Janssen, Pfizer/Seagen, and Sanofi/Genzyme took the top three slots when ELAVAY weighed both response rate and quality. Janssen scored strongly in disease education and awareness, coalition support, and patient-centric insights and collaboration. Sanofi showed strength in patient financial support and advisory initiatives. Those behaviors matter because they touch the brutal practical questions patients face. What do I have? Where do I go? What will it cost? Who can help me fight the denial?

The gaps tell the real story. Advocacy organizations want more coalition support than the industry provides, with interest at 5.86 and support at 4.36. They want more patient-centric insights and collaboration, with interest at 5.56 and support at 4.36. They want more patient access support, with interest at 5.12 and support at 3.89. Nobody needs another glossy promise. They need working coalitions, better navigation, and companies that answer the damn email after launch week.

Health equity exposes the same gap. ELAVAY respondents ranked social and economic inequality, individual education, and social support networks as the top SDOH initiatives. Yet 63.37% of organizations reported no dedicated resources for health disparities and health equity. That should embarrass anyone who still thinks a heritage month graphic counts as strategy.

The sharper companies fund the unsexy stuff. Financial navigation. Plain language education. Transportation. Food insecurity. Language access. Community partnerships. State policy explainers. Payer education. They build with advocacy organizations instead of parachuting in with a pre-approved asset and a smile from procurement.

ELAVAY’s qualitative feedback points the same direction. Advocates praised companies that listen, communicate regularly, collaborate, maintain transparent communication, support nonprofit education, and align goals with patient needs. That kind of praise sounds boring until you remember how rare it feels to patients trapped in a system built on hold music and denial codes.

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Here comes the punch in the mouth.

If you lead patient advocacy, commercial strategy, medical affairs, market access, health equity, or corporate affairs, stop asking whether your organization has a patient centricity strategy. Ask whether your organization can look a sued patient in the eye and explain what it did to reduce the risk of that moment.

Did you map medical debt exposure in your patient services strategy? Did you fund advocacy organizations fighting for billing transparency? Did you build payer education tools that help patients and advocates challenge harmful benefit designs? Did you measure whether your support programs actually reduce financial strain? Did you give advocacy teams enough internal power to challenge commercial plans when those plans ignore lived reality?

Or did you build a softer story around a harder truth?

Patients do not grade us on intention. Advocates do not need another panel where someone says we need to listen better. They need proof. They need response. They need follow-through. They need companies willing to say out loud that the patient journey includes bills, debt, courtrooms, garnishment, fear, and avoidance of care.

Patient centricity dies at the courthouse door because too many organizations end their strategy at diagnosis, prescription, adherence, or brand support. The patient keeps walking. She walks into billing. She walks into plan design. She walks into a court system that turns illness into a docket number.

Follow her there, or stop using the word patient like a shield.

Take the Advocacy Influence Diagnostic if you want to measure whether your advocacy function holds real influence inside your organization at http://aid.ELAVAY.com. Request access to the 2026 ELAVAY report as it launches in May to see where your company stands in the eyes of the organizations representing your patients. Or reach out directly to [email protected] for a conversation about what the data reveals.