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The Journey

Transforming the Patient-Provider Experience

Written, edited and curated by Loyale founder Dan Peterson, The Journey explores ideas and innovation to enrich the patient-provider relationship

Healthcare’s Strategy for Patient Engagement & Patient Payments: If Hospitals Don’t Drive, Regulators Will

Posted by Kevin Fleming, Chief Executive Officer on Mar 12, 2019 3:51:36 PM

The trend of patient consumerism has gained a lot of steam in recent months, bolstered by administration policy proposals to force providers into more patient-friendly behavior. Successful providers must find the will to take the future into their own hands.

In recent months,  the affordability of healthcare has received unprecedented attention from regulators. Recently, two agencies operating within the Department of Health and Human Services (DHS) proposed complementary rules that would expand patient access to their personal health records and provide for unprecedented levels of price transparency.

The proposed rules from the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (OHM) are sweeping in scope, going so far as to reduce the incidence of surprise medical bills and threatening to publicize the reduced rates that are negotiated between providers and payers (insurers).  These rules reflect the DHS’ longer-term objective of improving transparency and interoperability throughout the healthcare industry by applying regulatory pressure to make the industry more consumer-friendly.

These are thorny issues for the healthcare industry’s complicated matrix of providers, payers and intermediaries. For decades, the American healthcare system has effectively hidden prices from patients. And, up until recently, most patients were fine with this arrangement because most of the costs for care were covered by the patient’s insurance company. That all changed in recent years with a historic shift in costs due to the introduction of High Deductible Health Plans.

Employers faced with year after year of above-CPI cost increases found they could not keep up with their employees’ health benefit plans’ outsized cost increases. To preserve the benefit, employers were forced to reduce the expense by shifting costs to their covered employees. As a result, millions of Americans now face out-of-pocket costs for care that would have seemed unimaginable not that long ago.

The results of the HDHP cost shift have been disappointing, if not catastrophic. Today, according to a recent survey from Westhealth Institute and NORC at the University of Chicago, “about 40 percent of Americans report skipping a recommended medical test or treatment and 44 percent say they didn’t go to a doctor when they were sick or injured in the last year because of cost.”  The same survey also observes that half of the respondents reported serious financial consequences due to the cost of healthcare.

When HDHPs were first introduced, employers and insurers explained that the plans’ revised financial structures would shrink premiums and encourage covered individuals and their families to be more cost-conscious consumers of healthcare. The problem is, patients have never had access to the kinds of information needed to make well-informed decisions about their care and its associated costs. Costs have continued to increase but instead of shopping for better value, more and more patients are forced to skip or delay care.

Patients’ financial struggles have not gone unnoticed. In a speech delivered by CMS Administrator Selma Verma in July of 2018 in regard to the state of America’s spending on healthcare, Ms. Verma pointed out that “the status quo is simply not sustainable”. She goes on to describe the steps CMS is taking to effect change, stating “This administration is guided by four pillars; empowering patients, increasing competition, realigning incentives and reducing barriers to value-driven care.” In other words, repositioning the American healthcare delivery system to look more like the rest of the economy, subject to the same competitive pressures every other business faces.

The competition is ramping up fast, motivated initially by a desire to control their own healthcare costs and quality. Most notable among these are Haven, the recently named joint venture of Amazon, JP Morgan and Berkshire Hathaway and Apple’s expanding healthcare footprint. These companies bring extraordinary technology, operational and customer-centric credentials to an industry that is ripe for disruption. And, as with the other industries these behemoths have disrupted, the change is likely to happen fast.

The scope and magnitude of these changes may cause some healthcare providers to despair, but here at Loyale Healthcare, we believe we’re on the threshold of healthcare’s golden age. We created Loyale and its signature solution, Patient Financial Manager™, to help health systems and hospitals accelerate their transition into the new healthcare economy. Our SaaS-based platform unifies disparate, disjointed systems to deliver seamless patient financial experiences from their first encounter to the day their financial obligation is fulfilled.  We enable this level of performance on an average of over 100,000 patient encounters per day and over 40 million per year. The future is here now.

Importantly, Loyale solutions go well beyond mere compliance with CMS rules to meet the longer-term objective of true consumer empowerment. In an age where healthcare provider success will be driven largely by consumer choice, Loyale Patient Financial Manager™ represents a critical component in industry’s transformation. A transformation that we believe will lead to better care, better outcomes and a more efficient model for the entire industry.

Traditional healthcare providers have an exciting opportunity. By embracing patient consumerism and taking steps now to meet market expectations, farsighted providers will seize the competitive high ground. A patient-first operating model will allow them to leverage their already firmly established reputations and brands to fend off emerging competition, grow market share and build a more sustainable business.   

Topics: healthcare consumerism, patient affordability, patient experience

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