How Adventist Health System increased patient self-service payments 83%

The proportion of hospital revenue stemming from patient dollars has grown dramatically over the last decade from 5 to 10 percent of revenue to 30 to 35 percent today. While it's no secret to health systems that patients are payers, organizations have been slow to better align their billing practices to the patient.

"When you ask patients, 3 out of 4 say they don't understand the bills they're getting. They're an important payer, but not one that's getting spoken to as a consumer," said John Dwight, vice president of marketing and partnerships at Simplee, a patient financial experience software as a service provider, in a webinar hosted by Becker's Hospital Review.

Hospital and healthcare bills can be expensive, and patients often don't understand how the charges on their bills break down, so they take the path of least resistance: They significantly reduce their use of healthcare services or avoid procuring them altogether, potentially driving up utilization and costs down the line.

However, it doesn't have to be this way. "There is light at the end of the tunnel," Mr. Dwight said. "We know when you do this well, and when the patient wins, the health system wins."

Altamonte Springs, Fla.-based Adventist Health System is proof that investing in the patient revenue cycle can positively transform the patient financial experience. During the webinar, Tim Reiner, Adventist's senior vice president of revenue management, described the health system's old billing experience as "pretty ugly."

"Several people were so antagonized by our old website that they would literally write our CEO emails and say, 'My 6-year-old could have programmed a better website than this,'" he said. "They were so offended by the experience that they sent us an email. You have to be pretty upset to be actively dissatisfied."  

Under a systemwide focus on the consumer, Mr. Reiner reframed the billing process at his hospital around convenience. Previously, the hospital provided patients with a paper bill and a fairly stripped-down payment portal. There was no option for paperless billing, no way for patients to see the breakdown of the charges in their bill, no way to set their own payment plan and no built-in feedback mechanism.

"Often in healthcare we've done things at our [the hospital's] convenience. If the patients fit into that, that was great. If not, they were going to sort of do it at our convenience no matter what because that was the way things worked," Mr. Reiner said. To turn this paradigm on its head, Adventist focused on developing an enterprisewide bill hosted on a digital, unified patient relationship platform supported by Simplee's solution. This platform is home to patient test results, messages from care teams, low- or no-cost virtual care, provider reviews, care directories, scheduling and payment.

Adventist's revamped revenue cycle experience is designed so a patient receives an email prompting them to pay their bill. If they click a link in the message, they can log in and see all their bills, from physicians and hospitals across the 45-hospital system, in one place. They can see what they owe for each encounter and the breakdown of those charges. They can even link their PayPal accounts for fast and secure payment. If patients can't pay in full right away, they can set up a payment plan and adjust it on their own as needed.

"If we don't allow people some flexibility, we just lose them altogether. They're demoralized and they just don't pay," Mr. Reiner said. The portal also gives patients the option to submit feedback regarding their financial experiences without ever leaving the website. However, unlike the old website, the feedback has been overwhelmingly positive.

"So excited that I can pay with PayPal AND set up payment plans. Had I known this I would have paid sooner!" one patient wrote in to tell the system. Another said, "I can see all my bills, which is nice because there are so many from childbirth it can get confusing."

Mr. Reiner credits the bill pay notification emails and user-friendly new website for the positive reviews. "People talk about negative experiences, and they may not actively talk about positive ones," he said. "I really want to make sure that patient satisfaction is something where they are happy with us and much more likely to come back, and billing is a component of that."

Increased patient satisfaction can also lead to greater propensity to pay. In its Orlando, Fla., market, Adventist found a 67 percent growth in collections within just 90 days of implementing the new website. Systemwide, it has seen 83 percent growth in self-service payments between December 2016 and December 2017.

The billing process has translated into a reputation-booster and brand-builder. Adventist Health System's net promoter score — a measure of consumer loyalty — related to billing topped the scores of Mercedes-Benz and Nordstrom, two companies known for customer service. Its score was twice that of the average healthcare organization.

However, the work is not nearly done, according to Mr. Reiner. His next major focus is to improve pre-service process, including upfront price transparency. 

To learn more about how Adventist transformed its billing experience and where Mr. Reiner plans to take it next, view the full webinar here.

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