Creating a Patient Financial Engagement Strategy

Boston-based Steward Health Care, a for-profit health system, uses a multi-layered approach to engage patients as financial partners.

A primary goal of patient financial engagement efforts should be encouraging patients to view their medical bills as a top priority, says Neville Zar, senior vice president of revenue operations at Steward Health Care.

"There is a sense of prioritization because consumers prioritize debt. So the mortgage bill, it gets paid straight away. Then the credit card gets paid. Then the question becomes, 'Am I going to pay the hospital bill or am I going to pay my cable bill? I'm going to pay my cable bill.' So medical debt goes to the bottom of the pile. It's discretionary income being used on non-discretionary services," Zar says.

"We try to approach it so that the more patients can do up front, the better."

Consistent messaging is critically important to help ensure patients keep medical bills at the top of the pile, he says. "Scripting is important for the front-line staff. You have a script that's a consistent message to patients."

Communication efficiency is also a key factor in Steward's patient financial engagement strategy, Zar says. "So, you may have two touches in an outpatient procedure. For diagnostic imaging, it really should be one call, but most providers will have somebody who will call up and do the preregistration.

Somebody else will call and say, 'We don't have the referral, so call your doctor's office and get the referral.' Someone else may call and say you owe a $50 co-pay. If you can get one call that does it all, we believe you will have better patient satisfaction."

For patients who face significant financial challenges paying for a medical service, Steward has developed a hands-on approach that includes call center representatives to help patients and their physicians work through the problem, he says.

The Delay-defer Process
"Let's say a patient has a scheduled service and either they don't have coverage or they're underinsured… We have a process, what we call delay-defer, and we do this 48 hours prior to service. We will delay the service."

"But at the end of the day," Zar says, "that's the physician's decision. So the reps on the phone aren't making the decision to delay the further service, they're saying, 'We have got to take a time out. We have got to talk to your doctor because if you need that procedure, we're going to do it.'

"In any given week, we process thousands of transactions and have 10 to 15 patients on the delay-defer list, which means we can't verify coverage or they have high out-of-pocket costs that we know they can't meet. We'll delay the further procedure and we'll create an item list. We'll contact the physician and say, 'What do you want to do?'

"If the doctor says, 'Go ahead,' then we're going ahead and we know we're going to eat that cost. But if the physician says, 'We can delay this for 30 days,' then we go back to the patient and say we're going to delay this for 30 days until we figure out what your coverage needs are; and with most of those delays, the right outcome happens from just giving you more time to figure it out."

View the complete HealthLeaders Media Roundtable report, "Engaging Patients as Financial Partners."