Why payer-provider collaboration is key to improving the patient financial experience

Health systems have done their best to improve the patient financial experience with simplified statements, multi-channel billing, and payment plans.

But even the most well-crafted bill will confuse and frustrate patients if it doesn't match the explanation of benefits (EOB).

During Becker's Hospital Review's 13th Annual Meeting, in a session sponsored by Cedar — an end-to-end healthcare financial engagement platform — Shanti Krishnan, Cedar's vice president of partnerships, moderated a discussion with James Rohrbaugh, chief financial officer at Pittsburgh-based Allegheny Health Network, about their shared vision for a connected patient financial experience. They explored details around the recent partnership between Allegheny Health Network and Highmark Health and the impact that Cedar’s Payer Intelligence Layer is having on the overall patient financial experience. 

Four key insights were:

1. Organizations are conscious of the need to redesign processes so that the bill-payment process is more consumer oriented. That includes better curating the patient financial experience, which is characterized by high friction on both the payer and the provider side and making it less stressful and more adaptive to patient preferences. "I've never heard anyone in my entire career say anything positive about the payment experience," Mr. Rohrbaugh said.

2. By combining benefits with billing information, we can provide patients with a more holistic, frictionless financial experience. By consolidating detailed billing and insurance information in one place, patients no longer have to log onto multiple portals or call in to figure out how much they owe their provider versus what their benefits cover. 

"Patients [whose provider and insurance plan have a partnership with Cedar] can see their explanation of benefits (EOB) and bill reconciled in one place, avoiding a lot of the guesswork of, 'I got two pieces of paper in the mail, which one's right?'" Ms. Krishnan said. 

Mr. Rohrbaugh, whose institution has partnered with Cedar, affirmed that Cedar's financial engagement platform has removed the fragmentation that traditionally exists between payers and providers in managing patient bills. 

Looking ahead, Mr. Rohrbaugh suggested that cross-provider bill consolidation — the coordination of all bills across different service lines within the health network (e.g., emergency department, diagnostic imaging, labs and professional services) – can further support payer-provider collaboration. 

3. The benefits of a data science driven, connected patient financial experience go beyond just increasing patient payments and satisfaction. As a result of its partnership with Cedar, Highmark Enterprise (parent company of Highmark Health Plan and Allegheny Health Network) has also experienced: 

    • Reduced inbound call volume, because consolidating the financial experience makes patients less likely to place calls that keep administrative staff busy with benefit-related inquiries.
    • Reduced overhead costs.
    • Improved patient satisfaction. 
    • Higher levels of digital engagement.
    • An increase in the utilization of health savings accounts (HSAs).
    • An increase in patient payments within 15-30 days after implementing the Cedar platform.

4. To realize those benefits, payers and providers must be aligned on a common goal. That goal could be improving digital engagement, patient satisfaction, financial performance or any other metric in which both sides have a mutual interest. "Payer-provider collaboration is not a new concept in healthcare, but it does feel like we're at varying stages of it across the industry," Ms. Krishnan said. "We have to spend more time talking about what we can do together rather than talking at each other," Mr. Rohrbaugh said.

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