Just published survey results paint a picture of an industry in serious financial distress, but with the lessons learned and tools acquired to overcome today’s challenges and position for long-term growth. Many of the best-practices of the COVID-19 crisis will have a lasting impact on every stakeholder in the American healthcare system for decades to come.
Over the last several months, the financial hardships faced by health systems in the United States as a result of the COVID-19 crisis have been well documented by us and many others. For many systems, the forced reduction in patient volumes and the addition of unexpected costs have had a devastating impact on balance sheets. And although patient volumes have begun to recover from their April lows, many system executives don’t expect business to look anything like usual until 2022.
But along with all this bad news, a thread of consistently good news is clearly visible throughout the healthcare industry’s response to the crisis. Since the beginning of the COVID-19 national health emergency, healthcare providers have demonstrated nimbleness, unity and innovative ingenuity in ways that would never have been explored were it not for the novel coronavirus. For us as patients, and for every other stakeholder in the American healthcare system, these newfound qualities will have a positive, lasting impact.
This uplifting interpretation is affirmed by the results of a recent survey of healthcare industry execs and finance leaders by healthcare consulting firm KaufmanHall. Their findings, titled “2020 State of Healthcare Performance Improvement Report: The Impact of COVID-19”, paint a picture of an industry that continues to reel from financial damage, but whose “ability to leverage the positive impacts of the pandemic as they work to mitigate its negative impacts will have a significant effect on their long-term health and the health of the communities they serve.”
Some of the survey respondents were interviewed. When sharing their thoughts on how the pandemic will change their organizations and, potentially, the healthcare industry, their responses fell into five qualities or categories:
- An enhanced sense of “systemness” – “the pandemic generated new levels of collaboration among the component parts of health systems”
2. A newfound nimbleness in adapting to rapid change – “One health system stood up a digital health strategy in six days. Another system set up a temporary hospital at a conference center in eight days.”
3. A realized return on investment in analytics – “the ability…to quickly pull together views of data that had not been created before, providing valuable information to inform decision-making when regular assumptions went out the window.”
4. Strengthened relationships – “how health systems within their market coordinated their response to the pandemic.” “how their relationships with schools, local and state governments, and community organizations grew even stronger, and think a long-term impact will be a better understanding of the essential role of the health system in the community.”
5. A fresh look at different payment models – “the pandemic has exposed weaknesses in a volume-driven fee-for-service model.”
The report calls out a number of health system best practice take-aways labeled “No Regrets” in the areas of Revenue and Operating Margin, Expenses and Care Delivery, many derived from – or supporting – the qualities listed above. We have followed these with our own observations about how these practices are being applied in the areas of patient payment and patient engagement.
Take-aways in the area of “Revenue and Operating Margin” each have direct relevance to patient payments and the patient’s financial experience. They include:
- Implementing proactive revenue cycle policies – “Pre-registration, pre-authorization, advance financial counseling, and point-of-service collection policies have had heightened value during the pandemic.” These capabilities clearly reside in the patient financial engagement category where their value to health systems had been thoroughly demonstrated long before the pandemic. We have written frequently about the shift of healthcare costs to patients over the last several years. As a result, many systems were already struggling to collect patient payments. The crisis, with its job losses and growing numbers of uninsured, is aggravating the problem and underscoring the importance of applying technologies, like our own Loyale Patient Financial Manager™, to deal with it.
- Building analytical capabilities – “With volumes uncertain, robust analytics are helping to monitor fluctuations in volume and predict recovery trajectories.” Analytics to uncover business intelligence in patient billing and payment behavior is proving to be vitally important to health systems. Until now, systems rarely had visibility into the complex matrix of what the industry calls patient revenue cycle. Systems now are able to leverage patient-pay analytics to reduce the cost of billing and drive continual improvement in patient payment performance.
The “No Regrets” take-aways listed in the KaufmanHall report in the area of Expenses call out health system investments that have paid off as providers responded to the unique challenges presented by the crisis. These include investments in safety for staff and patients. They also include developing relationships with domestic suppliers to overcome supply chain disruptions. One other category has relevance in the area of patient revenue cycle, redeploying staff.
- Redeploying staff – “Moving staff into new roles, although it did require some training, helped interviewees’ organizations fill critical vacancies and avoid furloughs or reductions in force.” In the area of patient financial engagement, health systems are finding that by automating labor intensive processes, expanding patient self-service and improving the productivity of personnel, staff members can be freed for higher-value patient-facing duties that improve patient satisfaction and contribute to better financial performance.
The “No Regrets” take-aways in the area of Care Delivery Models include “breaking down clinical barriers” to leverage the increased versatility revealed by the crisis, and “educating the public,” which addresses health systems’ efforts to educate the public about the pandemic and “effective preventive measures.” This kind of community-minded outreach has “eased concerns and built trust in the health system.” As healthcare providers plan for their post-COVID-19 recoveries, this trust will be vital to their efforts to reinvigorate their brands. The area with the most direct relevance to patient revenue cycle, however, is labeled “Taking a giant leap.”
- Taking a giant leap – “The pandemic forced (health systems) to take a leap into the deep end (of telehealth). Interviewees expressed pride in the ability of their organizations to adapt quickly to a new care model and confidence in the implications for rapid changes in care delivery in the future.” We have written extensively about the astounding success of telehealth during the crisis, and the opportunity this exciting new channel represents for health systems and patients alike - most recently in an article titled, “The Future for Virtual Health Care in a Consumer-Driven Marketplace.” In it, we looked to our own clients to point out that “The next phase in the development of this exciting new channel calls for holistic patient experiences that build on the remarkable accomplishments that have already been achieved.” We are convinced – and our clients’ outcomes confirm – that by integrating patients’ financial and clinical experiences throughout the care journey, all of the benefits listed above will follow.
The participants in the KaufmanHall health system survey we’ve referenced have experienced varying levels of financial disruption, with “seventy four percent extremely or moderately concerned about the financial viability of their organization in the absence of an effective vaccine or treatment.” And one third of respondents saying they “saw year-over-year operating margin declines in excess of 100% from Q2 2019 to Q2 2020.”
Speaking to the unique challenges this crisis has presented in the areas of patient volumes, expenses, workforce, telehealth and competition, each described their system’s response, noting that “one third of survey respondents believe the pandemic has affected competitive dynamics in their market by making consumers more likely to seek care at retail-based clinics.”
In our view, nearly every provider should be concerned about the growing competitive threat of retail and other alternative providers. But this is a threat that can be overcome. By upgrading patients’ experiences to include every dimension of care from beginning to end, we’re confident that health systems will complete the transformation that COVID-19 accelerated. As that vision becomes a reality across the industry, we believe the patient-provider relationship will become more satisfying and more mutually rewarding than ever. As a company, that’s what we’re aiming for.