Leveraging technology to help health affordability

Medical costs are a major concern for patients and transparency about these costs has been lacking. Providers need better processes and technology to give patients the price transparency they need and to improve the payment experience.

During a May Becker's Hospital Review webinar sponsored by Flywire, revenue management leaders discussed how technology can help healthcare organizations provide greater transparency and narrow the affordability gap. Panelists were: 

  • Scott Boyes, chief financial and operating officer, Wooster (Ohio) Community Hospital
  • Seth Katz, vice president of revenue cycle and HIM, University Health (Kansas City, Mo.) 
  • Rhonda Ridenour, director, revenue cycle, Avita Health System (Ohio)
  • John Talaga, executive vice president and general manager, Flywire

Four key takeaways were:

  1. Technology can help organizations improve price transparency. Government-led initiatives such as the Price Transparency regulation and the No Surprises Act make clear that healthcare organizations are expected to improve how they present pricing information. As a result, many organizations have begun publishing prices and providing good faith estimates. But manually extracting patient-specific data to build such estimates — which include physician orders, pre-certifications and prior authorizations — is a laborious process that surpasses the capacity of revenue cycle human resources.

    "People need to know going in what their costs are going to be," Mr. Katz said. "To achieve that, because [the data that goes into medical prices] is high volume, you have to bring in technology to automate that."

  2. Technology is being used to improve the payment experience. Beyond advancing transparency, technology is being leveraged to provide patients with more payment options. With a growing number of organizations recognizing the affordability problem of lump sum bills, many providers are looking for technology solutions that enable offering more affordable self-service payment plans.

    "Payment plans have been around for a long time but have traditionally been used as a tactic of last resort," Mr. Talaga said. Flywire's solution helps organizations present payment plans more strategically to patients by offering them the ability to activate such plans in a self-serve digital or offline environment without having to get help. 

  3. Technology aids in matching patients with the right plan. Targeting the appropriate payment plan to each patient depends on having prior knowledge about a patient's ability to pay, propensity to pay or other relevant metrics. "I'm using technology to segment patients so we know who may be in financial distress, so we can target that way," Ms. Ridenour said.

    Mr. Boyes agreed: "Without the use of technology and targeting our resources in the right way, you can't tailor your service to the needs of your customer." He said this way of thinking applies not only to the present but to the future, when a large percentage of baby boomers will require high-touch healthcare, yet the economics of the U.S. will call for more low-cost healthcare. "If we don´t leverage technology, we won't be able to make those needs work together."

  4. Technology is a lifesaver in times of staffing shortages and elevated labor costs. The utility of robotic process automation, artificial intelligence and machine learning is growing. Apart from offloading manual work from overstretched workers, a promising application of technologies in healthcare is conversational chatbots. Chatbots are able to handle ever more complex patient inquiries, authenticate patient identity, automate authorizations and enhance the patient experience. 

"In the coming years, hospitals and their competitors are going to be [designing such systems] and those that can connect patients seamlessly, that make pricing transparent and that make scheduling and follow-up easy are going to succeed because that's what patients want and it's got to be about the patient," Mr. Katz concluded.

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