Exploring the journey to becoming a patient-centered organization, Loyale Healthcare and a nationwide healthcare provider client recently presented to a gathering of industry leaders in Finance, Accounting and Revenue Cycle Management. The principles this provider applied to its patient financial engagement initiative represent a proven roadmap to success for providers and for their patients.
At a recent healthcare industry event, Loyale Healthcare chairman Dan Peterson joined a Loyale client for a peer to peer presentation exploring the client’s success engaging with, and collecting from, its patients. This client’s experience offers some valuable lessons for other healthcare providers who are dealing with the transition into today’s increasingly value-based and consumer-driven healthcare marketplace.
Like other Loyale clients, our co-presenter’s company was experiencing mounting patient balances, with far too much being written off as bad debt. At the same time, trend analysis indicated that patient choice had become an increasingly important factor affecting their plans for growth (of both the top and bottom lines). Consequently, they set out to fix their patient-pay and patient engagement challenges with a systematic, highly disciplined process characterized here as the three “I”s. These “I”s represent the following key principles.
- Identify systemic inefficiencies
- Invest for short- and long-term ROI
- Investigate continually for long-term performance
Identifying systemic inefficiencies (and overcoming resistance to change)
Of all the complex systems in healthcare, revenue cycle management (RCM, the pricing, billing and collecting of balances from patients and insurers, government and private) may be the most complex of all. This complexity can create a kind of house of cards that resists change because of the downstream implications of disruption.
Fortunately, the patient-facing elements of healthcare revenue cycle, what we call patient financial engagement, can be dealt with in relative isolation without sacrificing seamless integration. This approach allows for the close analysis of patient financial experiences that lead to targeted modifications. Modifications that affect patient experiences and payment outcomes without threatening other working systems or technologies. This happens to be especially true with Loyale solutions.
Based on this principle, the company closely analyzed its patients’ financial journey. From the initial point of engagement through diagnosis, treatment, billing and finally payment in full. As a result of this analysis the company recognized a number of contributors to their underperforming patient revenue cycle systems. These included:
- Legacy technologies and vendors
- Doctors fielding complaints from patients about poor billing and payment experiences
- Accounts receivables getting lost in the system, leaving valuable revenues on the table; and
- A “clunky” collections process causing negative financial experience for patients.
Having made this assessment, the company then set out to “make the leap to a better patient engagement solution”. Importantly, the company avoided its well-worn tendency to simply reduce costs, determining instead that the surest path to success required investment that would generate operating leverage. To quote the client, “Spending money is not bad if it generates incremental earnings.”
Invest for short- and long-term ROI
After determining that additional investment was appropriate to the challenge, the company then distilled its objectives into 4 patient financial imperatives:
- Provide clear, customized communication – recognize that every patient is unique, not one-size-fits-all
- Communicate early – getting a bill weeks after treatment is one of the most negative experiences
- Reach patients on all media – 97% of the US population uses a smart phone – many for 6+ hours a day
- Remove barriers to payment – Don’t be your own worst enemy
With these outcomes in mind, the company embarked on a broad-based search of the best solutions, each chosen for excellence and for its fit within its segment. It then established a champion-challenger assessment to find the right partner. 30 vendors were evaluated to determine industry best practices and to configure the optimal suite of solutions.
Evaluation criteria centered around each solution’s ability to support the project objectives of clean, clear messaging; detailed patient balance explanations; clear calls to action for payment; secure login and HIPAA compliance; simple attractive design; and a seamless mobile and statement experience. These criteria applied to all communications media including the patient portal, text, email and online chat.
The company then established a standard dashboard to track the performance of all 30 vendors, some in head-to-head comparisons as measured against a control group. For an even more granular level of detail, this dashboard segmented patients and patient balances based on a variety of balance size and demographic criteria. It then measured ROI for each project element on a daily basis to determine which prospective partner offered the most promising prospects for long-term operating and financial performance. Naturally, we at Loyale were pleased to make the cut.
Investigate continually for long-term performance
The third in this 3-step "I" cycle, investigating calls for scrutinizing the key performance metrics established for the initiative. Just as important, however, is the importance of considering the criteria itself. The healthcare industry and the healthcare market have seen enormous changes in recent years, but that change is about to accelerate.
New entrants like Haven, the joint healthcare company formed by JP Morgan, Berkshire Hathaway and Amazon and led my renowned physician and author Atul Gawande threaten the status quo. Companies like Haven, Apple and others bring a customer-centered, technology-enabled, continually evolving set of solutions to the markets they serve. To thrive, maybe even survive, healthcare providers will need to emulate that ethic.
The ability to conduct this level of investigation demands access to data. Data that drives deep understanding of customers and operations, leading to smart decision-making that in turn drives superior operating performance. It’s this dynamic intelligence that empowers our client, powered by access to data from disparate sources and aggregated seamlessly to reveal a truth they didn’t have access to before their initiative was executed.
Using this cycle - identifying systemic inefficiencies, investing for short- and long-term ROI and investigating continually for long-term performance to identify new or other inefficiencies, this Loyale client has developed a durable, measurable protocol for success. A protocol that holds vendors and internal stakeholders accountable, generates measurably positive operating outcomes and helps ensure provider competitiveness in a market where the competition is in the early stages of transformation.
Loyale solutions prevailed in the rigorous comparisons conducted by this client because of our track record of flexibility, customer-first commitment and rapid execution. We’re grateful for the relationship, and although we were confident we would win the business, we know we’ll need to keep earning it every day. Healthcare providers who intend to succeed in the new healthcare economy should expect nothing less.