The discussion of money is one of our most enduring social taboos. Forthright conversations centered around financial matters—from cost-of-living and college tuition to rent, raises and retirement—are neatly cordoned off by a strict social code that most of us can’t articulate a reason for beyond a vague feeling of discomfort.
This code extends to the patient-provider relationship. However, with patients bearing ever greater costs of their own care, those uncomfortable conversations have become a necessity.
What used to be electronic claims resolved by insurers, employers and the health systems far from the point of care is now a mountain of paper spilling off the kitchen table. There are a lot of words printed on those bills, EOBs and balance-due notices, but the overarching message to the patient is stark: You’re on your own.
One Unhappy Experience for Everyone
The damage this amorphous, one-size-fits-all approach to consumer finance is causing to patients, hospital margins and the overall healthcare experience is clear. Complicating matters is the fact that many health systems have discovered that their hesitance to discuss financial matters with patients is, in reality, a profound inability to do so with transparency, empathy, and clarity. As a result, there are many pathways to better health, but only one way to pay for it.
The best attributes of patient care need to extend into the financial realm. Most of the essential elements that comprise the ideal consumer financial experience—collaboration, education, consistency, engagement across multiple touchpoints—have informed successful clinical practice for years.
Rounding the Square of Experience
When we founded VisitPay in 2010, we embraced a simple mission—“We help people manage patient bills for good”—to solve one of healthcare’s most significant challenges: a needlessly convoluted and inefficient billing system that buried health systems under a mountain of bad debt and left both providers and patients deeply unsatisfied.
Part of the problem is that the average healthcare journey is a clinical experience book-ended by the financial components. It sounds straightforward, but for patients carrying large obligations, this looks more like a dark alley than a well-lighted path. How much will services cost? Is everything in-network? What are the options to make low-interest payments over time? Who can help me?
These questions are suffused with anxiety and uncertainty. Left unanswered, it’s no wonder that so many patients find delaying or forgoing care the least-worst option.
What many health system CFOs are coming to understand is that clinical and financial experiences are no longer mutually exclusive; patients increasingly view them as a single experience. Interactions in one area impacts decisions in another. Negative sentiment in the financial domain dilutes positive sentiment in the clinical domain.
For this reason, financial touchpoints must stretch across an entire healthcare journey and education and communication regarding financial options must be tailored to the specific needs and preferences of the patient.
For example, a young, healthy adult who may not have had much experience with the healthcare system may need a leg-up on the basics—i.e., how copays, coinsurance and deductibles work and need to be managed. A senior citizen may need to understand potential coverage gaps and benefit shifts when they transition from a commercial health plan to Medicare. An expectant mother may need to understand the best options for resolving medical bills in the context of all the other financial burdens that come with a new baby.
The ability to have these varied conversations requires the ability to identify the right person with the right offer at the right time, with maximum efficiency for the revenue cycle.
Fulfilling these imperatives begins with actionable data that reflects the unique needs and preferences of patients and ensures that the resulting experiences are consistent across multiple touchpoints. Data drawn from electronic health records, billing platforms and other systems of record, then structured based on desired outcomes helps create a detailed segment of the consumers, as well as their interactions, obligations, behavioral tendencies and ability to manage financial responsibilities.
Once health systems understand who the patient is and where they are in their life, financial options (the right offer) can be designed to uniquely suit their needs. This can include low-interest financial plans, discounts for prompt payment and charity care.
Knowing how and when to engage with consumers (the right time) requires collaboration among key stakeholders who traditionally have had little to do with billing operations—clinicians, front office personnel, marketing—but are essential for fostering a financial experience that makes patients feel heard and empowered within the context of a long-term patient-provider relationship.
Additionally, the revenue cycle needs to have multiple options for engaging the consumer—phone (staff serviced), text message, paid searches on Google, geo-targeting on the website, email, in-person conversations, even paper statements. The goal is to understand the individual to the point where you not only understand the best financial offer for their situation but the best way to make that offer so they are likely to respond.
Finally, the advanced technologies that personalize the revenue cycle for the individual can also help reduce the cost of running the revenue cycle. This involves putting the same tailored and dynamic information about the consumer at the fingertips of each revenue cycle employee, enabling them to intentionally prioritize channels and experiences.
From Risk to Opportunity
Healthcare is full of “fundamental shifts” that often speak more to marketing acumen than a genuine realignment. But the patient-as-payer really is a profound inflection point for our industry. The success of our technology platform with the most respected health systems in the country speaks to the maturation of the patient financial health market.
However, technology absent a larger strategic framework is inherently limited. As a result, rewiring a financial journey that works for the patient requires health systems to change how they think about experience.
We recognize that clinical and financial domains share common moments, from prevention through recovery, and from pre-service through post-visit. This is the path by which health systems can forge a comprehensive and cohesive approach to medical billing that aligns with individual clinical journeys.
The patient-as-payer era is fraught with risk, but it also offers opportunities to health systems that approach this challenge with empathy, transparency and the desire to help patients manage their bills for good.