speeding up your revenue: personalizing your patient financial … · 2019. 2. 11. · reduction in...

Speeding Up Your Revenue:

Personalizing Your Patient Financial Experience

HFMA Texas Gulf Coast Winter InstituteFeb. 11, 2019

Confidential and Intellectual Property of PatientMatters®

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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


5Confidential and Intellectual Property of PatientMatters®


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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

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


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

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Average employer cost for

family insurance plan

is $20k per year

Average deductible

is $5K per year

Average household savings

is $1K


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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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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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

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


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



Assessment 16%

Assessment 234%

Assessment 327%

Assessment 418%

Assessment 515%

ARKANSAS 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


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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:


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


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

https://www.healthcarebusinesstoday.com/refining-the-overall-patient-financial-experience/

speeding up your revenue: personalizing your patient financial … · 2019. 2. 11. · reduction in...

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