Price Transparency
Whether it’s due to pressure from governing bodies or price-shopping health consumers, many healthcare organizations are being challenged with price transparency efforts. With so many moving parts to determine a patient’s financial liability, how can accurate patient estimates be provided in a timely manner? Giving patients the right pricing information at the right time Like many healthcare systems, Blessing Health relied on various printouts and spreadsheets of price lists from different departments of the hospital to provide patient estimates. Lists needed to be manually updated, and the staff often relied on outdated information. The process wasn’t standardized, and estimates were inconsistent across the enterprise. While Blessing wanted to make sure that patients were getting accurate information, the estimates didn’t consider a patient’s insurance information. Since patients weren’t understanding their true financial obligation, it caused frustration among patients and employees. In today’s competitive environment, it’s important to reduce instances in the patient journey that might cause irritation. A recent report from Trends in Healthcare Payments, notes that patients who are satisfied with billing are five times more likely to recommend the hospital. At a time when hospitals are being asked to do more with less and reduce the cost of care, manual processes and work must be reduced and automated with data to provide accurate information. Patient liability estimation is a complex process of calculating multiple components, not easily available to users, including insurance benefits, charges, contractual adjustments and provider discounts. If hospital staff are manually estimating the processes, they could be using outdated pricing lists which may not include application of insurance benefits, contract rates, and discounts. As consumers gain access to pricing information, health leaders should invest in data-driven technology that can provide consumers with accurate personalized estimates. Most healthcare organizations already have the basic data they need to use automated technology to construct estimates for basic services, including claims data, real-time eligibility and benefits information, payer contracts and charge description master (CDM) information. Blessing Health knew they needed to find a way to advise patients of their financial liability, as well as give staff a tool they could confidently use to request patient payments upfront to increase collections. They wanted real-time estimates that were personalized based on a patient’s insurance and contract information. To do this, Blessing Health reached out to Experian Health to integrate Patient Estimates into their Allscripts® workflow. What to look for in price estimator tools Healthcare organizations should implement price transparency and collection practices that are standardized across the enterprise. A pricing transparency tool eliminates the need for manually updating price lists, and removes the guesswork and tedious manual processes, which often result in outdated, inaccurate estimates. Price transparency software should also include reporting features that give greater control over the process and can be agile in managing transparency initiatives as well as track potential versus actual collections. A price transparency tool should highlight a patient’s financial situation, as well as their propensity to pay, allowing you to optimize your collection strategies from the start and get patients on the right programs. To help reduce traffic to call centers, a price transparency tool should be integrated into consumer-facing estimates that are personalized and available through a web portal or mobile app. Price estimation can help with patient collections Through an automated, data-driven process, Blessing Health is now able to provide personalized patient estimates that are 80 percent to 90 percent accurate. (Inaccuracies result from unexpected tests or procedures.) As a result, Blessing Health benefited from a 58 percent increase in point-of-service patient collections. Based on the cost to implement these services, Blessing Health experienced a 1,200% return on investment. After realizing success on the hospital side, Blessing Health implemented Patient Estimates for their physician group as well. — Learn more about how you can empower the patient financial experience.
Patients are paying significantly more for healthcare these days. The typical patient spent $10,739 in 2017, compared to just $355 in 1970. And the percentage of people with private insurance enrolled in high-deductible plans continues to grow, reaching about 47 percent in 2018. More than ever, patients are demanding to know upfront how much they will be paying for the services they need. Saratoga Hospital, an organization of 450 physicians and other medical professionals in Saratoga Springs, New York, was like many hospitals around the country. It was struggling to give accurate estimates for patient responsibilities. Wading through the many insurance plans and rules associated with them to figure out what is covered and how much can be a confusing and time-consuming task for hospital staffers. The sheer volume of information, various medical billing codes, and more hampered efforts to provide transparent estimates at Saratoga Hospital. To ensure patients wouldn’t be hit with costly surprise bills later, the hospital first needed to know how much patient insurance would cover for each service provided. In 2016, Saratoga Hospital began using Experian Health’s Patient Estimates, a web-based pricing transparency tool for hospitals, medical facilities, and physicians that tells patients the cost of services at a particular healthcare organization. For example, the tool combines all related charges to estimate an accurate bill for a patient\'s appointment, which might include blood tests, medicines, facility fees, and the physician\'s charge. In addition, information such as deductibles, co-pay, and co-insurance are calculated into the tool, as are financial assistance policies for patients without insurance, including discounts for prompt payments, state-mandated discounts, and payment plans. Using all of these variables makes estimating payments much easier, and it produces greater accuracy. By training its preregistration department to use the Patient Estimates tool, Saratoga Hospital could accurately estimate authorized services for patients at the point of service (or even before), streamlining price transparency requests. This proactive approach engages patients because it keeps them informed of their responsibilities and improves their overall experience and satisfaction. Addressing this aspect of medical care is essential, considering that 85 percent of adult patients are concerned with their medical costs. Saratoga Hospital staff quickly found that patients embraced the transparency because it helped them understand their financial responsibility for receiving care before stepping into the hospital. This helped them make quicker, more informed decisions. The hospital\'s staff, equipped with a more comprehensive knowledge of what patient insurance was authorized to handle, was also more confident in requesting payments for services before they were administered. The numbers at Saratoga Hospital speak for themselves: Cash collections increased by 400 percent from 2015 to 2018. As the demand for price shopping continues to grow among health consumers, price estimates can be incorporated into an online service that creates personalized estimates. At every turn, greater transparency and efficiency in the payment process benefited patients and Saratoga Hospital alike. It provided a boost and highlighted the importance to the hospital\'s preregistration department, giving staffers the necessary training to use and maintain the Patient Estimates tool properly. And implementing the tool also led to improved quality assurance, an increase of refunds, and more efficient handling of canceled appointments. To learn more about Saratoga Hospital’s experience with price transparency, click here to watch a quick video about its success and to download the case study.
