Online or in-person, shopping in America has been transformed by the popularity and growth of eCommerce. A similar transformation is underway in healthcare. Will you be ready?
In some ways, the American healthcare industry looks a lot like the retail industry that many of us remember from the 1990s and earlier. If you wanted something, you had to go get it. Depending on how much time you had, you might take the time to travel to a couple of stores or make a few phone calls to compare prices and availability, but for the most part we were happy with what we could get from the brands we trusted and called it good. We didn’t expect much more than the product we were seeking and a little courteous service from sales staff.
Until very recently, consumers of healthcare in the U.S. had a similar kind of experience. If they felt like they needed care, they went to the provider in their health plan’s network and got what the provider offered. How much it cost wasn’t particularly important because the plan paid for most of it.
That all began to change in the 2,000s. Healthcare’s opaque pricing structure led to year after year of outsized cost increases and the introduction of high-deductible health plans by employers who were no longer able to bear the burden of the higher cost of care. As a result, average family premiums topped a record $20,000 per year in 2018, according to a Kaiser Family Foundation employer survey. Facing high deductibles and copays, suddenly patients began asking “How much will it cost?” and “How will I pay for it?”. For too many, the answers have been, “I don’t know. They won’t tell me” and “I can’t afford it.”
At the beginning of the millennium, few of us would have guessed that online shopping would soon completely transform the American retail industry. Yet, according to analysis published by Digital Commerce 360, in 2018 alone online purchases in the U.S. amounted to $517 billion, up 15% from the previous year (compared to just 3.9% overall). Perhaps more significantly, this growth in eCommerce led to the closure of 1,521 retail storefronts and accelerated industry consolidation with 21 all-retail acquisitions among companies striving to stay relevant and profitable. Any way you look at it, the business of retail has changed forever.
Transformation in Healthcare is Inevitable
A similar kind of transformation is underway in the American healthcare industry, driven largely by patients. Emboldened by difficult personal financial circumstances and enabled by rapidly advancing technologies and the emergence of new entrants like Haven Healthcare, Walgreens Health, CVS Health and others, patients are demanding more.
Patients are finding allies in state and federal government where the list of proposed legislation and regulations to control costs and improve access contains 927 different bills. Patients, who once represented a small portion of healthcare’s overall operating revenue, are now the third largest (behind only Medicare and Medicaid). As consumers, patients are finding they have a choice when it comes to where and how they get their care. For executives and strategists, patients are now a force that must be reckoned with.
According to the Top health industry issues report from PwC, “The US health industry has often lagged other industries when it comes to modernizing. Once thought to operate outside the greater US economy, the industry—with its byzantine payment system, complicated regulatory barriers and reliance on face-to-face interactions—is being disrupted. Finally, there’s robust evidence that what PwC calls the New Health Economy is kicking into gear.”
This report’s reference to the “New Health Economy”, acknowledges patients’ growing influence and their increasing willingness to break away from traditional care delivery models. The report’s authors note that “54% of consumers would be likely to try an FDA-approved app or online tool for treatment.” Additionally, it challenges providers to “Create the Southwest Airlines of healthcare”, by finding ways to serve patients who are un- or under-insured and do it profitably.
This comparison to a well-recognized consumer brand is not an accident. More than ever, healthcare providers are now in the business of winning and keeping patients and the revenue controlled by the choices patients make. One example is HCA Healthcare’s recent acquisition of 24 MedSpring urgent care centers, growing its urgent care network to 160 centers across the country. In response to increasing demand for healthcare services that are closer to where people live and work, HCA is adapting to “provide more convenient access for our patients”. Significantly, these outpatient services are also less costly for patients and providers, as studied in this recent Loyale article.
For Patients, It’s Only One Experience
Healthcare providers have made significant investments in technologies and systems to improve the quality of clinical care and comply with regulatory requirements for health information privacy, security and portability. Advanced clinical applications and the industry’s virtually universal adoption of Electronic Health Records (EHR) systems represent some of the important and beneficial outcomes of these multi-billion dollar investments.
Great as these improvements are, the industry is only now facing the fact that patients don’t measure their experiences by clinical metrics alone. To win and keep patients’ healthcare “business”, every patient touchpoint must be understood and addressed. For many, that process begins with price transparency, something the current administration and CMS have made a high priority as a means of “enabling patients to be active consumers of healthcare”.
For us at Loyale, transparency is certainly part of the picture. But delivering game-winning patient experiences calls for a much bigger picture. One that empowers healthcare providers and their teams to predictably and systematically deliver financial and administrative experiences that are on par with their clinical care. We believe that this will be the new standard by which healthcare providers are judged in the New Health Economy.
Six Ways to Engage Patients for Better Consumer and Provider Outcomes
As healthcare providers turn their attention toward patients’ experiences in dimensions other than clinical care, they are considering new ways to structure and deliver multi-dimensional care experiences that are more affordable and convenient. To compete and win in the new consumer-driven healthcare market, Loyale has learned that each of the following six elements must be present in order to remove obstacles to care and address deteriorating patient satisfaction that results from unsatisfactory nonclinical experiences.
- Full scope payment integration – A coherent, integrated bridge to make payment the outcome of engagement, not just an isolated transaction. This is characterized by automated fund distribution, full-scope tender types and technologies, refund management and electronic refunds, lowest-cost merchant routing, single-threaded control and reconciliation.
- Omni-channel engagement - Intelligent, context-sensitive communications where patients want it and/or where their behavior shows they are most responsive. Adaptable for clinical communications too: This includes virtual consolidated bills, messaging via email and mobile SMS, secure chat, fully integrable with RCM vendors.
- Open architecture – Solutions like Loyale Patient Financial Manager™ operate a single, secure hub that enables seamless interoperability between all existing and future technologies and processes for long-term durability and value: this structure facilitates integrated, unbiased vendor management, single sign-on for both clinical and financial portals.
- Affordability, for patients and providers – The Loyale Affordability Workbench™ delivers pricing and payment strategies that align with provider objectives for improved access, lower costs and better patient collections while making care more affordable for patients - all configurable by setting.
- Staff and enterprise-friendly - Process improvement tools and reporting to improve staff productivity and satisfaction and deliver best-in-breed revenue cycle decision analytics: User-friendly, provider facing functionality that gives providers visibility into behavioral patient intelligence, real-time patient experience assessments, intelligent collection workflows and enterprise analytics, all HIPAA, PCI, HITRUST, SOC2 audited.
- End to end coherence of data, process, point solutions, analytics and management for a One Bed, One Bill experience - Full integration of all systems, single source of payers’ behavioral truth, a fully controllable patient financial experience offering peerless visibility into revenue cycle vendor performance.
Loyale has been optimizing the payment behavior of consumers and patients for nearly thirty years. We were among the first to recognize the growing importance of patient choice in a changing healthcare marketplace, so we designed and engineered Loyale’s Patient Financial Engagement Platform to address each of these six patient experience imperatives. Now operating for more than 12,000 healthcare facilities across 48 states and processing more than 100,000 patient encounters daily, we’re pleased to be an important part of healthcare’s next generation.