3 lessons from UConn Health's journey to patient-centric billing

Hospital revenue cycle efficiency is not only a cornerstone of operational excellence, but it is also essential to patient-centric care. No matter how deluxe the hospital room or how excellent the care delivery, a bad billing process will diminish an otherwise positive patient experience.

This content is sponsored by Optum.

Creating tomorrow's perfect billing experience in today's healthcare environment is no easy feat. National trends are driving patient out-of-pocket costs upwards, which puts financial pressure on hospitals. This pressure can become even more significant for health systems undergoing expansions. As health systems grow, via mergers or capital improvement projects, the complexity of the billing process grows along with its patient population.

Farmington-based UConn Health found itself in this position in 2015, as patient volumes increased after the completion of an $864 million expansion at its John Dempsey Hospital in Farmington. The expansion added 169 single rooms, an outpatient pavilion and an ambulatory care center. System leadership wanted to elevate revenue cycle performance to take advantage of economies of scale and preserve the firstrate care experience created by the modernization project.

"The patient could have the best experience with the physician, have surgery in our hospital and leave, but then get a bill that's upsetting at the end," UConn Health CFO Jeffrey Geoghegan said. "We can ruin that whole patient experience just on the revenue cycle side."

UConn Health coupled its revenue cycle initiative with an EMR upgrade and was able to improve operations, making billing more patient-centric. It accomplished this without incurring new costs or adding more staff. The following article examines the process UConn Health used to streamline and update its revenue cycle, as well as the challenges the system faced and lessons it learned.

Background

In 2011, state lawmakers approved a plan called "Bioscience Connecticut," which earmarked $864 million to renovate and expand the medical and dental schools at UConn Health; offer medical, dental and urgent care services at a town center in Mansfield, Conn.; and add 169 rooms, an ambulatory care center and an outpatient pavilion to John Dempsey Hospital. The approval marked the beginning of a period of unprecedented growth for the health system. After completing this project in 2015, the health system saw a 10 percent increase in inpatient discharges and a 2 percent increase in overall outpatient volume.

This major growth presented a new administrative challenge. The hospital was on a different billing system than the health system's 325-physician University Medical Group, and each department within the hospital sent out individual bills for various services within a single stay. If a patient accidentally called the hospital about a bill from a physician's office visit, the hospital was unable to look up their bill to answer questions.

"In the past, we had 34 different sub-systems across our revenue cycle," Mr. Geoghegan said. "These systems did not communicate with one another, and it made for a frustrating patient experience. This EMR upgrade was our opportunity to shift to a single billing office. We wanted patients to have one number to call where all their questions could be answered."

As part of their "Big Bang" Epic go-live in April 2018, UConn Health decided to focus on creating a more efficient and patient-centric revenue cycle. The health system did this by moving to a single billing office with a centralized management structure. It enlisted Optum Advisory Services for interim leadership of the revenue cycle and insight on best practices for process improvement. Through this transition, they were able to accommodate the growth in patient volume without adding overhead.

Here are three lessons UConn Health learned throughout the billing office centralization process:

1. Culture change is 'the biggest part.' As part of its revenue cycle revamp, UConn Health had to develop an organizational structure to support their streamlined billing model. This meant relocating staff to a centralized location overseen by an interim chief revenue cycle officer from Optum.

Properly communicating the transformation throughout the organization was critical to getting the project off the ground, according to Mr. Geoghegan. UConn Health created a steering committee for the implementation. Committee members included hospital operational leads, physician practice leaders, and the system CIO and CEO. "Everybody bought in from the top down just to make sure this was successful," he said.

UConn Health is what Mr. Geoghegan calls a "union shop," with nine unions representing employees across the organization. Its staff is incredibly loyal, with many having worked at the hospital for years and even decades. Changing the location, focus and duties for a person who has worked in a job for 30 years requires some diplomacy. This meant leadership had to work closely with union representatives and employees to communicate the reasoning behind the changes. They had to relocate some employees and shift their entire mindset about work from "I have a billing job" to "I have a patient job."

It also required some training on what to expect from today's patients. "Patients have a lot more questions nowadays," Mr. Geoghegan said. They want to understand the charges beyond their copay, and the call center needed to be ready to field questions about inpatient and outpatient charges, deductibles and co-insurance.

2. Deviate from the plan if necessary. Keeping patient-centric care in view as the "true north" guiding the project meant making a few course corrections throughout the project to achieve the desired results. At first, UConn Health combined billing offices, the call center, scheduling and registration into one unit. The hope was that streamlining these functions would standardize the patient experience and reduce errors without requiring additional staff.

However, adding these functions together proved to be too complex, bogging down the workflow. The health system's dropped call rate went up, and it began taking longer to schedule patient appointments, driving down patient satisfaction.

Despite the original goal to consolidate these functions into one office, the health system quickly decided to decouple scheduling and registration. "When you move forward, and things are not working as planned, don't be afraid to fail and make adjustments," Mr. Geoghegan said. "We can think it's the best thing in the world, but if it's not actually helping the patient, we have to be able to react quickly."

3. Start with a baseline and track success from the beginning.

UConn Health was able to quickly pivot and split scheduling and registration because it measured progress against baseline performance from the beginning. It chose to track time to schedule, time to register and number of dropped calls in the call center. And, in the billing department, it tracked number of statements and time to send. Prior to the integration, it was sending invoices from various departments in a span of five to 15 days. The new goal was to send one unified bill in less than 15 days. "It's really important to have success metrics so you can actually measure yourself," Mr. Geoghegan said.

"You have to be able to react," he said. "But, the ability to actually monitor and calculate to see where you stand against your baseline is probably the biggest [lesson]."

While new technology is not needed to start standardizing the revenue cycle, it can accelerate progress by tracking performance on the front-end and in the back office. The Epic rollout helped make this possible, and UConn Health used technology to help get to its goal of a single patient statement and improved cash posting.

What's next

As part of a greater strategic initiative to improve the patient experience and operations after an expansion, UConn Health successfully moved to a single billing office to serve more patients without adding overhead. By creating a plan, carefully communicating it across the organization, tracking progress and reacting as needed, UConn Health was able to successfully improve revenue cycle efficiency and offer a more patient-centric billing experience.

Now the system is working to provide patient education sooner so patients aren't caught off-guard by an unexpectedly high bill after a visit. "We're moving a lot of the education for the patient up front in the revenue cycle. So, as they're scheduling and going through the process and talking with their physicians, we want them to know what their insurance comprises and what their coverage actually is," Mr. Geoghegan said. To do this, UConn Health has opened discussions with payers to better coordinate coverage information.

Mr. Geoghegan recognizes that UConn Health's journey toward patient-centric billing is a long one, without a clear end. Rather, the evolution is ongoing and will require new relationships with other healthcare players.

"We have to react to the nationwide changes that we've seen in healthcare, while paying attention to [our] local markets. We have to be open to creating partnerships, especially with the players [in our market] as they are creating new plans and new initiatives," Mr. Geoghegan said. "It has to be more and more collaborative as we look forward."

To view video interview with Mr. Geoghegan visit www.optum.com/CFOrealitycheck.

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