We spoke with the organization about how they selected their automated solution, the key players involved, and results they've seen.
Pennsylvania based Allegheny Health Network (AHN) brings in $4.5 billion in annual revenues. Like many healthcare businesses, it has recently invested in the digitization of its revenue cycle, specifically the automation of patient billing.
To tackle the network's growing issue of uncoordinated bills and fragmented communications between patients, payers, and providers, they looked for a solution that would benefit providers and payers while also helping patients understand healthcare costs.
James Rohrbaugh, CFO and treasurer for AHN, explained to HealthLeaders that now that patients are shouldering more of the cost of their healthcare, not trusting the billing process and not understanding their benefits makes for a frustrating and stressful experience.
It can also cause the patient to disengage from the healthcare system, he added.
"It was clear to us that the patient billing process is broken, and that providers and payers alone can't solve the systemic challenges," Rohrbaugh said.
When brainstorming options for streamlining billing and insurance process, leaders from Highmark Health were involved in the decision-making process along with AHN staff from the communications, information technology, revenue cycle, and finance departments.
Previous strategies and technologies AHN implemented weren't curated for customer preference and, Rohrbaugh added, customer preference should be the main driver in patient-facing technology.
That's when Highmark Health and AHN partnered to implement a financial engagement platform from Cedar that improves the end-to-end journey for its patients. Patients now have a connected financial experience that integrates their payer, provider, and financial institution.
A unique element of the solution AHN chose is that they're able to integrate patient's claims data with explanation of benefits data seamlessly between Highmark and AHN.
Customer preference regarding how patients can choose how they communicate with the AHN network had previously been an area that AHN had been behind the curve on, Rohrbaugh said. The network's new tool assists with this and includes a portal where patients can choose a payment plan and access different self-service tools to meet other healthcare needs.
Once decision-makers found the patient billing solution that aligned with the AHN's goals, during the implementation process, they identified specific priority areas for the network to focus its efforts on collectively.
Testing the tool with a pilot group of patients, they measured the results to see what was and wasn't working, making the necessary adjustments to meet their objectives.
When considering an investment like this, financial leaders must consider cost and return on investment. According to Rohrbaugh, building a contract with your vendor partner where both parties share in the success, and failures, is also important.
"Ongoing tracking of the KPIs that will drive value and financial [growth] is a critical part of return on investment," he added. "I would also say having operational metrics as well, because we need to balance the financial metrics with making sure that the patient engagement and patient satisfaction is equally important."
Absence of this, he said, creates situations where people don't want to access care.
Since implementing the tool into the network's operations, AHN has seen a $17 million increase in patient payments, a 33% lift in the utilization of HSA/FSA accounts, and an 11% reduction in call center inquiries. Patients have also been satisfied with the new payment process.
“It was clear to us that the patient billing process is broken, and that providers and payers alone can’t solve the systemic challenges.”
James Rohrbaugh, CEO, treasurer, Allegheny Health Network
Jasmyne Ray is the revenue cycle editor at HealthLeaders.
With patients shouldering more of their healthcare costs and not understanding the benefits, a provider's billing process can make accessing care frustrating.
When looking at options to streamline the AHN's billing and insurance process, leaders from the network and Highmark Health were involved in the decision-making.