Personalizing the Patient Financial Experience of Care · Reduction in cancellations, no-shows and...

Confidential and Intellectual Property of PatientMatters® 2019

Personalizing the Patient

Financial Experience of Care

HFMA Florida

Spring Conference

May 20th, 2019


2

Meet the Moderator

Gordon Jaye

Vice President, Hospital Operations

PatientMatters


3

Meet the Panel

Michelle Farrell

Associate Vice President, Revenue Management

Orlando Health

Errno Jeannot

Director, Patient Access

John Hopkins All Children’s Hospital


▪ The Shifting Healthcare Financial Landscape

▪ Pre-Access/Service Model

▪ Using Data to Drive Outcomes

▪ Personalizing the Patient Financial Experience

▪ Questions & Answers

4

Agenda


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The Shifting Healthcare Financial Landscape

The Patient as a Consumer

Patients are taking a more proactive

approach to their healthcare as a

result of rising out-of-pocket expenses:

▪ Higher deductibles

▪ Increased medical costs

▪ Increased out-of-network fees


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5% 10% 15% 20%

35%

95% 90% 85% 80%

65%

2000 2005 2010 2015 2019

MEDICAL BILL RESPONSIBILITY

% of Patient Responsibility % of Insurance Responsibility

Source: Forbes

Healthcare Provider

Challenge

Healthcare organizations are

searching for new solutions to

meet the demands of patient

guarantors while:

▪ Wrestling for market share

▪ Competing to retain patients

▪ Seeking to differentiate by

providing a superior consumer

experience

https://www.forbes.com/sites/allbusiness/2017/06/28/what-we-can-all-do-about-rising-healthcare-costs/#3476872e2f37


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Employer-sponsored family

premium costs rise 5% to $20K avg

Nearly a quarter of insured have

a $2K or greater deductible

Nearly two-thirds of US households

have less than $1K in savings

Sources: Henry J Kaiser Family Foundation; The Tennessean

2

0

1

8

https://www.kff.org/health-costs/press-release/employer-sponsored-family-coverage-premiums-rise-5-percent-in-2018/

https://www.tennessean.com/story/money/industries/health-care/2016/03/07/why-more-than-half-hospital-bills-dont-get-paid/81297202/


1. Treat patients as consumers

2. Empower hospital registration teams with

customized, scripted patient workflows

3. Personalize the patient financial payment

model with tailored payment options

4. Implement a seamless financial clearance

process

5. Drive accountability through KPI’s and metrics

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Personalizing the Patient Financial Experience

Essential components of a personalized patient

financial experience:

Personalized Patient

Financial Experience


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Treat Patients as Consumers

Source: Medical Economics

Meeting consumer-driven expectations for

healthcare services is not as easy or obvious as it

might seem, as patients often:

▪ Have no idea what their expected financial responsibility will

be even after all care has been delivered

▪ Receive a confusing mix of bills and EOBs from multiple

entities that are complex and can be difficult to understand

▪ Are surprised by additional bills after believing their balance

has been paid

▪ Don’t understand the provider’s collection policies and

perceive they are being unreasonably targeted by the

collections team

http://www.medicaleconomics.com/medical-economics-blog/growing-financial-impact-patient-satisfaction/page/0/1


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Panel Discussion – Patient as the Consumer

▪ There are many ways to treat your patients as consumers.

What are some ways your organization has enabled this

philosophy?

▪ Do patients receive the same level of financial services across

your entire enterprise? If one were to go to your facility, will the

front-end processes one encounters be the same regardless of

service area? If it differs, why does it differ?

▪ Do you offer discounts that are exclusively available on the

front-end? For example, do you offer deeper discounts at Pre-

Access/Service and time of service versus post statement?

▪ Do your staff offer payment plans on the front-end? If so, what

are some payment options do you accept?


Implement a deep-level approach to estimation:

1. Calculate estimations down to the physician level

2. Include the estimated allowable to compare to the actual

insurance reimbursement

3. Identify and report any significant drops or changes in revenue

from month-to-month for:

‐ Estimations for specific CPT/Procedure codes to quickly identify

drop in higher dollar services

‐ Physicians ordering/performing procedure changes at your facility

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Accurate bill estimates are the cornerstone of

the perfect patient-consumer experience


13


Provide interactive, integrated and user-friendly

payment methods

Accounts Payable

P.O. Box 1230

Any Town, USA 12345

John Adams

123 Sycamore Ave

Orlando, FL 32801

Account Payable

123 Elm Street

Any Town, USA 12345

Welcome to your

Capital Health System

Patient Payment Portal

We thank you for choosing us for your

medical needs.

Use our online patient payment portal to

easily track and manage your bills online.

Your portal gives you the flexibility to

manage your payment plan and track your

charges, payments, and balances for you or

your entire household in one place.

Questions? Contact our Patient Financial

Services department at 1-888-234-5678.

Privacy Statement

Need help? Chat with a customer service representative.

Need help? Chat with a customer service representative.


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Offer a variety payment options to patients such as:


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Provide Customized Patient Workflows

Customized Workflow

Identify and implement tailored sequences of repeatable operations

that normalize the patient intake process across your system

PATIENT

▪ Predictable

experiences

▪ Educated

consumers

▪ Positive

experience

CLINICIAN

▪ Reduction in

cancellations,

no-shows and

schedule gaps

▪ Educated patient

consumers

STAFF

▪ Consistent patient

financial

conversation path

+ scripting

▪ Increased

productivity and

job satisfaction

HOSPITAL

▪ HFMA Patient Financial

Communication Adopter

Recognition Program

achievement

▪ Increased up-front

collections

▪ Improved patient

satisfaction scores


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Provide Customized Patient Workflows

Physician

creates service

order request

Referral to Pre-

Access Center

Agent contacts

patient to

schedule

service

Patient

schedule for

requested

services is set

Pre-

registration

completed and

service level

assigned

Patient

reminders

sent prior to

service date

General Pre-Access Workflow

Financial

clearance

complete


▪ Level 1: No-StopTM

Patients are fully pre-registered and cleared directly to their clinical location

▪ Level 2: Quick-StopTM

Patients are pre-registered and elect to pay in person

▪ Level 3: Full-StopTM

Patients choose not to participate and use a traditional registration and payment system at point-of-service

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Streamline Registration with Patient Navigation

Centralize your pre-access workflows based on three patient

financial clearance pathways:

Results

Rapid patient movement from pre-

access to clinical care that:

▪ Reduces patient wait times

▪ Improves overall patient

experience

▪ Enhances quality assurance

through gap analysis

▪ Increases front-end collections


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Panel Discussion - Pre-Access/Service Model

▪ What are some strategies you have implemented on the front-

end to improve patient financial education and to help improve

collections?

▪ Do you have a Pre-Access (Service) Center with dedicated staff

working to financially clear all outpatient scheduled

appointments prior to service? If not, how are you handling this

complex work?

▪ One of the biggest concerns, especially from clinical staff, is

that if a patient is informed of their cost of care and payment is

requested at Pre-Access stage, they may not follow through

with their pending services. Did you experience any significant

volume loss and if so, how did you remedy the situation? What

were some of the measures you use to identify pre-access

payment collections as the root cause?


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Personalize the Patient Financial Payment Model

When it comes to the ability to pay, each patient’s

financial situation is unique

Patient Example:

▪ Patient has a $1,200

healthcare balance

▪ Traditional approach has

patient entering into payment

plan of $100 month


Income/Expense Patient A Patient B

Income +$4,000/mo. +$800/mo.

Rent/Mortgage -$800/mo. None

Utilities -$800/mo. -$300/mo.

Car/Gas -$400/mo. None

Food -$300/mo. -$200/mo.

Other Misc. -$100/mo. -$200/mo.

Medication None -$100/mo.

Residual $1,600 $0

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Patient-Guarantor Example


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Anticipate patient-guarantor payment behavior:

▪ Analyze data from credit-reporting agencies and other financial

demographics:

‐ Guarantor Credit Score

‐ Payment History

‐ Residual Income Measurements

▪ Assess patients to identify unique payment path


22

Panel Discussion - Patient Financial Payment Model

▪ Are you using data to help better understand your patient’s

financial standing at time of engagement?

▪ Is the data your staff receives easy to understand and if so, how

do they use it?

▪ If a patient is fully financially cleared, how does the arrival/check-

in differ on day of service? Where does the patient present when

they arrive?


Assessment 16%

Assessment 234%

Assessment 327%

Assessment 418%

Assessment 515%

GUARANTOR ASSESSMENT EXAMPLE

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HOSPITAL ACTION

Assessment 5

Hold for patient payment plans

Assessment 4

Consider holding for extended

payment plans based on patient

history, process some through early-

out vendor

Assessment 3

Release to early-out vendor

Assessment 2

Release to early-out vendor;

Consider hospital charity

Assessment 1

Hospital charity program


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Implement a Seamless Financial Clearance Process

1. Define financial repayment policy for

your facility

2. Identify patient financial obligation

3. Assess financial options for each

patient

4. Communicate patient payment

options

5. Secure financial clearance at pre-

access stage


25

Drive Accountability Through Metrics

Measuring and reporting the right factors

As better indicators of

the health of your point-

of-service collections

processes, consider:

▪ Patient payment

status

▪ Captured payment

opportunities

▪ Missed payment

opportunities

Monitoring Missed Patient Payment Opportunities Allows for Improvement

This representative view of a community hospital’s patient payments shows opportunities

for patient payment improvement by monitoring missed opportunities.

% of Patients by

Payment StatusSeptember October November December

Grand

Total

Missed

Opportunity60.4% 53.7% 56.6% 65.2% 58.1%

Paid in Full 23.9% 28.9% 29.8% 21.7% 26.8%

Partial Payment 12.3% 11.2% 9.5% 8.7% 10.6%

Payment Plan 3.4% 6.2% 4.2% 4.3% 4.5%

Grand Total 100% 100% 100% 100% 100%


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Drive Accountability Through Metrics

Key questions include:

▪ What percentage of patient-payment opportunities are

captured or missed?

▪ What percentage of patients have paid in full for their

obligations prior to service?

▪ What percentage of patients have made partial payments?

▪ What percentage of patients have been put on a payment

plan?

▪ What is the patients’ ability to pay across the entire patient

population?


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Hospital Case Study

Regional Medical Center

▪ 323 inpatient bed facility combined

with numerous outpatient facilities,

urgent care clinics and specialty

clinics

▪ Serving over 13,500 inpatients and

57,000 outpatients, including nearly

nearly 1,800 newborn deliveries

and 42,000 emergency room visits

ChallengeUndefined and inefficient front-end

collections processes negatively

impacted cash flow, bad debt risk,

productivity & patient satisfaction

Solution StrategyTransform traditional registration

function into a pre-access service

center by implementing integrated,

personalized approach

ResultsIn three years, the integrated approach

yielded:

▪ POS CC increased to 38% of

opportunity from less than 5%

▪ 95% patient bill estimate accuracy

rate


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Benefits of a Personalized Financial Approach

▪ Accelerate patient payments at pre-access and beyond

▪ Reduce early-out referrals

▪ Decrease bad-debt write offs

▪ Enhance patient engagement and experience

▪ Optimize staff performance through daily KPI measurement and

monitoring

▪ Improve registration staff job satisfaction

Enhancing your organization’s technology,

workflows, performance monitoring and training

programs through personalization will:


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Panel Discussion – Challenges and Future

▪ We have talked a lot about ways your organization has

helped educate patients on their financial responsibility.

What are some strategies that your facility implemented

that didn’t work? What lessons did you learn from it?

▪ What are some initiatives you are working on right now to

help improve your patients overall financial experiences

and at the same time continue to improve patient cash

collections?


FEBRUARY 2019

Healthcare Business Today

Moving the Needle with Personalized Patient Payment Plans

JANUARY 2019

Wall Street Journal, January 6, 2019

Health Startups Take Down Data Silos That Block AI Adoption

Medical Economics, January 2, 2019

The Benefit of Flexible Patient Payment Options

NOVEMBER 2018

HFMA Revenue Cycle Strategist, November 2018

Transforming Patient Access and Engagement

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Additional Resources

https://www.healthcarebusinesstoday.com/personalized-patient-payment-plans/

https://www.wsj.com/articles/health-startups-take-down-data-silos-that-block-ai-adoption-11546783200

http://www.medicaleconomics.com/money/benefit-flexible-patient-payment-options

https://www.hfma.org/Content.aspx?id=62346

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