Last year, a Kaiser Family Foundation study revealed that employer-based health insurance deductibles in the U.S. were at an average of $1,505. In 2006, the average was only $303. During this span of 11 years, the majority of responsibility for healthcare costs shifted from insurance companies to patients themselves, and many are still reeling from the sticker shock. Before consumerism and routinely high deductibles, healthcare providers focused most of their collection efforts on health insurance companies. Now, patients are a main source of providers' revenue, and some organizations are struggling to fit their old revenue cycles into the new payment landscape. However, many patients aren’t prepared for the increasingly high costs of healthcare, so they may opt to delay their care until they’ve met their deductibles at the end of the year. This creates a volatile and unpredictable revenue cycle in which organizations are slow in quarter one and quarter two and then slammed in quarter three and quarter four. Other patients could forgo medical care altogether, cutting down revenue for providers. Both scenarios contribute to a less healthy general populace and a vicious cycle in which more patients need increased care but most of them continue to hesitate or refuse it. At Experian Health, we recognize and want to bring change to this unstable healthcare climate. Our healthcare price transparency tools take sticker shock completely out of the equation by stabilizing the revenue cycle and putting transparent pricing in healthcare and payment options at the forefront. Applying consumerism to transparent pricing in healthcare Healthcare might have been a bit slow to catch up, but modern consumerism has already changed virtually every other industry. Today, consumers demand to know what they’re paying for and exactly how much before any transactions are complete. They need payment options that make their lives simpler and the ability to manage their accounts conveniently online without jumping through hoops. All of this is possible for healthcare organizations to provide, but they must be proactive in helping patients overcome the burden associated with modern healthcare costs. From financial education to flexible financing programs, any organization can improve patient satisfaction by providing transparent price information and affordable solutions upfront. With that goal in mind, Experian Health offers a variety of healthcare price transparency tools that can set your organization on the path to financial clarity, education, and advocacy: Patient Estimates A high medical bill is stressful alone, but it’s infinitely more so when the amount of the bill far exceeds what a patient expected. Price transparency is paramount to overcoming that stress. It’s also mandated in several states and will soon be in all others. With Patient Estimates, you can deliver transparent pricing in healthcare to every patient before or at the point of service. Our Patient Estimates tool automatically generates estimates based on treatment costs, payer rates, and a patient’s eligibility for benefits. The platform takes the guesswork out of the process by automatically storing and populating this information so you can provide patients with highly accurate estimates as early as possible. Patient Statements When patients know what price to expect on their medical bills, they’re more prepared to pay them. Yet if they can’t read or understand the bill, they might still delay paying it until they have time to thoroughly address any concerns. To simplify the final bill, we offer Patient Statements software that combines separate billings into one simple, easy-to-understand statement. Patient Statements not only simplifies a patient’s bill, but it also helps you turn it into a valuable engagement tool. Every statement can be personalized with educational information about the patient’s condition, links to relevant videos and websites, and marketing messages for products that can improve the patient’s quality of life. Patient Self-Service Consumers are used to going online and managing their finances from a smartphone or computer. They often choose retailers based on this availability, and soon, most will choose healthcare providers on the same basis. Giving them convenient, 24/7 access to their healthcare accounts through Patient Self-Service portals will become increasingly more important for organizations to stay competitive. An online, self-service portal allows patients to view their estimates, manage their integrated fundraising accounts, pay their bills, and stay up-to-date with changes to their healthcare. Our self-service healthcare price transparency tools are also protected by highly secure payment processing technology, so patients can be confident that their information is closely guarded every time they interact with the platform. PaymentSafe® Collecting healthcare payments requires the combined security of protected health information and a patient’s personal and financial data. Our comprehensive PaymentSafe solution makes it possible to safely and conveniently collect payments at any point in the care cycle and from any department within the organization. Every payment is automatically settled throughout the system, as well, so patients are never double-billed. PaymentSafe also applies to every type of remittance — from electronic checking and debit cards to cash, checks, and money orders. In addition to satisfying information safety compliance standards, the technology gives patients peace of mind and encourages them to be more proactive in settling their healthcare bills. Transforming your revenue cycle to make it more consumer-centric and price transparent can seem like a daunting task, especially in an industry in which every small change has resounding consequences. At Experian Health, we’ve made it our mission to make that transformation easier by helping organizations provide the healthcare price transparency tools and payment options that their patients demand.
In a new whitepaper, Technology and Data-Driven Decisions Driving Best Practices for Patient Collections, Experian Health analyzes the results of two recently fielded surveys aimed at learning how organizations approach the process of obtaining payment from patients. The paper reviews both an HFMA-led survey and an Experian Health-facilitated one, discussing the current state of patient collections, as well as emerging best practices to improve performance. While knowing that organizations are working with varying degrees of success to offer more patient-friendly financial interactions, using technology and data to inform and drive patient engagement, Experian Health wanted to understand the best practices that organizations are using to elevate performance in patient collections. Our findings were published in this HFMA whitepaper which discuss the findings from these two research projects and validate best practices and offer unique insight into the successes and shortfalls of the patient financial experience at health organizations.
Manually cold-calling patients to remind them of upcoming appointments or of bills nearing a due date has never been an effective engagement strategy. On the contrary, such reactive tactics reduce engagement quality and can harm revenue cycles. It's important to remember that real connection empowers patients to be proactive in their care and improve their own outcomes, which encourages them to keep up with future appointments and medical payments. For modern healthcare organizations, maintaining this level of high engagement requires more than the automatic actions they’ve grown used to. Instead, the overall healthcare world needs more robust patient engagement to push forward and stay relevant with patients. Without this change, organizations are more likely to encounter skipped appointments, preventable readmissions, missed payments, revenue loss on several fronts, and poor patient outcomes. Fortunately, Experian Health offers a range of solutions that make it easy to engage patients in their care, improve patient outcomes, and create more profitable revenue cycle management (RCM) throughout an entire organization. Using patient engagement technology to improve care As previously mentioned in an Experian Health blog, patient portal technology — among others — is rewiring the technological landscape and capabilities in the physician and patient relationship. Portals are used for secure messaging by 41 percent of family practice physicians, and 35 percent of physicians also use them for patient education. This type of patient engagement technology culminates in our Patient Self-Service portal, which pools together data from our Patient Estimates, Patient Statements, and Coverage Discovery tools. The portal gives patients a single point of access to request estimates, pay bills, check financial assistance eligibility, and receive advice from doctors, nurses, and specialists. The above are just a few results from elevated, proactive patient engagement. Another perk is the portal’s unique ability to automatically populate patient-specific and payer-specific information into each estimate for optimal accuracy. This feature gives patients peace of mind by knowing what their exact out-of-pocket expenses amount to. When they receive a bill that matches the estimates they’ve been budgeting for, patients are more likely to adhere to payment obligations and return to a healthcare organization for future medical needs. This also makes it easier for an organization to collect payment at point of service and throughout the rest of the patient’s care continuum. Risk stratification for more successful revenue recovery For the first time in history, there is a growing convergence of powerful, internet-connected personal devices and massive amounts of analytical, social, financial, and behavioral data tied to individual patients. Experian Health’s timely patient engagement tools allow providers to tap into this convergence to revolutionize how they engage with patients at all points throughout their care. For example, by analyzing patient-specific financial information, this engagement technology can help providers identify when patients may benefit from financial assistance, especially for upcoming treatments. In turn, the provider can send the patient information about how to request for this type of assistance through an interactive portal with accurate estimates. To help reduce readmission rates for non-critical concerns, Experian Health’s tools can also help identify when patients may need unique, targeted engagement. For instance, patients with heart conditions can benefit from information regarding diet and lifestyle changes that improve cardiovascular health. These tools help providers determine the best type of content to send and the appropriate medium to send it through, such as email, text, or app notifications, according to the patient’s specific preferences. By working together with healthcare providers, Experian Health’s solutions combine highly personalized self-service with accurate price transparency and patient-risk stratification to proactively engage with patients. You, too, can be at the forefront of improving patient outcomes and RCM strategy effectiveness by understanding the changing healthcare environment. Utilizing tools, such as a patient portal and others, can position your organization to increase patient engagement and benefit from being a forward-facing healthcare provider.
With the ability to research products, compare price information, and conduct transactions all from their mobile devices, today's consumers are more savvy than ever. They expect an unprecedented level of transparency from companies. In fact, they demand it and will easily take their money elsewhere if a company doesn't follow through. Consumers expect the same high-level transparency from healthcare providers, and the demand is growing as patients are forced to bear more out-of-pocket costs for medical care. They want to avoid surprises, such as higher-than-expected cost estimates for services or insurance that may cover only a small portion of the expense. Price transparency initiatives are becoming increasingly more important in healthcare systems, and providers must embrace new capabilities to meet patients' expectations. The old model of billing patients weeks or months after they’ve received services is no longer viable. Billing needs to move to the front of the revenue cycle management process, and a number of Experian Health's solutions are designed to help do just that. 3 tools for greater price transparency in healthcare As patients are responsible for a higher percentage of their healthcare costs, healthcare providers' financial performance depends on an optimal collections strategy that focuses on patient engagement. The advantage of patients knowing and having confidence in healthcare cost estimates makes the collections process much easier and helps drive the future revenue cycle. Here are three Experian Health solutions that can help healthcare providers improve price transparency: 1. Patient Estimates: Patient trust is built on meeting expectations. With this in mind, Experian Health's Patient Estimates tool brings accurate, upfront price transparency before or at the point of service so patients know what to expect and can confidently make decisions about their healthcare. Cost estimates are derived from numerous types of data, including a patient’s benefits information, a healthcare provider's reimbursement agreements, and payer contract rates, among others. Much of the information can be automatically populated into the system, eliminating the need to constantly update price information lists and reducing the risks of inaccurate cost estimates resulting from error. With Patient Estimates, healthcare providers can also more effectively comply with state and federal price transparency requirements. 2. Patient Statements:Accurate price information is one thing, but even if the patient’s billing statement matches the cost estimates, collections can be a challenge if the statement is hard to read or understand. Patient Statements is a communications tool that simplifies and customizes patient billing statements, complete with important, easy-to-understand updates and messages. Making billing statements straightforward for patients to manage helps healthcare providers build a stronger level of trust when it comes to payments. Personalizing the statements with marketing and educational information turns them into valuable resources that create a better overall patient engagement experience. 3. Patient Self-Service:With accurate, upfront price estimates and simple, useful bill-paying systems and statements, healthcare providers can more successfully integrate our online self-service portal. Experian Health's Patient Self-Service tool digitally delivers cost estimates and statements to patients. It also allows patients to securely make payments and conveniently schedule future appointments from their desktop or mobile devices. Patient Self-Service brings the high level of price transparency to healthcare providers that consumers now expect. This makes it more likely for patients to meet their self-pay responsibilities and return for future healthcare services. Patient Self-Service also helps healthcare providers more efficiently comply with "meaningful use" Stage 2 program requirements. The capabilities for price transparency that these solutions provide is just a small sampling of what we offer today, and we’re continuing to research and develop even more useful tools. In addition, we’ve recently launched an extensive consumer research project to better understand patients’ wants and needs. We’re excited to use these insights to continue developing solutions that help healthcare providers improve engagement with patients.
Cincinnati Children’s Hospital Medical Center (CCHMC) is a distinguished nonprofit academic medical center and one of the oldest pediatric hospitals in the United States. A few years ago, the center set out to make a much-needed change: upgrade its online bill pay system, as the current system was not popular with patients. The center kept two important objectives in mind while implementing the reboot: offering patients an attractive online experience and making it easier for patients to understand what payments they owe. Attracting patients with an intuitive bill pay system In 2012, CCHMC launched Patient Self-Service to deliver a more intuitive, comprehensive online portal. Before the launch, 900 families used the medical center’s basic online bill pay system. But after a small marketing push to promote the new option — a simple note on the center’s paper statements describing Patient Self-Service — enrollment jumped from 900 to more than 45,000 families in a single year. Plus, CCHMC saw immediate cost savings and increased revenue: The cost of distributing general notices dropped to $0. This was a significant change because mailing a notice about a new customer service phone number in the past could cost $1,400. Online payments increased from $200,000 to $800,000 per month. The medical center’s patients now use the portal to ask questions of their healthcare providers, change on-file insurance information, and schedule or revise appointments. These features reduce customer service phone calls and other related costs. In addition, the new bill pay system makes it easier for patients to clearly see and complete payments. Patients can request a cost estimate before treatment, submit payments, and set up payment plans — all online and whenever it is most convenient for them. Helping patients understand the bills they pay When CCHMC released its new self-service portal, the center also used Patient Statements to simplify and customize hard-copy bills. In the first year after the launch, the medical center saved $70,000 in invoicing costs for three reasons. First, the medical center reduced printing and mailing costs by utilizing a more attractive, interactive online bill pay system. Second, it minimized material costs by trimming invoices to a one-page statement. Lastly, the center saved on postage rates by earning the five-digit ZIP code discount. Institutions can earn a discount by bundling statements directed to the same ZIP code, thus reducing time in a postal processing center. CCHMC also combines hospital and doctor bills in a single statement that explains all treatment costs. The medical center can also add personalized messages related to each patient’s interests to foster engagement through educational opportunities, videos, microsites, and social media. Two of the most important ways a company communicates with its customers are through billing and customer service. For example, a bill pay system can give many impressions: that a company cares about its customers, doesn’t care, or, worst of all, attempts to trick its customers. It’s common to read stories about the hidden fees lurking in airline or cellphone bills. In fact, entire marketing campaigns are built around the idea — think of those “no hidden fees” commercials. Unfortunately, such instances also occur in the medical industry, which is why it is crucial to be upfront and transparent with patients. For a medical center like CCHMC, billing and customer service may rarely be in the same important spotlight as patient interactions with doctors and nurses. Still, no medical center wants to detract from its reputation by providing any kind of faulty service. CCHMC proves it cares about its patients every day by giving them an intuitive, comprehensive self-service portal and improved statements that just make sense. In the end, the hospital saved money and boosted revenue with its improvements, but it ultimately achieved much more in the overall care for its patients. To learn more about CCHMC use of Patient Self-Service to improve its bill pay system, read this case study. To see how Experian Health helps improve ROI in healthcare, view the full list of our client videos and case studies.
Yale New Haven Health is an award-winning academic healthcare system, and a big part of why its people achieve success is because they continually ask, “How can we do better?” For two years, the financial preservice team used focus groups and other feedback to learn about the financial concerns of patients and their loved ones. Then, they pursued a rigorous, tech-driven transformation to better develop estimates, identify patient payment solutions, explain billing and collections, and engage with patients. Yale New Haven Health employees and executives view patients’ financial care as an important facet of healthcare. By pairing their own dedication and know-how with Experian Health products, they’ve improved the patient experience and increased staff satisfaction. Here’s how: Create transparent, plain-language patient estimates The preservice team wanted to give patients cost estimates that were easier to understand and more accurate. Now that they’re using Eligibility, team members know exactly what procedure a patient is having and are better equipped to verify eligibility and explain the patient’s deductibles, co-insurance, and out-of-pocket expenses. For example, the team has standardized the varying (and sometimes cryptic) eligibility responses returned by hundreds of different insurance companies and other payers. Team members give patients the same clear answer — no matter how many ways payers use to describe what their plans will and won’t pay for. Find alternative payment solutions Another challenge confronting Yale New Haven Health was helping patients find ways to pay for procedures. The preservice team deployed Coverage Discovery, which can find and verify insurance coverage that patients didn’t even know they had. As patients register for their procedures, the tool searches for previously overlooked Medicare, Medicaid, and commercial insurances. Patients can sometimes avoid costly self-pay situations, and Yale New Haven Health avoids write-offs and unwarranted charity designations. Also, the preservice team is watching trends in what Coverage Discovery finds so they can spot potential problems earlier and identify payment alternatives sooner. Make it less painful to receive a bill It’s nearly impossible to achieve pain-free billing, but the confusing terms and codes found on most healthcare statements shouldn’t add to the pain. As part of its financial care transformation, Yale New Haven Health started using Patient Statements to combine hospital and physician billing into one easy-to-understand document. It even added customized messages to further explain the procedures and costs. Patients have said that they’re happy with the new design. Give patients a way to be self-sufficient Patients want an easy, digital way to evaluate options and understand what products and services cost. Healthcare is no exception. Yale New Haven Health uses Patient Self-Service to serve up a self-service portal that gives patients a greater say in their healthcare and connects them to their providers. For example, patients can set up their own payment plans (within parameters set by Yale New Haven Health). It saves time for the patients and the preservice team, which enjoys a reduced volume of customer service calls. Yale New Haven Health already had a relationship with Experian Health. It was already using Payer Alerts and Collections Optimization Manager to improve back-end revenue cycle operations. This time around, it focused on preservice processes and added Eligibility, Coverage Discovery, Patient Statements, and Patient Self-Service to its financial care system. These tools have garnered more satisfied patients, to be sure. They’ve also served as physical expressions of Yale New Haven Health’s commitment to excellence. Staff members can take greater pride in their jobs knowing they have the tools to better fulfill their patient-centered mission. A lot is said about treating the whole person instead of just the disease. By approaching financial care as an important companion to clinical care, Yale New Haven Health has discovered countless ways to answer the question “How can we do better?” Learn more about Yale New Haven Health’s patient financial care transformation. Read the case study.
Rudyard Kipling famously wrote, “Oh, East is East, and West is West, and never the twain shall meet.” That was once true of care delivery and medical payments; they were two separate departments encountered at different stages during a physician or hospital visit, and each was siloed to the activities of the other. Today, patients are avid participants in their care and are more engaged and concerned with where their healthcare dollars are spent. With that in mind, savvy providers are collaborating with patients not only on a clinical level, but also on the financial side to better navigate their options. This new approach gives patients the power to make informed financial decisions about their care, with discussions taking place prior to treatment, rather than after when an unexpected bill or lack of understanding around financial obligations can negatively impact a patient’s overall perception of their care and the organization itself. While it’s no surprise that patients are taking on greater financial responsibility for their healthcare costs due in large part to the rapid rise of high-deductible health plans, the statistics are overwhelming. In 2006, only 55 percent of covered workers had an annual deductible, which averaged $584. In 2014, according to the Kaiser Family Foundation, that deductible has more than doubled to an average of $1,217 for 80 percent of the covered workforce. When you consider that slightly over half of covered workers have an annual out-of-pocket maximum of $3,000 or more, that creates a gap that providers can’t ignore for the sake of their fiscal health, or that of their patients. At the heart of achieving better patient engagement on the financial side is accurate, real-time information. Advanced technology gives providers the ability to provide patients with a more comprehensive picture of financial information and to present them with financial options that fit their needs. Three key steps to achieving higher payments and better patient satisfaction include: 1) Be proactive – Talking to patients prior to receiving care not only results in higher patient engagement and satisfaction, it also substantially increases the amount providers can expect to collect. For example, showing online full-disclosure of billing data builds trust among patients. 2) Provide accurate estimates – Patients deserve the right to make informed decisions based upon the cost of care. For example, providers should be able to quickly – and easily – review expected costs and explain insurance coverage. Offering patients tools, such as the ability to request a real-time estimate online, gives them more control over the financial side of their healthcare. 3) Offer choices – Payment plans designed in cooperation with patients, such as the ability to set up automatic payments, not only empowers them, it improves payments and reduces administration burdens. Implementing these initiatives creates a more informed patient, which leads to a positive care experience and eases financial stressors. Patients are able to make educated choices and, if necessary, structure a payment plan that meets their needs or identify potential financial assistance programs. Providers also see benefits, such as increased patient loyalty as well as an improved revenue cycle and decreased administrative burdens when it comes to collections and follow up. Mr. East, meet Ms. West. By integrating the clinical and financial sides of healthcare, patients are more engaged with their care, leading to better health for the patient and improved financial outcomes for providers.
Meet Joe—a patient who is walking into a healthcare office, terrified of the news he might hear. He is confused and overwhelmed, not sure of where to turn for help. Joe isn’t entering a doctor’s exam room – he is actually walking into a hospital’s patient registration area, waiting to receive information about how much his procedure is going to cost. Although anxious about the procedure, Joe is even more concerned about its impact on the family budget, unsure of his insurance co-payment or what will be covered. He’s worried that he can’t afford to pay a large bill in one payment. His interactions with the registration staff over the next few minutes will set the stage for the remainder of his experience with the hospital. Now, let’s say the hospital realizes the value of having caring and compassionate financial conversations with patients at the start of the patient visit. Patient access staff quickly become the patient’s advocate while also improving the organization’s ability to collect from the patient and payer. In this instance, leveraging a data-driven approach allows staff to verify Joe’s identity and insurance coverage as well as provide an accurate estimate of his payment responsibility. The staff even can review data to assess his ability to pay and evaluate various payment plan and/or financial assistance options. Even after Joe is discharged, the hospital continues to employ a patient-centered approach to collections, using patient financial data to segment accounts that share demographic and financial profiles, rather than simply looking at balance amounts and number of days open. Joe’s financial data places his in the “most likely to pay” segment, indicating that he would not receive a payment follow up call until (for example) day 75 instead of the traditional call on day 45. This not only saves staff time and increases successful collections, it also preserves Joe’s satisfaction by eliminating unnecessary phone calls when he is likely to pay. Joe expected the hospital’s clinical staff to be responsive to his medical needs. When he found that the revenue cycle team was equally attentive to his financial needs, his satisfaction with the entire experience grew exponentially. It was fueled by a positive encounter that eased his mind about payment and allowed his to focus on his health. Using this proactive, personalized approach, the revenue cycle team had a major impact on both Joe’s experience and the bottom line. What is your healthcare organization doing to enhance the patient experience? Comment below to share some of your best practices.
There aren’t too many situations in which an individual purchases a product or service, but is NOT asked to pay for it right away. Healthcare, however, is somewhat unique in that regard, often avoiding a retail-based experience where patients receive service, but pay quite some time later, whether in full or the balance. Not surprisingly, this approach often times adversely impacts healthcare organizations in many ways. Best-case scenario, patient payments, while unpredictable, are received, but not in a timely manner and after a good deal of effort on the collections staff’s part. Worst-case scenario, the organization is left holding the proverbial bag, forced to write off bad debt, when payment could have been received if handled differently. In between, there are poor cash collections, increased revenue cycle costs and lower patient satisfaction. Organizations can avoid this perfect storm with a more precise approach to optimizing patient revenue. By leveraging tools that empower and improve upfront financial counseling communication, healthcare organizations stay one step ahead by accurately predicting patient responsibility payments and enhancing pre-service collections. When fueled by data and analytics, these tools offer a powerful two-pronged approach to minimizing risk and driving revenue: Avoid patient payment delays. Without knowing what insurance companies allow, many providers postpone collections until payer reimbursement is received. Healthcare organizations should instead have access to the latest contract terms, payment rules and fee schedules in order to identify patient and payer responsibility much earlier in the revenue cycle. Increase time-of-service collections. By proactively using patient payment data and current payer contract terms to calculate the amount owed by the patient at the time of service, organizations can effectively collect either a portion or all of that payment upfront. In the end, data-driven estimates of patient payment responsibility allow healthcare organizations to capture more revenue at the right time and boost cash flow. An added bonus is enhanced patient satisfaction because there are no confusing bills or ongoing collections calls, enabling a more personal experience for the patient. Hospitals have an opportunity to use data and analytics to improve the revenue stream and patient satisfaction. Learn about how Experian Healthcare Patient Responsibility Pricer can improve your collections on the front end of the revenue cycle and enhance the overall the patient experience.