Showing posts with label HealthPay24. Show all posts
Showing posts with label HealthPay24. Show all posts

Monday, April 22, 2019

Healthcare Providers Take Cues from Consumer Expectations to Improve Patient Experiences

https://www.northwell.edu/

Transcript of a discussion on how healthcare providers are employing processes and technologies from such industries as retail and financial services to vastly improve the experience and quality of care from the medical patients’ perspective.

Listen to the podcast. Find it on iTunes. Download the transcript. Sponsor: HealthPay24.

Dana Gardner: Hi, this is Dana Gardner, Principal Analyst at Interarbor Solutions, and you’re listening to BriefingsDirect. Our next healthcare insights discussion explores the shift medical services providers are making to improve the overall patient experience.

Gardner
Taking a page from modern, data-driven industries that emphasize consumer satisfaction and ease, a major hospital in the New York metro area has embarked on a journey to transform healthcare-as-a-service.

To learn more about the surging importance and relevance for improving patient experiences in the healthcare sector using the many tools available to other types of businesses, we are joined by Laura Semlies, Vice President of Digital Patient Experience, at Northwell Health in metro New York, and Julie Gerdeman, President at HealthPay24 in Mechanicsburg, Penn. Welcome to you both.

What are the trends driving a makeover in the overall medical patient experience?

Semlies: The trend we’re watching is recognizing the patient as a consumer. Now, healthcare systems are even calling patients “consumers” -- and that is truly critical.


In our organization we look at [Amazon founder and CEO] Jeff Bezos’ very popular comment about having “customer obsession” -- and not “competition obsession.” In doing so, you better understand what the patient needs and what the patient wants as a consumer. Then you can begin to deliver a new experience. 

Gardner: This is a departure. It wasn't that long ago when a patient was typically on the receiving end of information and care and was almost expected to be passive. They were just off on their way after receiving treatment. Now, there’s more information and transparency up-front. What is it about the emphasis on information sharing that’s changed, and why?

Power to the patients


Semlies: A lot of it has to do with what patients experience in other industries, and they are bringing those expectations to healthcare. Almost every industry has fundamentally changed over the course of a last decade, and patients are bringing those changes and expectations into healthcare. 

Semlies
In a digital world, patients expect their data is out there and they expect us to be using it to be more transparent, more personalized, and with more curated experiences. But in healthcare we haven’t figured it out just yet -- and that’s what digital transformation in healthcare means. 

How do you take information and translate it into more meaningful and personalized services to get to the point where patients have experiences that drive better clinical outcomes?

Gardner: Healthcare then becomes more of a marketplace. Do you feel like you’re in competition? Could other providers of healthcare come in with a better patient experience and draw the patients away?

Semlies: For sure. I don’t know if that’s true in every market, but it certainly is in the market that I operate in. We live in a very competitive market in New York. The reality is if the patient is not getting the experience they want, they have choices, and they will opt for those choices. 

A recent study concluded that 2019 will be the year that patients choose who renders their care based on things that they do or do not get. Those things can range from the capability to book appointments online, to having virtual visits, to access to a patient portal with medical record information -- or all of the above. 

And those patients are going to be making those choices tomorrow. If you don’t have those capabilities to treat the patient and meet their needs -- you won't get that patient after tomorrow.

Gardner: Julie, we're seeing a transition to the healthcare patient experience similar to what we have seen in retail, where the emphasis is on an awesome experience. Where do you see the patient experience expanding next? What needs to happen to make it a more complete experience?

Gerdeman: Laura is exactly right. Patients are doing research upfront before providers interact with them, before they even call and book an appointment. Some 70 percent of patients spend that time to look at something online or make a phone call.

Competitive, clinical customer services


We’re now talking about addressing a complete experience. That means everything from up-front research, through the clinical experience, and including the financial and billing experiences. It means end-to-end, from pre-service through post-service.

Gerdeman
And that financial experience needs to be at or better than the level of experience they had clinically. Patients are judging their experience end-to-end, and it is competitive. We hear from healthcare providers who want to keep patients out of their competitors’ waiting rooms. Part of that is driving an improved experience, where the patient-as-consumer is informed and engaged throughout the process. 

Financially speaking, what does that mean? It means digital engagement -- something simple, beautiful, and mobile that’s delivered via email or text. We have to meet the consumer, whenever, and wherever they are. That could be in the evening or early in the morning on their devices. 
That’s how people live today. Those personalized and curated experiences with Google or Alexa, they want that same experience in healthcare.

Gardner: You don’t want a walk into a time machine and go back 30 to 40 years just because you go to the hospital. The same experience you can get in your living room should be there when you go to see your doctor. 

Laura, patient-centric care is complicated enough in just trying to understand the medical issues. But now we have a growing level of complexity about the finances. There are co-pays, deductibles, different kinds of insurance, and supplemental insurance. There are upfront cost estimates versus who knows what the bill is going to be in six months.

How do we fulfill the need for complete patient-centric services when we now need to include these complex financial issues, too?
Learn How to Meet Patient Demands
For Convenient Payment Options
For Healthcare Services
Semlies: One way is to segment patients based on who they are at any moment. Patients can move very quickly from a healthy state to a state of chronic disease management. Or they can go from an episode where they need very intense care to quickly being at home.
First, you need to understand where the patients’ pain points are across those different patient journeys.

Second is studying your data and looking back and analyzing it to understand what those ranges of responsibility look like. Then you can start to articulate and package those things. You have more norms to do early and targeted financial counseling.

The final part is being able to communicate, even as things change in a person’s course of treatment, and that has an impact on your financial responsibility. That kind of dialogue in our industry is almost non-existent right now.

Sharing data and dialogue


Among the first things patients look for is via searches based on their insurance carrier. Well, insurance isn’t enough. It’s not enough to know you are going to see doctor so-and-so for x with insurance plan B. You need to know far more than that to really get an accurate sense of what’s going on. Our job is to figure out how to do that for patients.

We have to get really good at figuring out how to deliver the right level of detail on information about you and what you are seeking. We need to know enough about our healthcare system, what are the costs are and what the options are so that we can engage in dialogue.

It could be a digital dialogue, but we have to engage in a dialogue. The reality is we know even in a digital situation that patients only want to share certain amount of information. But they also want accurate information. So what’s that balance? How do you achieve that? I think the next 12 to 18 months is going to be about figuring that out.

Transparency isn’t only posting a set of hospital charges; it’s just not. It’s a step in the right direction. There is now a mandate saying that transparency is important, and we all agree with that. Yet we still need meaningful transparency, which includes the ability to start to control your options and make decisions in association with a patients’ financial health goals, too.

Gardner: So, the right information, to the right person, in the right context, at the right time. To me, that means a conversation based on shared data, because without data all along the way you can’t get the context.

What is the data sharing and access story behind the patient-centric experience story?
One of the biggest problems right now is the difference between an explanation of benefits and a statement. They don't say the same thing, and are coming from two different places. It's very difficult to explain to a patient.

Semlies: If we look at the back-end of the journey, one of the biggest problems right now is the difference between an explanation of benefits and a statement. They don’t say the same thing, and they are coming from two different places. It’s very difficult to explain everything to a patient when you don’t have that explanation of benefits (EOB) in front of you. 

What we’re going to see in the next months and years -- as more collaboration is needed between payers and health systems and providers – is a new standard around how to communicate. Then we can perhaps have an independent dialogue with a patient about their responsibilities. 

But we don’t own the benefits structure. There are a lot of moving parts in there. To independently try to control that conversation across health systems, we couldn’t possibly get it right.

So one of the strategies we are pursuing is how do we work with each and every one of our health systems to try and drive innovation around data sharing and collaboration so that we can get the right answer for a shared patient. 

That “consumer” is shared between us as providers as well as the payer plan that hosts the patient. Then you need to add another layer of extra complexity around the employer population. Those three players need to be working carefully together to be able to solve this problem. It’s not going to be a single conversation.

Gardner: This need to share collaborative data across multiple organizations is a big problem. Julie, how do you see this drive for a customer-centric shared data equation playing out?

Healthy interoperability 


Gerdeman: Technology and innovation are going to drive the future of this. It's an opportunity for companies to come together. That means interoperability, whether you're a payments provider like HealthPay24, or you're providing statement information, you're providing estimates information. Across those fronts, all of that data relates to one patient. Technology and innovation can help solve these problems.

We view interoperability as the key, and we hear it all the time. Northwell and our other provider customers are asking for that transparency and interoperability. We, as part of that community, need to be interoperable and integrate in order to present data in a simple way that a consumer can understand. 

When you’re a consumer you want the information that you need at that moment to make a decision. If you can get it proactively -- all the better. Underlying all this, though, is trust. It’s something I like to talk about. Transparency is needed because there is lack of trust.

Transparency is just part of the trust equation. If you present transparency and you do it consistently, then the consumer -- the patient -- has trust. They have immediate trust when they walk into a provider or doctor’s office as a patient. Technology has an opportunity to help solve that.

Gardner: Laura, you’re often at the intercept point with patients. They are going to be asking you – the healthcare provider -- their questions. They will look to you to be the funnel into this large ecosystem behind the scenes.

What would you like to see more of from those other players in that ecosystem to make your job easier, so that you can provide that right level of trusted care upfront to the patient?

Simplify change and choice


Semlies: Collaboration and interoperability in this space are essential. We need to see more of that.

The other thing that we need -- and it's not necessarily from those players, but from the collective whole -- is a sense of modeling “if-then” situations. If this happens what will then happen?

By leveraging from such process components, we can remodel things really well and in a very sophisticated fashion. And that can work in many areas with so many choices and paths that you could take. So far, we don't do any of that in price transparency with our patients. And we need to because the boundaries are not tight.

What you charge – from copay to coinsurance – can change as you're moving from observation to inpatient, or inpatient back to observation. It changes the whole balance card for a patient. We need the capability to model that out and articulate the why, how, and when -- and then explain what the impact is. It's a very complicated conversation.

But we need to figure out all of those options along with the drivers of costs. It has to be made simple so that patients can engage, understand, and anticipate it. Then, ultimately, we can explain to them their responsibility.

I often hear that patients are slow to pay, or struggle to pay. Part of what makes them slow to pay is the confusion and complexity around all of this information. I think patients want to pay their share.

Earn patients’ trust

It’s just the complexity around this makes it difficult, and it creates a friction point that shouldn't be there. We do have a trust situation from an administrative perspective. I don't think our patients trust us in regard to the cost of their care, and to what their share of the care is. 

I don’t think they trust their insurers and payers tremendously. So we have to earn trust. And it’s going to mean that we need to be way more accurate and upfront. It’s about the basics. Did you give me a bill that I can understand? Did I have options when I went to pay it? We don’t even do that easy stuff well today.

I used to joke that we should be paying patients to pay us because we make it so difficut. We are now in a better place. We are putting in the foundation so that we can earn trust and credibility.
I used to joke that we should be paying patients to pay us because we made it so difficult. We are now in a better place. We are putting in the foundation so that we can earn trust and credibility. We are beginning the dialogue of, “What do you need as a patient?” With that information, we can go back and create the tools to engage with these patients. 

We have done more than 1,000 hours of patient focus group studies on financial health issues, along with user testing to understand what they need to feel better about their financial health. There is clinical health, there are clinical outcomes -- but there is also financial health. Those are new words to the industry.

If I had a crystal ball, I’d say we’re going to be having new conversations around what a patient needs to feel secure, that they understood what they were getting into, and that they knew about their ability to pay it or had other options, too.

Meet needs, offer options

Gerdeman: Laura made two points that I think are really important. The first is around learning, testing, and modeling -- so we can look at the space differently. That means using predictive analytics upfront in specific use cases to anticipate patient needs. What do they need, and what works? 

https://www.northwell.edu/
We can use isolated, specific use-cases to test using technology -- and learn. For example, we have offered up-front discounts for patients. If they pay in full, they get a discount. We learned that there are certain cases where you can collect more by offering a discount. That’s just one use-case, but predictive analytics, testing, and learning are the key. 

The second thing that is dead-on is around options. Patients want options. Patients want to know, “Okay, what are my choices?” If that’s an emergency situation, we don’t have the option to research it, but then soon after, what are the choices?

Most American consumers have less than $500 set aside for medical expenses. Do they have the option of a self-service and flexible payment plan? Can they get a loan? What are their choices to make an informed choice? Perhaps at home at their convenience.

Those are two examples where technology can really help play a role in the future. 

Gardner: You really can’t separate the economics from healthcare. We’re in a new era where economics and healthcare blend together, the decision-making for both of them comes together.
We talked about the need for data and how it can help collaboration and process efficiency. It also allows for looking at that data and applying analytics, learning from it, then applying those lessons back. So, it’s a really exciting time.

But I want to pause for a moment. Laura, your title of “Vice President of Digital Patient Experience” is unique. What does it take to become a Vice President of Digital Patient Experience?

Journey to self-service 

Semlies: That is a great question. The Digital Patient Experience Office at Northwell is a new organization inside of the health system. It’s not an initiative- or a program-focused office where it’s one and done, where you go in and you deliver something and then you’re done. 

We are rallying around the notion that the patient expects to be able to interact with us digitally. To do so we need to transform our entire organization -- culturally, operationally, and technically to be able accommodate that transformation. 

Before, I was responsible for revenue cycle transformation of the Northwell Health system. So I do have a financial background. However, what set me up for pursuing this digital transformation was the recognition that self-service was going to disrupt the traditional revenue cycle. We need to have a new capability around self-service that inherently allows the consumer to do what they want and need to manage their administrative interactions differently with the health system.
See the New Best Practice
Of Driving Patient Loyalty
Through Estimation
I was a constant voice for the last decade in our health system, saying, “We need to do this to our infrastructure so that we can be able to rationalize and standardize our core applications that serve the patient, including the revenue cycle systems, so that we can interoperate in a different way and create a platform by which patients can self-serve.”

And we’re still in that journey, but we’re at a point where we can begin to engage very differently. I’m working to solve three fundamental questions at the heart of the primary pain-points, or friction points, that patients have.

Patients tell us these three things: “You never remember who I am. I have been coming here for the last 10 years and you still ask me for my name, my date of birth, my insurance, my clinical history. You should know that by now.”

Two, they say, “I can't figure out how to get in to see the right doctor at the right time at the right location for me. Maybe it’s a great location for you, or a great appointment time for you. But what if it doesn't work for me? How do I fix that?”

And, third, they say, “My bills are confusing. The whole process of trying to pay a bill or get a question answered about one is infuriating.”

Whenever you talk to anyone in our health system -- whether it’s our chief patient experience officer, CEO, chief administrative officer, or COO -- those are the three things that were also coming out of customer service, Press Ganey [patient satisfaction] results, and complaints. When you have direct conversations with patients, such as through family advisory councils, the complaints weren’t about the clinical stuff.

Digital tools to ease the pain

It was all on the administrative burden that we were putting on patients, and this anonymity that patients were walking through our halls with. Those are what we needed to focus on first. And so that’s what we’re doing.

We will be bringing out a set of tools so our patients will be able to, in a very systematic way, negotiate appointment management. They will be able to view and manage their appointments online with the ability to book, change, and cancel anything that they need to. They will simply see those appointments and get directions to those appointments and communicate with those administrative officers.

The second piece of the improvement is around the, “You never remember who I am” problem, where they have been to a doctor and get the blank clipboard to fill out. Then, regardless of whether they were there yesterday or went to see a new doctor, they get the same blank clipboard.

We’re focused on getting away from the clipboard to remembering information and not seeking the same information twice -- only if there is the potential that information has changed. Instead of a blank form, we present them the opportunity to revise. And they do it remotely on their time. So we are respecting them by being truly prepared when they come to the office.
The second piece of the improvement is around the, "You never remember who I am" problem, where they have been to a doctor and get the blank clipboard to fill out. Regardless of whether they were there yesterday or go to a new doctor, they get the same blank clipboard to fill out.

The other side of “never remembering who I am” is proper authentication of digital identity. It’s not just attaching a name with the face virtually. You have to be able to authenticate so that information can be shared with the patient at home. It means being able to have digital interactions that are not superficial. 

The third piece [of our patient experience improvement drive] is the online payment portal for which we use HealthPay24. The vision is not only for patients to be able to pay one bill, but for any party that has a responsibility within the healthcare system -- whether it’s a lab, ambulance, hospital or physician – to provide the capability to all be paid in a single transaction using our digital tools. We take it one step further by giving it a retail experience, with such features as “save the card on file” so if you paid the bill last week you shouldn’t have to rekey those digits into the system. 

We plan to take it even further. For example, providing more options to pay -- whether by a loan, payment plan, or to use such services as Apple Pay and Google Pay. We believe these should be stable stakes, but we’re behind and are putting in those pieces now just to catch up. 

Our longer-term vision goes far deeper. We expect to go all the way back to the point of when patients are just beginning to seek care. How do I help them understand what their financial responsibility and options are at that point, before they even have a bill in our system? This is the early version of digital transformation.

Champion patient loyalty

Gerdeman: Everything Laura just talked about comes down to one word -- loyalty. What they are putting in place will drive patient loyalty, just like consumer loyalty. In the retail space we have seen loyalty to certain brands because of how consumers interact with them, as an emotional experience. It comes down to a combination of human elements and technology to create the raving fans, in this case, of Northwell Health.

Gardner: We have seen the digital user experience approach be very powerful in other industries. For example, when I go to my bank digitally I can see all my transactions. I know what my balances are. I can set payment schedules. If I go to my investment organization, I can see the same thing with my retirement funds. If I go to my mortgage holder, same thing. I can see what I owe on my house, and maybe I want a second property and so I can immediately initiate a new loan. It’s all there. We know that this can be done.

Julie, what needs to happen to get that same level of digital transparency and give the power to the consumer to make good choices across the healthcare sector?

Rx: Tech for improved healthcare

Gerdeman: It requires a forward-looking view into what’s possible. And we’re seeing disruption. At the recent HiMSS 2019 conference [in February in Orlando] a gathering of 45,000 people were thinking like champions of healthcare -- about what can be done and what’s possible. To me, that’s where you start. 

Like Laura said, many are playing catch-up. But we also need to be leapfrogging into the future. What emerging technologies can change the dynamic? Artificial intelligence (AI) and what’s happening there, for example. How can we better leverage predictive analytics? We’re also examining Blockchain, so what can distributed ledger do and what role can it play?

I’m really excited about what’s possible with marrying emerging technology, while still solving the nuts and bolts of interoperability and integration. There is hard work in integration and interoperability to get systems talking to one another. You can’t get away from that ugly part of the job, but then there is an exciting future part of job that I think is fundamental. 


Laura also talked about culture and cultural shift. None of it can happen without an embrace of change management. That’s also hard because there are always people and personalities. But if you can embrace change management along with the technology disruption, new things can happen.

Semlies: Julie mentioned the hard, dirty work behind the scenes. That data work is really fundamental, and that has prevented healthcare from becoming more digital. People are represented by their data in the digital space. You only know people when you understand their data.

In healthcare -- at least from a provider perspective -- we have been pretty good about collecting information about a patient’s clinical record. We understand them clinically.

We also do a pretty decent job at understanding the patient from a reimbursement and charges perspective. We can get a bill out the door and get the bill paid. Sometimes if we don’t get the bill paid, when it gets down to the secondary responsibility, we do collect that information and we get those bills out. The interaction is there. 

What we don’t do well is managing processes across hundreds of systems. There are hundreds of systems in any big healthcare system today. The bridges and connections between those data systems are just not there. So a patient often finds themselves interacting with each and every one of them.

For example, I am a patient as the mom of three kids. I am a patient as the daughter of two aging parents. I am wife to a husband who I am interacting with. And I am myself my own patient. The data that I need to deal with -- and the systems I need to interact with -- when I am booking an appointment, versus paying a bill, versus looking for lab results, versus trying to look for a growth chart on a child -- I am left to self-navigate across this world. It’s very complex and I don’t understand it as a patient. 

Our job is to figure out how to manage tomorrow and the patient of tomorrow who wants to interact digitally. We have to be able to integrate all of these different data points and make that universally accessible.

Electronic medical record (EMR) portals deal more with the clinical interactions. Some have gotten good at doing some of the administrative components, but certainly not all of them. We need to create something that is far broader and has the capability to connect the data points that live in silos today -- both operationally as well as technically. This has to be the mandate.

Open the digital front door

Gardner: You don’t necessarily build trust when you are asking the patient to be the middleware, to be the sneaker-ware, walking between the PC and the mainframe. 

Let’s talk about some examples. In order to get cultural change, one of the tried-and-true methods is to show initial progress, have a success story that you can champion. That then leads to wider adoption, and so forth. What is Northwell Health’s Digital Front Door Team? That seems an example of something that works and could be a harbinger of a larger cultural shift.

Semlies: Our Digital Front Door Team is responsible for creating tools and technology to provide a single access point for our patients. They won’t have to have multiple passwords or multiple journeys in order to interact with us.

Over the course of the last year, we've established a digital platform that all of our digital technologies and personnel connect to. That last point is really important because when a patient interacts with you digitally, there is a core expectation today that if they have told you something digitally, as soon as they show up in person, you are going to know it, use it, and remember it. The technology needs to extend the conversation or journey of experience as opposed to starting over. That was really critical for our platform to provide.
When a patient interacts with you digitally, there is a core expectation today that if they have told you something digitally, as soon as they show up, you are going to know it and use it. The technology needs to extend the conversation.

Such a platform should consist of a single sign-on (SSO) capability, an API management tool, and a customer relationship management (CRM) database, from which we can learn all of the information about a patient. The CRM data drives different kinds of experiences that can be personalized and curated, and that data lives in the middle of the two data topics we discussed earlier. We collect that data today, and the CRM tool brokers all of this so it can be in the hands of every employee in the health system. 

The last piece was to put meaningful tools around the friction points we talked about, such as for appointment management. We can see availability of a provider and book directly into it with no middleman. This is direct booking, just like when I book an appointment on OpenTable. No one has to call me back. They may just send a digital reminder.

Gardner: And how has the Digital Front Door Team worked out? Do you have any metrics of success?

Good for patients, good for providers

Semlies: We took an agile approach to implementing it. Our first component was putting in the online payment capability with HealthPay24 in July 2018. Since then, we have approximately $25 million collected. In just the last six months, there have been more than 46,000 transactions. In December, we began a sign-in benefit so patients can login and see all of their balances across Northwell. 

We had 3,000 people sign-in to that process in the first several weeks, and we’re seeing evidence that our collections are starting to go up.

We implemented our digital forms tool in September 2018. We collected more than 14,000 digital forms in the first few months. Patients are loving that capability. The next version will be an at-home version so you will get text messages saying, “We see you have booked an appointment. Here are your forms to prepare for your visit.” They can get them all online. 

We are also piloting biometrics so that when you first show up at your appointment you will have the opportunity to have your picture taken. It’s iris-scanning and deep facial recognition technology so that will be the method of authentication. That will also be used more over time for self check-ins and eventually to access the ultimate portal. 

The intent was to deploy as early as there was value to the patient. Then over time all of those services will be connected as a single experience. Next to come are improved appointment management with the capability to book appointments online, as well as to change, manage, see all appointments via a connection to the patient portal.

All of those connection points will be rendered through the same single sign-in by the end of this quarter, both on our website, https://www.northwell.edu/, and via a proprietary mobile app that will come out in the app stores.

Gardner: Those metrics and rapid adoption show that a good patient experience isn’t just good for the patient -- it’s good for the provider and across the entire process. Julie, is Northwell Health unique in providing the digital front door approach?

Gerdeman: We are seeing more healthcare providers adopt this approach, with one point of access into their systems, whether you are finding a doctor or paying a bill. We have seen in our studies that seven out 10 patients only go to a provider’s website to pay a bill. 

From a financial perspective, we are working hard with leaders like Laura whose new roles support the digital patient experience. Creating that experience drives adoption, and that adoption drives improved collections.

Ease-of-use entertains and retains clients

Semlies: This channel is extremely important to us from a patient loyalty and retention perspective. It’s our opportunity to say, “We have heard you. We have an obligation to provide you tools that are convenient, easy to use, and, quite frankly, delight you.”

But the portal is not the only channel. We recognize that we have to be in lots of different places from the adoption perspective. The portal is not the only place every patient is going. There will be opportunities for us to populate what I refer to as the book-now button. And the book-now button cannot be exclusive to the Northwell digital front door.
View More Provider Success Stories
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I need to have that book-now button in the hands of every payer agent who is on the phone talking to a patient or in their digital channel or membership. I need to have it out in the Zocdocs of the world, and in any other open scheduling application out there. 

I need to have ratings and reviews. We need to be multichannel in our funnel in, but once we get you in we have to give you tools and resources that surprise and delight you and make that re-engagement with somebody else harder because we make it so easy for you to use our health system. 

And we have to be portable so you can take it with you if you need to go somewhere. The concept is that we have to be full service, and we want to give you all of the tools so you can be happy about the service you are getting -- not just the clinical outcome but the administrative service, too.

Gardner: It certainly sounds like Northwell is significantly differentiating itself with this customer-centric focus. It’s likely that as experiences improve, patients will vote with their spend across their healthcare provider choices. This will then further instigate more change in the culture and the overall adoption of improved best practices for patient well-being and satisfaction. 

I’m afraid we’ll have to leave it there. You have been listening to a sponsored BriefingsDirect healthcare insights discussion exploring the shift medical services providers are making to improve the overall patient experience in the healthcare sector.


And we have learned how improving patient experiences will increasingly rely on the many tools available to other types of businesses.

So please join me now in thanking our guests, Laura Semlies, Vice President of Digital Patient Experience at Northwell Health in metro New York, and Julie Gerdeman, President at HealthPay24 in Mechanicsburg, Penn.

And a big thanks to our audience for joining this HealthPay24-sponsored thought leadership discussion. I’m Dana Gardner, Principal Analyst at Interarbor Solutions, your host and moderator. Thanks again for listening, and do come back next time.

Listen to the podcast. Find it on iTunes. Download the transcript. Sponsor: HealthPay24.

Transcript of a discussion on how healthcare providers are employing processes and technologies from such industries as retail and financial services to vastly improve the experience and quality of care from the medical patients’ perspective. Copyright Interarbor Solutions, LLC, 2005-2019. All rights reserved.

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Monday, March 11, 2019

Price Transparency in Healthcare Requires Higher Accuracy and Technology Adoption to Regain Patient Trust

https://www.healthpay24.com/
Transcript of a discussion on how new transparency on costs in healthcare provides both a step toward more educated choices as well as an opportunity to use technology to inform and instruct throughout increasingly complex payer-provider-patient processes.

Listen to the podcast. Find it on iTunes. Download the transcript. Sponsor: HealthPay24.

Dana Gardner: Hi, this is Dana Gardner, Principal Analyst at Interarbor Solutions, and you’re listening to BriefingsDirect. Our next healthcare finance insights discussion explores the impacts from increased cost transparency for medical services.

Gardner
The recent required publishing of hospital charges for medical procedures is but one example of rapid regulatory and market changes. The emergence of more data about costs across the health provider marketplace could be a major step toward educated choices – and ultimately more efficiency and lower total expenditures.

But early-stage cost transparency also runs the risk of out-of-context information that offers little actionable insight into actual consumer costs and obligations. And unfiltered information requirements also place new burdens on physicians, caregivers, and providers – in areas that have more to do with economics than healthcare.

To learn more about the pluses and minuses of increased costs transparency in the healthcare sector, we are joined by our expert panel:

Welcome to you all. For better or worse, we are well into an era of new transparency about medical costs. Heather, why is transparency such a hot issue right now?

Kawamoto
Kawamoto: It’s largely due to a cost shift. Insurance companies are having patients owe more of a payment’s portion. With that there has been a significant rise in the high-deductible health plans -- not only in the amount of the deductible, but also in the number of patients on high-deductible plans.

And when patients get, sadly, more surprise bills, we start to hear about it in the media. We also have the onset this month of the IPPS/LTCH PPS final rule from the Centers for Medicare and Medicaid Services (CMS) [part of the U.S. Department of Health and Human Services].

The New York Times did a recent story about this, and that’s created buzz. And then people start saying, “Hey, I know I have a medical service coming up, I probably need to call in and actually find out how much my service is going to be.”

Gardner: It seems like the consumer, the patient, needs to be far more proactive in thinking about their care, not just in terms of, “Oh, how do I get better? Or how do I stay as healthy as I can?” But in asking, “How do I pay for this in the best possible way?”

That economic component wasn't the case that long ago. You would get care and you didn't give much thought to price or how it was billed.

Joann, as somebody who provides care, what’s changed that makes it necessary for patients to be proactive about their health economics?

Know before you owe

Barnes-Lague
Barnes-Lague: It’s the consumer-driven health plans, where patients are now responsible for more. They have to make a decision – “Do I buy my groceries, or do I have an MRI.”

The shift in healthcare makes us go after the patient before insurance is paid 100 percent. Patients now have a lot of skin in the game. And they have to start thinking, “Do I really need this procedure, or can it wait?”

Gardner: And we get this information-rush from other parts of our lives. We have so much more information available to us when we buy groceries. If we do it online, we can compare and contrast, we can comparison shop, we can even get analysis brought to the table. It can be a good thing.

Julie, you are trying to help people make better paying decisions. If we have to live with more cost transparency, how can technology be a constructive part of it?

Gerdeman
Gerdeman: It's actually a tremendous opportunity for technology to help patients and providers. We live in an experience economy, and in that economy everyone is used to having full transparency. We’re willing to pay for faster service, faster delivery.

We have highly personalized experiences. And all of that should be the same in our healthcare experiences. This is what people have come to expect. And that's why, for us, it’s so important to provide personalized, consumer-friendly digital payment options.

Sanborn: As someone who has been watching these high-deductible health plans unfold, data has come out saying the average American household can't afford a $500 medical bill, that an unexpected $500 medical bill would drastically impact that household’s finances for months. So people are looking to understand upfront what they are going to owe.

At the same time, patients are growing tired of the back-and-forth between the provider and the payer, with everyone kicking the can back and forth between then saying, “Well, I don’t know that. Your provider should know that.” And the provider says, “Well, your health plan is the one that arbitrates the price of your care. Why don't you go ask them?” Patients are getting really, really tired of that.
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Now the patients have the bullhorn, and they are saying, “I don't care whose responsibility it is to inform me. Someone needs to inform me, and I want it now.” And in a consumer-driven healthcare space, which is what’s evolving now, consumers are going to go where they get that retail-like experience.

That’s why we are seeing the rise in urgent care centers, walk-in clinics, and places where they don’t have to wait. They can instead book an appointment on their phone and go to the appointment 20 minutes later. Patients have the opportunity to pick where they get their care and they know it. At the same time, they know they can demand transparency because it's time.

Gardner: So transparency can be a force for good. It can help people make better decisions, be more efficient, and as a result drive their cost down. But transparency can put too much information in front of people, perhaps at a time when they are not really in a mindset to absorb it.

What are you doing at CVS, Alena, to help people make better decisions, but not overload them?

Clear information increases options

Harrison
Harrison: The key to good transparency tools is that they have to be a 100 percent accurate. Secondly, the information has to be clear, actionable, and relevant to the patient.

If we gave patients 10 data points about the price of a drug -- and sometimes there are 10 prices depending on how you look at it -- it would overwhelm folks. It would confuse them, and we could lose that engagement. Providing simple, clear data that is accurate and actionable shows them the options specific to their benefit plan. That is what we can do to help consumers navigate through this very complex web in our healthcare system.

Gardner: Recondo helps people create and deliver estimates throughout this process. How does that help in providing the right information, at the right time, in the right context?

Kawamoto: It's critical to provide [estimate information] when a patient schedules their service, because that gives them the opportunity -- if there is a financial question or concern -- to say, “Okay, I don’t know that I can pay for that. Is there another location where the price might be different? What are my financial options in terms of the payment plan or some sort of assistance?”

Enabling providers to proactively communicate that information to patients as they schedule a service or in advance gives patients an opportunity to shop. They know they are going to be meeting with an orthopedic surgeon because they need knee arthroscopy.

In advance of that, they should be able to get some idea of what they are going to owe, relative to their specific benefit information. It puts them in that position to engage with the orthopedic surgeon to say, “I looked at the facility and it's actually going to be $3,000. What are my options?” Now, that provider can be a part of the cost discussion. I think that is critical.

Barnes-Lague: As providers we have to be okay with patients making that decision, of saying, “Maybe I won’t have that service now.” That’s consumer-driven. And sometimes that hurts our volume.

We may have had a hard time understanding that in the beginning, when we shared estimates and feared that the patients wouldn't come. Well, would you rather trick them and then have bad debt?
As providers we have to be okay with patients making that decision, of saying, "Maybe I won't have that service right now." That's consumer-driven. ... It's about being comfortable with the patient making educated decisions.

It’s about being comfortable with the patient making educated decisions. Perhaps they will come back for your MRI in December when their deductibles are met, and they can better afford it.

Gardner: Part of this solution requires the physician or practitioner to be educated enough to help the patient sort out the finances, as well as the care and medical treatments. As someone who has a lot of clinicians, technicians, and physicians, are they not the primary point for more transparency to the patient?

Barnes-Lague: That would be the ideal solution, to have the physicians who are referring these very expensive services to begin having those conversations. Often patients are kind of robotic with what their doctors tell them.

We have to tell them, “You have a choice. You have a choice to make some phone calls. You have a choice to do your own price shopping.” We would love it if the referring physicians began having those price-transparency conversations early, right in their offices.

Gardner: So the new dual-major: Economics and pre-med?

Julie, your background is in technology. You and I both know there are lots of occupations where people have complex decisions to make. And they have to be provided trust and accommodation to make well-informed decisions.

Whether you are a purchasing agent, chief executive, or chief marketing officer, there are tools and data to help you. There have been great strides made in solving some of these problems. Is that what we are going to see applied to these medical decisions across the spectrum of payer, provider, and patient?

Easy-to-access, secure data builds trust

Gerdeman: This field is ripe for disruption. And technology, particularly emerging technology, can make a big difference in providing transparency.

A lot of my colleagues here have talked about trust. To me, the reason everybody is requiring transparency is to build trust. It goes back to that trusted relationship between the provider and the patient.

The data should be available to everyone. It’s now time to present the data in a very clear, simple, and actionable way for them to make decisions. The consumer can make an informed decision, and the provider can know what the consumer is facing.

Gardner: Yet to work, that data needs to be protected. It needs to adhere to multiple regulations in multiple jurisdictions, and compliance is a moving target because the regulations change so often.

Beth, what do we do to solve the data availability problem? Everybody knows data is how to solve it. It’s about more data. But nobody wants to own and control that data.

Sanborn: Yes, it’s the $64,000 question. How do you own all that data and protect it at the same time? We know that healthcare is one of the most attacked industries when it comes to cyber criminals, ransomware, and phishing.

Sanborn
I hear all the time from experts that as much as the human element drives healthcare, as far as data and its protection [the human element] is also the greatest vulnerability. Most of the attacks you hear about happen because someone clicked on a link in an email or left their laptop somewhere. These are basic human errors that can have catastrophic consequences depending on who is on the receiving end of that error.

Technology is, of course, a huge part of the future, but you can't let technology develop faster than the protections that have to go with it. And so any developer, any innovator who is trying to help move this space forward has to make cybersecurity a grassroots foundational part of anything that they innovate.

It’s not enough to say, “My tool can help you do this, this, and this.” You have to be able to say, “Well, my tool will help you do this, this, and this, and this is how we are going to protect you along the way.” That has to be part of, not just the conversation, but every single solution.

Gardner: Alena, at CVS, do you see that data solution as a major hurdle to overcome? Meaning the controlling, managing, and protection of the data -- but also making it available to every nook and cranny that it needs to get to?

Harrison: That’s always a key focus for us, and it’s frankly ingrained in every single thing we do. To give a sense of what we are putting out there, the price transparency tools that we have developed are all directly connected to our claims system. It’s the only way we can make sure that the patient out-of-pocket costs we provide are 100 percent accurate. They must reflect what that patient would pay as they go to their local pharmacy.
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But making sure that our vendor partners have a robust and very rigorous process around security is paramount. It takes time to do that, and that’s one of the challenges we all face.

Gardner: So we have a lot going on with new transparency regulations, and more information coming out. We know that we have to make it secure, and we are going to have to overcome that. So it’s early still.

It seems to me, though, there are examples of the tools already developed and how they can be impactful; they can work.

Joann at Shields, do you have any examples of what benefits can happen when you bring in the right tools for transparency and for making good decisions?

Transparency upfront benefits bottom line

Barnes-Lague: Yes, we bring in more revenue and we bring it in timely. We used to be at about 60 percent collected from the patient’s side overall. Since we implemented tools, we are at 85 percent collected, a 400 percent increase in our overall revenue.

We have saved $4.5 million in [advance procedure] denials, just based on eligibility, authorization, and things like that. We are bringing in more money and we don’t require as much labor because of the automation. We are staffed around the automation now.

Gardner: Julie, how does it work? How do better tools and more information in advance help collect more money for a medical transaction?

Gerdeman: It works in a couple of ways. First, from a patient-facing perspective, they have the access to pay whenever and wherever they are. Having that access and availability is critical.
We have saved $4.5 million in [advance procedure] denials -- just based on eligibility, authorization, and things like that. We are bringing in more money and we don't require as much labor because of the automation.

Also they need to be connected. An estimate – like Heather talked about, to be able to make a decision from that -- has to be available from the very beginning.

And then finally, it's about options. All of these things help drive adoption if you give a patient options and clarity upfront. They have a choice of how to pay and they have the knowledge about costs. That adoption drives success.

So if you implement the tools appropriately you will see immediate impact. The patients adopt it, the staff adopts it, and then it drives up the collections that Joann is talking about.

Gardner: Heather, we have seen in other industries that tracking decision processes and behaviors leads to understanding use patterns. From them, incentivization can come into play. Have you seen that? How can incentives and transparency improve the overall economic benefits?

Incentivization improves savings

Kawamoto: Being able to communicate to patients what their anticipated out-of-pocket costs will be is powerful. A lot of organizations have created the means where they say to the patient, “If you pay this amount in advance of your service, you will actually get a discount.” That puts the patient in a position to say, “I could save $200 if I decide to pay this today.” That's a key component of it. They know they are going to get a better cost if they pay sooner, and then many of them are incented to do that.

Gardner: Any other thoughts about incentives, Alena?

https://www.healthpay24.com/

Harrison: Yes. An indirect incentive, but still quite relevant, is that our price transparency tools are available to all of our CVS Caremark members. We are seeing about 230,000 searches a month on our website.

When members search for the drugs they are taking, if there are lower-cost alternative options, we see members in their next refill order one of those lower cost drugs 20 percent of the time. That results in an average savings of $120 per prescription fill for those patients. As you can imagine, over the course of several months, that savings really starts to add up.

Gardner: We have come back to the idea of the out-of-pocket costs. The higher the deductible, the lower the premiums. People are incentivized therefore to go to lower premiums. But then, heaven forbid, they have an illness, and then they have to start thinking about, “Oh my gosh, how do I best manage that out-of-pocket deductible?”

Nowadays, with technologies like machine learning (ML), artificial intelligence (AI), and big data analytics, we are seeing prescriptive or even recommendation types of technologies. How far do we need to go before we can start to bring some of those technologies about making good recommendations based on data -- rather than intuition or even a lack of informed decision making — to medical finance decisions? How do we get to that point where we can be proscriptive in automated recommendations, rather than people slogging through this by themselves?

Automated advice advances

Gerdeman: At HealthPay24 we are looking at predictive analytics and what role the predictive capability can play in helping make recommendations for patients. That’s not necessarily on the clinical or pharmaceutical side, but we know when a patient makes an appointment and gets an estimate what their propensity to pay will be.

Proactively we can offer them options based on what we know ahead of time. They don't even have to worry about it. They can just say, “Okay, here are my choices. I have only saved up $500; therefore, I am going to take advantage of a loan or a payment plan.” And I do believe that technology will help.

On the AI side, it’s already starting. As you talk to providers, they are using it for repetitive processes. But I think there is even more opportunity on the cognitive side of AI to play [a role] in hospitals. So there is a big opportunity.


Gardner: We already see this in financial markets. People get more information, they get recommendations, and there is arbitrage. It’s not either/or. It’s what are the circumstances? What’s the credit we can offer? How do we make the most efficient transaction for all parties?

So, as in other transactions, we have to gain more comfort with the combination economics and medical procedures. Is that part of the culture shift? You have to be a crass consumer and you have to be looking out for your health.

Any thoughts about the need to be both a savvy consumer as well as a patient?

Kawamoto: It's critical. To Julie’s point, we are now looking through our data and finding legitimate savings opportunities for patients, and we’re proactively outreaching to those patients. Of course, at the end of the day, the decision is always in the provider’s hands -- and it should be, because not all of us are clinicians. I certainly am not. But to allow patients to prompt that fuller conversation helps drive the process, so the burden isn't just on the provider. This is critical.

Gardner: Before we close out, any recommendations? How should the industry best prepare for more transparency around procedures and payments in medical environments? Joann, what do you think people should be thinking about to better prepare themselves as providers for this new era of transparency?

Lead with clear communication

Barnes-Lague: Culture is very important within the organization. You need to continue to talk. It’s shifting. Let’s talk about the burden to the provider, now that the patients are responsible for more. There is no other product that you can purchase without paying upfront. But you can walk away from healthcare without paying for it.

The more technology you implement, the more transparency you can provide, the more conversations you can have with those patients – these not only help the patients. You as providers are in business for revenue. This helps bring in the revenue that you have lost with the shift to consumer-driven health plans.

Gardner: Heather, as someone who provides tools to providers, what should they be thinking about when it comes to a new era of transparency?
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Kawamoto: While there have been tools available to providers, now we have to make those tools available to patients. Providers are, in many cases, the first line of communication to patients. But before that patient even schedules, if they are in a position to know they need a service, they can go out and self-shop.

That’s what providers need to be thinking about. How do I get even further out into the decision-making process? How do we engage with that patient at that early point, which is going to build trust, as well as ensure that revenue is coming to your particular facility?

Gardner: Beth, what advice do you have for consumers, the patients? What should they be thinking about to take advantage of transparency?

Take care of physicians and finances

Sanborn: First, I want to advocate for the physicians. We hear all the time about change fatigue, burnout; burnout is as hot a topic as transparency. If providers are going to be put in the position of having to have financial conversations with patients, I think health system leaders need to be aware of that and make sure that providers are properly educated. What do they need to know so that they can accurately communicate with patients? And they need to understand how that's going to affect the workload -- that is already onerous and at times damaging -- to physicians. So along Joann’s comments about culture, there needs to be a culture around ushering in physicians into that role.

From a consumer standpoint, when we look at the law that just went into effect, patients need to understand what are they looking at. The price list that the hospital is publishing is a chargemaster. It’s a naked price from a hospital. It's not what they are going to pay, and so we need to eradicate the sticker shock that I am sure is happening at first glance.

Gardner: The patient needs to self-educate about what’s net-net and what’s gross when it comes to these prices?
Patients need to be educated on what they are looking at, and then understand the options available to them as far as what they are actually going to pay. Payers need to make sure they are reaching out and make sure their consumers understand how the benefits work.

Sanborn: Right. You can put these prices in plain terms. The chargemaster is what a hospital charges. But remember you have insurance. There are discounts for self-pay. There could be other incentives or subsidies that you are eligible for.

So please don't have a heart attack, literally, when you look at this price and go, “Oh, my gosh, is that what I am responsible for?” Patients need to be educated on what they are looking at, and then understand the options available to them as far as what you are actually going to pay.

And the other thing is benefits literacy. Payers need to make sure they are reaching out to their consumers and making sure their consumers understand how the benefits work so that they can advocate for themselves.

Gardner: Alena at CVS, as a provider of pharmaceutical services and goods, what advice do you have about making the best of transparency?

Harrison: Beth hit the nail on the head with a lot of her points. We see similar brute-force regulation happening in the prescription drug space. So pharmaceutical manufacturers now need to publish their “sticker” prices.

Little do most people know, the sticker price is something no one pays. Payers don't pay it. Patients certainly don't pay it. The pharmacy doesn’t pay it. And so it is so critical as this information becomes available to make sure that your customers, consumers, and members understand what they are looking at. You as an organization should be prepared to support them through the process of navigating this additional information.

Gardner: Julie, what should people be thinking about on the vendor side, the people providing these tools, now that transparency is a necessary part of the process? What should the tool providers be thinking about to help people navigate this?

Gerdeman: It comes back to the user experience -- providing a simple, clear, and consumer friendly experience through the tools. That is what’s going to drive usage, adoption, and loyalty.
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Technology is a great way for providers to drive patient loyalty, and that is where it’s going to make a difference. That’s where you are going to engage them. You are going to win hearts and minds. They are going to want to come back because they had a great clinical experience. They feel better, they are healthier now, and you want the rest of their experience financially to match that great clinical experience.

Anything we can do in the tools themselves to be predictive, clear, beautiful, and simple will make all the difference.

Gardner: I am afraid that we will have to leave it there. You have been listening to a sponsored BriefingsDirect digital business innovation podcast on the emergence of more data about costs across the health provider marketplace.

And we have learned about the pluses and minuses of increased costs transparency in the healthcare sector and ways to reduce the risk of out-of-context information that offers little actionable insight into actual consumer costs and obligations.

So please join me now in thanking our guests, Heather Kawamoto, Chief Product Officer at Recondo Technology in Denver; Joann Barnes-Lague, Revenue Cycle Director at Shields Health Care Group in Quincy, Mass.; Julie Gerdeman, President at HealthPay24 in Mechanicsburg, Penn.; Beth Jones Sanborn, Managing Editor at Healthcare Finance News/HIMSS Media in Portland, Maine, and Alena Harrison, Senior Director of PBM Innovation at CVS Health in Woonsocket, RI.

And a big thanks to our audience for joining this HealthPay24-sponsored thought leadership discussion. I’m Dana Gardner, Principal Analyst at Interarbor Solutions, your host and moderator. Thanks again for listening, and do come back next time.

Listen to the podcast. Find it on iTunes. Download the transcript. Sponsor: HealthPay24.


Transcript of a discussion on how new transparency on costs in healthcare provides both a step toward more educated choices as well as an opportunity to use technology to inform and instruct throughout increasingly complex payer-provider-patient processes. Copyright Interarbor Solutions, LLC, 2005-2019. All rights reserved.

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