Shine a light into the dark corners of growing patient responsibility

Just last month, a colleague and I were meeting with a hospital CFO in the Rocky Mountain West about the transformation to consumer healthcare. When I asked if his revenue cycle systems were keeping up with the growth in patient responsibility, he smiled, and said, “I wish!”

“I am an experienced healthcare executive with a successful track record”, he said. “But today I feel half-blind about patient pay. Do I rely on internal staff or go to an early-out service? What kind of self-service options will work for our patients? How much financial information should we share up front?”

“We have no coherent framework for the point solutions we’ve used successfully in the past, never mind the ones we’ll need in the months ahead.”

“The bottom line”, he said, “is that I have no practical way of knowing what’s working and what isn’t. How do you manage what you can’t measure, or even see?”
When point solutions aren’t enough

There are a number of revenue cycle solutions that address one or more points in a patient’s financial journey: Eligibility, estimation, propensity-to-pay, billing, and payment services. These solutions may seem sufficient on their own, but they’re not.
What’s missing is an organizing principle. An architecture that integrates patient information from EMR and accounting systems and spans the patient experience from initial encounter through final resolution. A “backbone” capable of intelligently coordinating point solutions and processes from any source.

What is needed is a platform that weaves evidence-based intelligence into each patient’s experience to make it personal, allowing providers to see what’s working, what’s not, and what’s next.

With such tools, management could reallocate resources away from what’s not working and focus on what is. Increased efficiency and collections along with improved staff morale and patient loyalty would follow, bringing the brand and financial outcomes that go with them.

Patient revenue cycle is a different animal

Current revenue cycle solutions don’t address the patient-as-customer financial experience. They were made for institutional payers, not patients. Collecting from payers can be complicated, but for the most part it’s a predictable business-to-business transaction—not so much with patients.

Today’s patient’s financial experience starts long before most providers realize. An increasing number of patients avoid treatment or walk away from scheduled procedures at the last minute because they cannot fit their share of the cost into an already tight budget.
When patients do engage, they expect transparency and more personalized financial service from diagnosis through final payment.

By taking a comprehensive approach to financial engagement, providers can shape the patient financial experience into a more positive journey. By analyzing patient behavior and feedback, providers can develop, test, and adopt policies and practices that improve financial outcomes and burnish their brands. Increasingly today, brand matters. It will matter even more tomorrow.

The power of the platform

Health system executives often believe their point solutions are enough. I’ve convinced many to reconsider.

I begin by explaining how point solutions are incapable of generating comprehensive business intelligence without an executive function operating at their core. I ask them to think about their capacity to execute a high-performing patient pay strategy across their ecosystem. I conclude by pointing out that, without a “what’s working, what’s not, what’s next” perspective, their results are destined to come up short.

If you’re tempted to presume your point solutions meet today’s patient-pay challenge, I urge you to ask yourself the following questions:

• Do you have a practical way to track every level of your patients’ financial journey?
• Do you employ evidence-based intelligence to continually refine workflows?
• Can you identify your highest performing financial locations and determine why?
• Can you predict the likely outcome of patient revenue cycle initiatives at every setting across your operating footprint?

Measuring success in the consumer driven healthcare market

Thriving in today’s healthcare industry demands innovation. The systems we have used for decades to optimize collections from payors are failing us and our patients. Patients are worried, frustrated, and confused. By blending our best tools to deliver a holistic patient experience, we’ll finally be able to deliver financial care as personal and compassionate as our clinical care.

Dan Peterson is the Chairman and Founder of Loyale Healthcare. Loyale and its signature solution, Patient Financial Manager, are the latest and most sophisticated iterations in Mr. Peterson’s career-long pursuit of innovative financial solutions that meet the needs of providers and consumers. Previous ventures include ePAY Healthcare, a patient payment portal and CashNet, employed by colleges and universities across the U.S. Mr. Peterson continues to serve as board member for a variety of technology companies.