As 40,000 health care leaders come together for HIMSS 2017, the Daily Briefing's Josh Zeitlin spoke with James Green, a National Partner with Advisory Board's Revenue Cycle Management Division, about pressing challenges everyone at the health IT conference will be talking about: how to give patients a great financial experience, how consumerism is transforming the industry, and more.
Question: James, you're someone who works on how technology like price transparency tools can improve patients' financial experience and hospitals' bottom lines. But some are skeptical that patients are actually shopping around for services. What's your response to that?
James Green: Patients in the last few years are just starting to understand that wow, I have this deductible and it's going to be coming out of my pocket.
Some organizations are starting to see consumers make conscious decisions to go to organizations that can give them visibility into what their costs are and give them experience throughout their financial journey that makes them want to come back.
Ultimately it's market-specific. Some markets are more activated than others, but when a market gets activated, there's a hockey-stick effect. It may start off slowly, but once it gets to a certain inflection point where employers are pushing high-deductible health plans on their employees, there starts to be far more shopping around.
So it won't be right for every organization to invest a ton right now in ways to improve that financial experience. But health care consumerism is going to have an effect on every market, whether it has yet or not. Everyone should have a strategy, and how quickly they implement that strategy is going to based on their market.
Q: The idea of having a strategy in place may sound great in practice, but where does an organization even begin?
Green: First, you need get a nonbiased understanding of your market. How activated is it? What do patients want? How common is it for patients to shop around and have high-deductible plans?
Where some organizations go wrong at this step is they survey their preexisting focus groups. The problem is, your focus group probably already receives your services, they come to you for a reason.
In our experience at Advisory Board of doing a lot of consumer surveys, we've found that the key is to survey our market in a nonbiased way by asking both patients who come to you and those who go to your competitors.
Once you learn more about your market, then you can figure out what you want to invest in, from technology to training, and which services you want to drive volume to.
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There's a whole host of investments you can make to improve the patient financial experience— upfront price estimators, external price estimators, authorization management software, eligibility software, bill aggregation technology, payment technologies, and on and on. Some will be right for some people, some for other people. It's ok to start smaller and scale up, but you need to do the work to know where you want to start.
Q: You mentioned using surveys to get a better idea of what patients want. Has anything particularly surprised you from the survey work Advisory Board and others have done on this?
Green: One thing I've found particularly interesting is that people will actually pay more if they have a seamless financial experience that is cohesive and simple to understand.
That may be intuitive to some, but in health care, it's kind of counterintuitive—the perception historically has been that people are looking for cheaper, the don't want to pay more for a service they can get for less.
One study that looked at this found that 74 percent of patients who had a positive financial experience with an organization—as measured by their Net Promoter Scores, which assess the degree to which patients would refer a family member or friend to a service—said they would actually pay their bill in full. By contrast, only 33 percent said they would if they had a negative financial experience. That's pretty powerful.
Members who have improved patients' financial experiences have also told us about a whole host of other benefits. Not only have their volumes gone up for services that are often fairly profitable, but many members have seen their no-show rates decline, their cost to collect go down, and their patient experience scores go up.
Q: As you've talked with organizations about their experiences implementing this technology, have they faced pushback from staff?
Green: Front-end staff who are really accountable for starting the financial journey, they really love some of this new technology that automates things like authorizations and eligibility so they'd otherwise have to do manually through spreadsheets and legwork and so forth or through legwork and all those sorts of things.
3 must-dos for a positive patient financial experience
With providers, there's a little bit of a mixed bag. Patients have stated that they want their physician to be able to give them insight into price. Some physicians don't want to be held accountable for that, and others are embracing it.
The key with providers is that you've got to make sure you are supporting them well. You need to have all the components in place so the provider has confidence they are going get this right 99% of the time.
And with all staff, it's crucial that you implement your plans with a degree of precision. A lot of organizations fall down on the implementation. You need to have an analytic system in place to be able to put metrics behind each one of the phases of the patient journey so you can measure success and hold people accountable.
Q: Are there any organizations you'd point to who are doing a particularly good job with the patient financial experience?
Green: Lots of organizations are planning it well.
In terms of implementation, Shields Healthcare Group is an example of a provider that a really thoughtful strategy. They have a patient estimator that's automated. They are doing aggregated bills.
They provide price transparency tools, they've automated lots of functions including eligibility, estimation, authorization, and medical necessity. And they have over 35 facilities across 3 different states, so they are very in tune with how technology works in various setting and in various states. Their CIO and CFO work really closely together.
Just in the past year, they've launched an iPad check-in system that preloads all information for patients, which makes the process way less of a hassle. Shields has also started giving every patient an email with a pre-service estimate and a phone call, and then afterwards they send patients a post-service bill that links back to ways to pay online.
Those kind of investments won't be right for every organization right away. But organizations need to be ready. Everybody should have a strategy right now. Everyone should be ready for their market to be activated.
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