Speeding Up Your Revenue:
Personalizing Your Patient Financial Experience
HFMA Texas Gulf Coast Winter InstituteFeb. 11, 2019
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Meet the Presenter
Marcia Leighton
Executive Director, Client ServicesPatientMatters
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Agenda
▪ The Shifting Healthcare Financial Landscape
▪ Personalizing the Patient Financial Experience
▪ Hospital Case Study
▪ Question and Answer
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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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The Shifting Healthcare Financial Landscape
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The Shifting Healthcare Financial Landscape
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
searching for new solutions to
meet demands of a growing
patient/guarantor while:
▪ Wrestling for market share
▪ Competing to retain patients
▪ Seeking to differentiate by
providing a superior consumer
experience
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The Shifting Healthcare Financial Landscape
Average employer cost for
family insurance plan
is $20k per year
Average deductible
is $5K per year
Average household savings
is $1K
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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
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Treat Patients as Consumers
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
drops in higher dollar services
‐ Physicians’ ordering/performing procedure changes at your facility
Accurate bill estimates are the cornerstone of
the perfect patient-consumer experience
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Treat Patients as Consumers
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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Treat Patients as Consumers
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
conversations
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
done and
service level
assigned
Reminders
sent to patient
prior to service
date
General Pre-Access Workflow
Financial
clearance
complete
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Personalize the Patient Financial Payment Model
When it comes to 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
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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
Personalize the Patient Financial Payment Model
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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
Personalize the Patient Financial Payment Model
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Assessment 16%
Assessment 234%
Assessment 327%
Assessment 418%
Assessment 515%
ARKANSAS GUARANTOR ASSESSMENT EXAMPLE
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Personalize the Patient Financial Payment Model
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
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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
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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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Northeast Alabama
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:
▪ 24X cash collections increase
▪ 95% patient bill estimate accuracy
rate
Hospital Case Study
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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
▪ Increase HCAHPS scores
▪ Reduce registration turnover
▪ Improve registration staff job satisfaction
Enhancing your organization’s technology,
workflows, performance monitoring and training
programs through personalization will:
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JANUARY 2019
Wall Street Journal, January 6, 2019Health 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
OCTOBER 2018
Healthcare Business Today, October 2018 Refining the Overall Patient Financial Experience
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Additional Resources
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