In recent years, patients' financial stress has risen rapidly. Premiums are increasing at a significantly faster rate than wages and inflation, and these trends are likely to persist.
As a result, patients are more likely to not seek the healthcare services they need and, when they do seek care, face difficulties paying medical bills.
More than half of patients are unable to pay a $1,000 medical bill, and over 75 percent of providers say it takes more than a month to collect any payment at all, according to an InstaMed report cited by Shawn Yates, director of healthcare product management at Ontario Systems.
"We know workers are paying more for premiums. We know deductibles are higher; employee wages are lagging behind. Patient choice is being eliminated from employer coverage, retail healthcare is grabbing market share from providers and regulations continue to stress healthcare finances," Mr. Yates said. Automation, registration practices, revenue integrity, business intelligence and analytics are all common ways to address these challenges, he said, "but you don't hear a lot about managing agent productivity."
During an Oct. 22 webinar hosted by Becker's Hospital Review and sponsored by Ontario Systems, Mr. Yates and Pam Jordan, director of collections at Parallon, discussed the challenges of increasing premiums and inefficient collections processes, and shared the solutions Parallon developed in partnership with Ontario Systems to address those issues.
The challenge
In creating a strategy to boost the performance of collections agents, Parallon faced several challenges. Most pressing was a lack of a standardized process among the company's service centers across the U.S. and U.K. "There was inconsistency in applying standards because there were no standards," Ms. Jordan explained.
Additionally, identifying and reviewing accounts was largely a manual process, leading to a lack of data made available for review and evaluation by all levels of management within the organization.
Finally, in terms of both agents and quality assurance, Ms. Jordan said, "The collectors had a feeling that the accounts being reviewed had some bias since they were not randomly chosen."
The solution
To address all these challenges in one fell swoop, Parallon developed a standard collection guide for agents that explains exactly how to work the most common insurance account statuses: paid, pending, denied, processing and no claim on file. The guide details the process flows for each of the five types of accounts. All agents are now trained on each process flow, with regular performance reviews and quality assurance processes performed each month.
Through the new workflow, accounts are randomly picked for each agent. Of these, 10 are selected each week for review by a quality assurance analyst, who assigns a "pass" or "fail" regarding the agent's performance. Agents see this information and can respond, rebut or clarify accordingly.
Information about agent performance is compiled into dashboards. "The dashboards were created so we could show the team as a whole how they perform against each other, and then, at the highest level, corporate can monitor how our collectors across different service centers perform against each other," Ms. Jordan explained. These productivity and QA scores were also integrated into the process of determining bonuses and raises.
Ultimately, the dashboards will be gamified. Parallon has developed an "agent scorecard," in which agents will receive points for each of the "passes" and "fails" they receive from their quality assurance reviews. "Then they can have meaningful conversations with their team lead or manager about their scores, and have the opportunity to rebut them," Ms. Jordan said.
The largely automated system will be deployed in all Parallon service centers by the end of the year. The system is expected to not only improve agent performance due to the newly standardized process, but also highlight further areas for improvement and training opportunities for agents, increase compliance throughout the collections process, foster greater visibility across the entire organization and, finally, result in cost savings due to the reduction in manual efforts.
"We'll be able to identify whether it's an agent who's having difficulty or if the issue is in our training material — uncovering where we have opportunities to improve," Ms. Jordan said.
View the full webinar here.
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