Patient consumerism and the need for a patient-centric revenue model

Reforms to the U.S. healthcare system in the last several years, many of which result from the Affordable Care Act, have created the need for a more patient-centric health system.

The shift to value-based care, electronic health records management, high deductible insurance plans, and health system interoperability have significantly contributed to a need to create a positive, thoughtful patient experience. The current landscape provides an opportunity for greater collaboration between a health care practice and how it engages with patients for billing and revenue collection in a way that puts the patient first.

Today, a greater portion of health practice revenue comes from the patient -- meaning physicians must be prepared to effectively engage with patients as much as insurers. The number of patients with high deductible health plans is growing as more employers move in this direction. As a result, amounts due from patients make up a greater proportion of the total practice revenue and patients are more interested than ever about where and when they spend their healthcare dollars.

Patients are now at the center of health practice operations – especially the revenue cycle. In fact, according to the 2016 HIMSS Revenue Cycle Improvement Task Force, as people take on larger amounts of direct financial responsibility for their health care, they begin to view health care as more of a retail experience. And, consequently, transfer expectations of a typical retail experience to health care. Patients have choices for the providers they utilize and providers are now expected to deliver upon retail-like service levels and this new health care model calls for fresh solutions in technology, infrastructure and mind-set to ensure a healthy financial experience for both patient and provider.

These days the practice revenue cycle process can often seem daunting and confusing to patients. In fact, the typical patient does not understand their medical bills, or the interconnected dynamics of payers, providers, and vendors, or their health insurance coverage and financial responsibilities. Practices can improve their patient care experience, including how fast and how much revenue is collected, by implementing a more patient-centric revenue model.

Creating a better patient experience and facilitating greater patient engagement is where we are headed. It’s our responsibility as health care companies to enable patients to become better consumers of care. The simplest way to do this is through innovative solutions.

To build a trust-based patient-physician relationship, providers need to offer multiple avenues of communication – and communicate early and often to keep the patients engaged. To do this effectively, health practices need to do the following:

1. Define the goals of the practice with the patient in mind and embrace simplification. Seek to empower the patient through providing a transparent experience with clear and concise information. Implement a strategy for patient engagement that’s timely and easy to use.

2. Establish clear, transparent communication and financial expectations with patients prior to their appointment. According to HIMSS, price transparency continues to be a key requirement for patients who simply want to understand what they are being asked to pay for. Train the staff to improve this experience through financial counseling, price transparency and better scripting. This will help facilitate greater understanding of the process while accelerating on-time and in-full payments, and allow a greater focus on what’s important – their health.

3. Embrace the patient. Convenience and ease of doing business is important to the modern patient that increasingly expect real-time, paperless transactions and instant access to health care information sources. As industry experts note, the patient-physician interaction -- whether face-to-face, through a traditional call center, via the internet, by a service kiosk, or from a smartphone app -- needs to demonstrate responsiveness, simplicity, convenience, and the capability to answer all of the patient’s clinical and financial questions. Providing convenient and secure payment options is beneficial as well.

As patients are better positioned to make well-informed decisions about their care they are becoming better partners to healthcare providers, who in turn, can ensure the patient-physician experience is not solely based on clinical outcomes, but is also a well-managed financial experience. The key to success in most value based reimbursement models is tied to effective patient engagement - both financial and clinical.

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