Creating access and engagement across the revenue cycle

In the wake of the 2019 White House Executive Order mandating price transparency,¹ many healthcare organizations have accelerated plans to enable greater cost transparency. Physician practices can substantially strengthen these plans by acknowledging that such transparency is irrevocably tied to patient experience, especially given that health insurance costs for the employed have risen more than 200% in the past 15 years.²

As patients shoulder more care costs, they want a better experience. They’re inundated with cutting-edge consumer experiences from companies such as Apple and Amazon, and while healthcare is far more complex than the typical retail exchange, these experiences are driving demand. In fact, 75% of patients research providers’ costs prior to a visit.³

Provider reputation is an increasingly important driver as well. Studies show 72% of patients use review websites to research other patients’ experiences before choosing a physician — and may use social and digital channels to gather opinions, too.⁴ As consumer use of these channels grows, an optimal patient experience is more than a survey score or component of a value-based payment performance. It’s a core part of the physician practice’s brand. A single comment such as, “I spent half an hour in the waiting room,” or “I’ve had to fill out the same paperwork three times,” can have a long-lasting, widespread effect on a practice’s reputation.

Patient demand isn’t the only reason access and engagement are important; they also have a significant effect on practice revenue. Because of patients’ greater financial responsibility, physician practices should think of them as a payer. From a bottom-line perspective, writing off self-pay dollars is no longer an option. Third-party reimbursement dollars are increasingly difficult to secure, especially due to value-based care, which intensifies the need for a patient payment strategy that educates patients regarding their financial responsibility and promotes payment in full.

For all these reasons, addressing the patient experience — including price transparency, plus patient access and engagement — will be crucial to the success and long-term growth of physician practices.

Technology’s role in patient experience

Revenue cycle technology is a major component of patient experience strategy due to the consumerization of healthcare and patients’ growing preferences for digital and self-service options. Increasing patient financial responsibility has made the front desk’s role in revenue cycle management (RCM) more important; therefore, the technology they use to determine and collect patient payments must be user friendly and able to streamline formerly tedious processes such as cost estimation. All revenue cycle teams, from the front desk to claims management and the billing office, should be able to easily share data.

Technology across the revenue cycle — including patient experience technology for cost estimation, point-of-service (POS) collections, online bill pay and payment plans — is often discrete and non-integrated. The same can be said for revenue cycle processes, which usually operate in departmental silos. Because patient experience is affected by both front and back office processes, a patient experience platform integrated with an RCM platform can be instrumental in supporting a streamlined, end-to-end patient financial flow that provides transparency and up-to-date information to both patients and staff.

Four strategies that can increase revenue and engage/satisfy patients

After decades of RCM processes that have changed very little, introducing new concepts and workflows may be met with some resistance. By following these four steps, physician practices can develop a patient experience strategy that can increase revenue and ensure patients are engaged and satisfied:

1. Develop a single integrated strategy for price transparency, patient access and patient engagement. Disparate and disconnected technology, as well as poor communication and lack of shared data, can lead to bottlenecks. Many administrative and financial aspects of patient flow were developed with staff in mind rather than the patient; therefore, making them completely patient-centric requires significant change. Developing a single strategy to address all facets of the patient experience — including patient access points, cost transparency and engagement at every point of the financial continuum — can help physician practices break down silos and create patient-centric workflows.
   For example, patient check-in and POS payment processes are especially vital to today’s physician practice, but they should be integrated with post-service billing processes.
   That single strategy should also work to ensure technology is appropriately integrated and supports best practices. Practices often use numerous systems for various processes tied to the patient experience, including scheduling appointments, generating cost estimates, collecting POS payments and setting up payment plans. Looking at these many workflows through a single lens makes it easier to identify areas that could lead to a poor patient experience.
   Many forward-thinking physician practices opt to leverage a single patient experience platform to optimize the end-to-end patient experience — addressing access, price transparency, patient payments and engagement at all points of the patient’s financial experience. An RCM system that includes a patient experience platform ensures a fully integrated workflow across the entire revenue cycle, helping staff work more efficiently and increase patient payment revenue. An integrated RCM platform can help practices address patient satisfaction goals as well as boost key performance indicators (KPIs) such as net patient revenue, patient volume and clean claim rate.
2. Provide a seamless digital experience with self-service options. A survey by Adobe Digital Insights indicates that about half of people under 35 would rather engage with a computer than a human.⁵ Moreover, while many people erroneously believe seniors aren’t avid technology users, Pew Research indicates 70% of Americans 65 and older use the internet, with about 75% of these users going online every day.⁶ Smartphone penetration in U.S. households is now nearly 75%.⁷
   The right digital patient experience platform can do more than keep patients happy and physician practices current and relevant in their patients’ eyes. It can also help integrate the front and back office, fostering streamlined workflows. For instance, when a patient who has a remaining balance schedules an appointment online, the patient experience platform can ask her if she’d like to pay off her balance. This eliminates manual work while collecting post-service dollars.
   In addition, digital patient experience platforms can eliminate administrative work further down the revenue cycle. Cost estimation technology, for example, enables staff to counsel patients regarding their care costs at the time of service or even before. This allows them to set up payment plans that enable patients to pay balances in full without any additional work from either the patient or staff.
3. Update RCM processes to be more engaging. Fifteen years ago, a practice’s front desk staff were primarily responsible for being the friendly face that registered and checked in patients. Today, they are still the friendly face — but they must also provide cost estimates, give financial counseling regarding payment options and collect payments. More responsibility often means that longtime staff members don’t feel equipped to ask for payments. If these same people must manually develop cost estimates, and if their technology for collecting payments isn’t seamless, they may feel inept, harried or burned out.
   Practices should evaluate all processes that have patient financial experience touchpoints by mapping the comprehensive financial patient flow, considering the contingencies and each patient’s choices at each step. What options does your patient have at each touch point, what processes are in place, and what technology do you currently have to support these choices?
   This exercise should help you determine what your processes should be — and what changes you must make to better support your patients. In addition, hold regular training for your front desk team and any staff that engages with patients regarding their financial responsibility.
4. Use intelligent automation across the entire revenue cycle. Through intelligent automation, digital self-service platforms can integrate key revenue cycle touchpoints such as scheduling, registration and account resolution to help optimize the revenue cycle, fostering higher collection rates and a lower number of missed appointments.
   Data-driven algorithms and artificial intelligence (A.I.) capabilities that leverage existing patient databases can help physician practices customize experiences based on each patient’s background. For example, data algorithms can be used to predict a patient’s likelihood of showing up to an appointment as well as paying the final healthcare bill. The self-service patient experience platform then can present the best appointment times or payment options available to the patient. A.I.-enabled chat bots also can be used to answer the patient’s basic questions during the registration and payment processes, which again allows front desk staff to focus on more strategic activities.
   Algorithms can also generate an estimate of the patient’s total out-of-pocket cost, as well as recommend financial assistance options to pay the final bill. Through automated workflows, practices can electronically request insurance information for each patient and use digital reimbursement modeling. This modeling enables practices to offer personalized payment plan options and financial counseling, thus helping patients better understand the cost of care, what to expect and how the practice can support them.

Delighting patients in the era of the consumer

As they develop integrated patient financial experience strategies, forward-thinking physician practices will ask the question: How can we go beyond merely satisfying patients and provide the type of financial experience that can earn their loyalty and go hand in hand with the highest quality clinical experience?

Many vendors offer technology to support individual processes within the patient financial experience. In the long run, however, an integrated patient experience platform can support a practice’s revenue and productivity goals, as well as delight patients with an engaging financial experience. The more streamlined and integrated you can make your patient experience — and the staff’s supporting processes behind the scenes — the more opportunities you’ll have to engage and satisfy patients, ultimately building your reputation, brand and patient volume.

Additional MGMA Resources:

1. Revenue Cycle Management: Don't Get Lost in The Financial Maze (book)

Notes:

1. White House. “Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First.” June 24, 2019. Available from: bit.ly/2FUXs1I.
2. Kaiser Family Foundation. “Employer Health Benefits Annual Survey Archives.” Sept. 25, 2019. Available from: bit.ly/2QWALjS.
3. TransUnion. “News Reports about a Weakening Economy Impacting How Some Patients Seek Medical Treatment.” Sept. 17, 2019. Available from: bit.ly/3a9gmzP.
4. Hedges L. “How Patients Use Online Reviews.” Software Advice. Feb. 11, 2019. Available from: bit.ly/36ZuRnF.
5. Abramovich G. “Millennials Have Higher Expectations for CX Than Older Generations.” CMO by Adobe. March 2019. Available from: adobe.ly/2NJRbu7.
6. Anderson M, Perrin A. “Tech Adoption Climbs Among Older Adults.” Pew Research Center. May 17, 2017. Available from: pewrsr.ch/38e37vB.
7. Holst A. “Smartphone in the U.S. — Statistics & Facts.” Statista. Oct. 17, 2019. Available from: bit.ly/36ZEGlx.