Healthcare Technology Insights

Consumer-Friendly Provider RCM Required for Positive Patient Experiences (Part 3 in a 3 Part Series)

January 5, 2016

Recent TripleTree blog posts have highlighted the need for innovation in patient financial responsibility and some of the technology advances required to improve payment processing in healthcare. This is the third of our three part series on the importance of the consumer in the changing paradigm of the provider revenue cycle management (RCM) landscape. Today, hospital are using innovative approaches to help ease the friction inherent in collecting balances owed from patients in a more consumer-friendly manner and reducing overall bad debt levels to more acceptable levels. Below are three approaches that can help providers on this transition:

Invest in CRM Solutions to Improve Patient Insights

Hospitals are undergoing a significant shift in thinking about “customers”, not just “patients”, and the improved service levels required to meet customer expectations. Beyond the near-term financial impact of positive patient satisfaction scores, providers realize there is substantial future economic value of patients’ good experience and the increased likelihood that they or other family members use the provider for future services. Hospitals need new, non-EMR systems to better understand their customers and have started to invest in customer relationship management (CRM) software to improve patient acquisition, retention and engagement strategies. By marketing to hospitals’ “best customers” (or those that are similar to them), providers can improve the financial profile of its patient pool. Conversely, being aware of patients with challenging financial situations or poor payment history can help a hospital manage these individuals in a more proactive manner from a RCM perspective. Without appropriate CRM systems, hospitals will struggle to derive these types of insights.

Improve Front-End RCM Intelligence to Drive Downstream Results 

Hospitals are increasingly realizing that they need to introduce the likelihood of patients’ out-of-pocket financial obligations as early as possible in their interactions with patients. Conversations about self-pay have moved up to become part of the scheduling and registration process for elective surgeries. Hospitals are increasingly focused on managing emergency department patients’ potential financial obligations in a manner that improves collections but complies with laws and does not adversely impact patient satisfaction scores. In addition, hospitals are starting to use patient payment estimation tools to better grasp patients’ future out-of-pocket financial obligations. The blending of traditional patient access / registration services with early-stage RCM services is an area where we expect to see a significant amount of innovation occur as many back-end RCM issues actually result from poor front end processes. Services augmented with RCM technologies can help improve this dynamic.

Instigate an Enhanced, Comprehensive Patient Financial Experience 

Some hospitals have recognized that for many patients, more assistance is required to enable them to understand their financial obligations. As the complexity of care increases and more providers become part of the care team, the challenge rises for patients to make sense of the barrage of medical bills that often come from different provider organizations (hospitals, physician groups, labs, etc.) with unfamiliar names. The simple question of, “What do I owe and to whom do I owe it?” quickly becomes challenging, especially when you add in payer considerations such as deductibles, out-of-network coverage, etc.

To help the most complex patients navigate these issues, some hospitals have begun to adopt concierge models where financial counselors trained in medical billing issues (both provider and payer) act as an advocate for the patient and assist them in determining which bills are acceptable to pay and which need additional insight before payment. In some instances, hospitals will offer these services across all the providers for a patient. To some degree, this may be helping competitors get paid as well, but hospitals see this as a differentiator in ensuring high-quality service and driving improved patient loyalty. Hospital billing advocate services are not new but have typically been driven by consumers (or their employers) engaging consultants to help them determine the appropriateness of charges and negotiate reduced payments. However, the emergent use of third-party concierge billing services funded by providers for the benefit of patients is a change that bears watching.

Ultimately, in order to be successful in the new consumer-friendly era of healthcare, hospitals will employ strategies that blend the “old” (legacy patient access services including eligibility determination and financial counseling with existing billing and collection practices) with the “new” (patient concierge services, patient financing alternatives, and technology to provide insight into the customer’s estimated financial responsibility, propensity to pay, and tools to make it easier for patients to do so). We will be monitoring these developments in 2016.

Let us know what you think.