Patients in the U.S. Healthcare System are forced to work with archaic systems that have not kept pace with changing economics and a much more demanding healthcare consumer. Bridging the gap between what patients expect and what they actually get calls for urgent but readily achievable action.
Sometimes, the complicated gap between what patients expect from their healthcare providers and what they actually end up getting can be captured in a single, simple idea. In One Bed – One Bill, Loyale Healthcare examines patient expectations and the procedural and technical underpinnings that enable the delivery of a seamless, satisfying holistic patient experience. This is a matter of increasing importance as patients and providers both struggle to overcome the challenges presented by patients’ increased personal costs.
Today’s Patient Financial Experience is Archaic
It’s no secret that consumers of healthcare have been frustrated by their medical billing experiences for a long time. In May, 2015, PwC’s Health Research Institute published a report titled “Billing and payment for a New Health Economy”. In it, PwC analysts noted that “the nation’s healthcare billing and payment system is an artifact of an earlier age.” The report added that “Much can be done to improve the system in the short term, but in the long term, structural change is needed to compete in the New Health Economy.”
As with other analyses of the “New Health Economy”, this report focused on the patient experience. Driven by the growing influence of patients on industry economics, the report summed up what most patients would tell you they want from their medical billing experiences. From well before 2015 to today, patients want a billing experience that is convenient, transparent, affordable, reliable and seamless. And as patients wield more and more clout, their desires are becoming demands. Healthcare providers who intend to compete for today’s consumers have no choice but to comply.
Instamed, (recently acquired by J P Morgan Chase) one of the healthcare industry’s leading payment networks, issued its ninth annual Trends in Healthcare Payments Annual Report: 2018 this spring. The report recognizes “Healthcare’s Blind Spot: The Consumer Experience”, a topic Loyale Healthcare wrote about in a 2018 guest article for The Beryl Institute, the country’s leading patient experience advocacy organization.
Instamed’s research found that 70% of consumers are confused by medical bills, 50% would not be able to pay a $1,000+ medical bill and 93% were surprised by a medical bill in 2018. For payers (aka insurers), 71% of consumers were confused by their explanations of benefits (EOBs) and 72% want eStatements for premium bills (42% can’t get them). Instamed’s Chief Technology Officer, Chris Seib, is quoted in the report introduction saying, “It is clear that increased consumer responsibility is one of the most significant trends shaping the future of healthcare payments for consumers, providers and payers.”
Operating with a Consumer-Centric Lens
What does a consumer-centric patient financial engagement system look like? To meet the objectives for all stakeholders – providers, payers and patients, it conforms to the following three principles.
1. It is holistic – A patient should be able to receive one consolidated bill from all providers for an associated clinical treatment episode, no matter how complex and how many providers are involved including network, affiliated physician and other service providers.
2. It is transparent – providers should be able to holistically tell patients what their treatment will cost and what their out-of-pocket will be. Further, and just as important, it presents patients with bills that make sense and are easy to pay. One example is the Loyale Affordability Workbench™, a patient “digital front door” that makes it easy for patients to see what their care will cost in total and to explore payment options, set up payment plans and view all their bills in one clear presentation for easy online payment.
3. It responds to patient and provider preferences – Health system technology ecosystems are notoriously complex, so delivering a consumer centric financial experience depends on the system’s ability to seamlessly integrate with all the other systems affecting a patient’s care experience and financial responsibility. This integration must then adapt to variances between various provider settings and convert data that’s valuable for providers and payers while ensuring that patients’ experiences are personalized. Amazon, Apple and Zappos are consumer all-stars because they continually mine consumer data to optimize their customers’ experiences and their own financial performance.
Systems that conform to these principles give patients the confidence they need to proceed with care by demonstrating a provider’s high clinical, administrative and financial standards. Providers themselves benefit because of the improved payment behavior resulting from a more satisfying financial experience.
Making One Bed (Patient) - One Bill a Reality
Digital rendition and patient financial engagement with a consolidated bill depend on the use of open architecture technology that can integrate and interoperate with multiple source systems in all healthcare settings, including:
- Acute care settings – Epic, Cerner and others
- Ambulatory settings – Allscripts, Athenahealth, etc.
- Ambulatory Surgical Centers – Advantx (SIS), HST
- Billing Services/Platform Companies – Change Healthcare, Waystar, others
- RCM Point Solutions – TransUnion, Experian, Optum, other revenue cycle management companies (RCM ‘s)
- Early Out and Collections Services – Firms such as Parallon
- Holistic Financing Solutions - CareCredit , ClearBalance, others
- Payment Processors – First Data, Global, Worldpay, TSYS, PayPal, Apple Pay, others.
Closed ecosystem technology will never be able to achieve “One Patient - One Bill” let alone holistic patient financial engagement. By definition, closed systems reject outside data sources thereby creating holes in the patient’s overall financial experience. The rationale behind powerful captive EMR systems is a non-starter when it comes to future success in patient financial engagement.
Another Achilles Heel for closed systems is their inability to support experimentation and the use of advanced management techniques such as champion-challenger as explored by a recent Loyale article. A closed system has no challenger and therefore rarely improves in response to competitive marketplace dynamics.
Bigger Picture Marketplace Dynamics
Many hospital networks use a number of Hospital Based Specialists outsourcing partners such as Envision for emergent services (ER), anesthesia and other specialty practices. Often, these outsource partners do not have the same payer network affiliations as the contracting Healthcare Network or Hospital.
This can lead to an acute financial disconnect with patients who are surprised to learn these services are out of network. Over the long run, this practice will prove unacceptable as regulatory pressure is brought to bear and negative consumer sentiment accrues for the Healthcare Network or Hospital - which was chosen by the patient precisely because the provider was in-network. For the hospital and outsourcer, this leaves four practical options:
- Merger or Acquisition - Buy the outsourcer and bring in-network – Highly expensive
- Outsourcer – Establish in-network status with all Provider client partners – Again highly expensive and not always feasible
- Collaboration – Use an adaptive platform technology such as Loyale PFM to provide integrated One Patient – One Bill consumer value add, with transparency to alert patients when services are out-of-network
- Stand Alone Enhancement – Short of achieving One Patient – One Bill competence, adopt system and policy enhancements to improve patient financial engagement capabilities between separate Network, Hospital and outsourcer domains – Suboptimal but this at least moves the needle, especially if executed with an open architecture technology that can then move to an integrated solution when ready.
The reality is that once one-patient-one-bill is implemented, few patients in any healthcare market will accept sub-standard offerings. For those who intend to compete, the time to formulate a strategy is now.
One Bed – One Bill is here today and can be implemented using Loyale’s open platform technology. The concept embodies the same principles that companies like Apple, Amazon, Microsoft, Netflix and others have used to achieve historical success and brand loyalty. Consumers expect it. Now Healthcare must step up to deliver it.