Price Transparency

A consumer-first healthcare revolution has been simmering for years. Despite efforts to create more human-friendly services, the industry still lags behind other consumer-centric sectors. Patients want healthcare to be simple, convenient and on-demand, but a persistent lack of coordination, accessibility and affordability leaves many struggling to navigate the healthcare landscape with ease. Is this about to change? Has COVID-19 flipped the switch?

Few of us would buy a new car or TV without checking the price tag first. Why should our healthcare be any different? Yet this is exactly what many patients are forced to do when they need medical tests or treatment. Following the breadcrumbs on a provider’s website is a time-consuming and confusing way for patients to piece together a price estimate. Even with a rough idea of the cost of care, variations in health plan pricing often bump up the final bill. The lack of transparency is stressful for patients and costly for providers, who end up chasing slow payments and losing revenue to bad debt. But could things be about to change? Many providers have been proactive in offering transparent pricing, and thanks to recent regulatory changes, this could soon be an industry-wide requirement. The CMS Price Transparency Final Rule mandates that by 1 January 2021, hospitals should publish consumer-friendly pricing information on certain ‘shoppable’ services, to help patients understand and plan their bills ahead of time. The proposed Health PRICE Transparency Act would similarly compel providers to publish real cash prices alongside rates negotiated with insurers. As households, businesses and public bodies grapple with the economic impact of COVID-19, any additional clarity around pricing that could help make a dent in healthcare-related debt is to be welcomed. Liz Serie, Director of Product Management and Patient Experience at Experian Health, says that regardless of changes to the regulatory landscape, pricing transparency is here to stay: “It’s great for the patient because they have visibility, transparency and clarity about what they owe. They can prepare financially before their visit, so they can focus on what matters most – healing. Providers are excited about price transparency tools because they let patients pick and plan payment options, reducing the total cost to collect. And with more reliable billing data, it’s a win from a decision-making perspective too.” Transparency is becoming the norm in other aspects of healthcare consumer experience, and billing should be no different. 4 steps to fast and simple patient-friendly pricing 1. Remove the guesswork with accurate, upfront pricing estimates No one wants to play detective with their deductibles. Giving patients pricing information upfront puts them in control of their payments, improving their engagement and increasing the likelihood of faster collections – a top priority for providers today as they continue to feel the effects of COVID-19 on the bottom line. A Patient Estimates tool can generate accurate, easy-to-understand estimates based on known treatment costs, payer rates and real-time benefits data. Estimates and secure payment options can be sent straight to the patient’s mobile device, improving the patient financial experience with a single text message. 2. Give patients 24/7 control through their online portal With COVID-19 pushing even more of our lives online, a 24/7 patient portal is a must for providers that want to stay competitive. Yale New Haven Health (YNHH) used PatientSimple to give patients a mobile-friendly, self-service portal through which they can generate price estimates, choose payment plans, and monitor payment information. Sharlene Seidman, Executive Director Corporate Business Services at YNHH says patients have welcomed online access: “ROI is not just tangible dollars in additional revenue, it’s patient satisfaction and improving the financial experience.” 3. Minimize delayed payments with quicker insurance checks Millions of Americans have experienced sudden job losses or changes to their insurance status in the wake of the pandemic, causing confusion about their current coverage. Payment delays and denied claims are an inevitable side-effect. Providers can help by offering fast, automated insurance eligibility verification, so patients can confirm coverage at the point of service and take the next steps with confidence. 4. Move to mobile for a more convenient patient experience Imagine if your patients could have all the information they need about their healthcare account, right there in their pocket. Patient Payment Solutions offer real-time pricing estimates based on provider pricing, payer rates and benefit information, so patients can review their bill at a time and place that suits them. There’s also the option to offer secure and contactless payment methods, so they can settle their bill at the click of a button. Estimates suggest that the average family of four could save up to $11,000 a year if they had the option to choose care on the basis of more transparent pricing. Savings on this scale mean that demand for clear information about out-of-pocket expenses is going to soar, whatever happens with price transparency regulations. Learn how Experian Health can help your organization support patients and improve collections through more transparent pricing.

The regulatory requirements for price transparency are in full effect. The Centers for Medicare and Medicaid Services (CMS) is moving forward with the OPPS Price Transparency Final Rule (CMS-1717-F2), which states that hospitals must provide transparency that will help consumers understand medical costs and make informed decisions. At this point, it is recommended that hospitals begin to form a strategy for price transparency. The concept behind price transparency is simple: provide transparency that will help consumers understand medical costs and make informed decisions. Experian Heath's commitment is simple: provide solutions that benefit the patient and the provider, that improve collections and patient satisfaction. Discover how Experian Health can help you succeed with price transparency.

With so many complexities surrounding deductibles, premiums, copays and more, consumers sometimes struggle to understand the financial components of their health plans and are often unaware of the out of pocket for their healthcare needs. Recognizing that confusion about healthcare costs can make it difficult for consumers to ask the right questions, define priorities and take a more active role in their healthcare, Silver Cross Hospital made a point to educate and provide its patient base with health care estimates prior to service being rendered. With the Self-Service Patient Estimates tool from Experian Health, patients of Silver Cross Hospital now have a consumer-friendly, easy-to-use and accessible path to obtain out of pocket cost estimates. The Self-Service Patient Estimates tool works both with the hospital’s electronic medical record (EMR) and as a standalone tool for the community to use when needed. Integrating with Silver Cross Hospital’s EMR, the solution calculates estimates based on the hospital’s charge master pricing information and payer contracted rates and utilizes each patient’s individual eligibility and benefits information to create specific out of pocket costs. The tool also allows for detailed and accurate estimate creation using historical claims data to determine the typical procedures and related charges to generate average out of pocket cost estimates by health plan. Accessible via the hospital’s website, the tool acts as a digital front door in the patient exploratory process. Patients can obtain an out-of-pocket estimate any time of day or night, and as part of the process are then connected to the next place of service, whether that be to schedule an appointment, ask additional questions or obtain more information. Since implementing Patient Estimates, Silver Cross Hospital has: Increased point of service (POS) collections by bringing more awareness and education of out of pocket costs to patients upfront Reduced inbound calls and queries to the organization regarding cost estimates Integrated the solution into scheduling and pre-registration workflows within the EMR Reduced time spent training staff on other systems or workflows Learn more about Patient Estimates and how we can help create accurate estimates of authorized services for patients before, or at the point-of-service. “Patient Estimates acts a great digital front door for Silver Cross Hospital, facilitating that first step in the patient exploratory process.” – Miguel Vigo IV, Administrator Director Revenue Cycle, Silver Cross Hospital

Medical expenses are often a source of anxiety for many patients, whether they are unsure about the amount owed or how they’ll ultimately pay for it. Unfortunately, intimidating collections processes don’t help, and a crisis like COVID-19 only exacerbates this stress. A more compassionate billing approach could help patients better navigate their financial obligations and also build long-term loyalty—a necessity for providers today looking to retain patient volume during a time of crisis. Consumers overwhelmingly want to understand the cost of healthcare services, prior to services being performed. Effective price transparency involves offering patients clear, accessible, and easy-to-understand estimates of their financial responsibility for services before they are performed. Give patients clarity from the start with precise pricing estimates and up-front info about what they’ll have to pay can reduce sticker shock, help them plan and create an overall better patient financial experience. By empowering your patients with financial expectations, their feeling of control increases, improving their engagement and the likelihood that you will collect payments faster and more efficiently. Just as you don’t provide identical medical treatment to every patient, processing all patient accounts the same way doesn’t make sense. Every patient is different. Using comprehensive data and advanced analytics, providers can better understand an individual's propensity to pay and make the payment process a positive one by assessing and assigning each patient to the appropriate financial pathway based on their unique financial situation. Medical bills are often the most direct contact providers have with patients after a service is rendered. Unfortunately, money is often a sensitive topic for patients and statements are often overwhelming and difficult for patients to read. Tailoring communications at each stage can convey compassion and increase patient satisfaction. Customizing patient statements gives providers the ability to simplify and customize bills quickly and easily, turning an often confusing process into one that adds value. Including relevant, personalized messages and educational updates can turn billing statements into a useful resource, all with the potential to drive revenue. In addition to offering personalized payment options, providers can also find out whether a patient prefers to discuss billing by phone or email. Minimizing friction at the point of payment is crucial to fostering compassionate collections. Providers should offer flexible options that include in-person, telephone, mobile and online patient portals, so they can pay in a way that’s most convenient for them. This also frees up staff to help those patients who may need a little extra help understanding their statement. Want to learn more? Check out Experian Health’s Collections Optimization Manager which helps providers segment patients based on an individual’s propensity to pay and payment preferences, informing a compassionate patient engagement strategy and improving collections.

All in, transparent pricing is an increasingly useful strategy to improve revenue alongside patient satisfaction.

Data-driven technology that automates, simplifies and unifies the revenue cycle can ensure timely communication between healthcare providers and insurers.

Experian Health acquires Mayan to evolve core revenue cycle management capabilities and enhance the patient experience with digital coordination solutions.

Data-driven technology creates a patient financial experience that is friendly, understandable and accessible, while delivering the good-faith estimates.