Healthcare providers are developing sophisticated strategies for engaging patients as financial partners.
As consumerism rises in the healthcare industry, ensuring patients know their financial responsibilities and helping them meet those obligations is becoming an essential capability at health systems and hospitals.
Health systems and hospitals must reach out early and often to help make sure patients pay for as much of their bills as possible, says Jane Berkebile.
She is the recently retired system vice president of revenue cycle for OhioHealth in Columbus. OhioHealth reported total operating revenue at $3.3 billion in fiscal year 2015.
"We're more likely to get paid if there is … at least an expectation that there is an out-of-pocket expense and we expect the patient to pay it."
Berkebile and Corey Meyer, director of strategic acceleration at Lancaster General Health in Pennsylvania, identify five elements to patient financial engagement.
1. Emphasizing Point of Service Collections
In 2015, OhioHealth posted $22 million in POS cash collections at the health system's dozen hospitals. In 2009, the figure was $9 million.
"We stress the need for communication with patients. We set targets. We track the dollars we collect," Berkebile says.
POS cash collection is a key focus for the training and education unit within OhioHealth's revenue cycle team. The training and education unit has about nine full-time staffers, and it provides instruction to revenue-cycle team members and employees outside the department who work with patients.
"It is critical that all of our physician practices know the policies for registration, point-of-service collection, and messaging to the patient."
2. Assessing Propensity of Patients to Pay
Many low-income patients benefit from the financial counseling services offered at OhioHealth, such as Medicaid enrollment facilitation.
In Ohio, the expansion of Medicaid under the Patient Protection and Affordable Care Act has been a boost for OhioHealth and the health system's low-income patients.
"That's a benefit to the patient," she says of the access to medical services that comes with Medicaid enrollment, adding that the health system's "charity care has been cut roughly in half" since Ohio expanded Medicaid to provide coverage to more low-income adults in January 2014.
3. Providing a Positive Financial Experience for Patients
Providers who fail to focus on the financial interactions with their patients do so at increasing risk, Meyer says. "In any other industry, a bad experience with the financial transaction will send the consumer looking for an alternative. Why would healthcare be any different?"
An August 2014 survey of 500 healthcare patients shows a clear link between billing experience and financial consequences, Meyer says. It found that 74% of patients who gave their billing experience a top score paid their bills in full, compared to a 33% payment rate for patients who were less than satisfied with their billing experience.
A positive billing experience also has a major impact on patient loyalty. For patients who gave their billing experience a top score, 95% reported they would return to the same hospital for another elective medical procedure.
For patients who were less than satisfied with their billing experience, only 58% said they would return.
"We are focusing on the entire financial experience from price estimation, to properly capturing insurance information, providing easy-to-understand bills, and offering multiple payment options including online payment and self-service payment plans," Meyer says.
4. Deploying Financial Advisers
OhioHealth employs dozens of financial advocates, with at least two at the health system's smallest hospitals and as many as 10 at the largest hospitals, Berkebile says. "We can really sit down with [patients] and help them understand the responsibility."
For non-elective inpatient cases, the financial advocates meet with patients as soon as possible following estimation of payer coverage and out-of-pocket costs.
Physicians are consulted to make sure patients are fit to hold a conversation. "We begin that dialogue, and we are standardized in our scripting and messaging. We keep asking for the copay and deductible until it gets paid," Berkebile says.
5. Streamlining Financial Processes for Patients
To help make elevated patient financial responsibility financially sustainable for healthcare providers, revenue cycle teams need to establish streamlined processes for patients to follow, Meyer says.
"We need make the financial experience simpler and less overwhelming for patients. Reducing surprises by explaining insurance benefits and options up front can reduce the sticker shock and can help engage patients in their care."
Mindset is a mammoth hurdle to clear as healthcare providers conduct financial conversations with patients, he says.
"Healthcare is something that no one really wants to buy. If I need a new couch or a new car, there is excitement in the purchase. Additionally, I will do some research on the item and the costs. With healthcare, it is not something that people want to spend money on or wade through cost information."
Building an expectation of patient financial responsibility can be delicate, but it is not an entirely foreign concept, Berkebile says. "It's getting patients to understand that healthcare costs money. When I take my cats to the vet, I have my checkbook out."
Christopher Cheney is the CMO editor at HealthLeaders.