3 challenges hospitals are confronting in patient engagement efforts

Providers are devoting roughly 25 percent of their investments to further their consumer engagement goals, according to a Change Healthcare survey of 340 executives across 251 hospitals. So why haven't more patients experienced needle-moving changes?

This content is sponsored by Change Healthcare.

If they want to survive, much less thrive, healthcare organizations must commit time and resources to better understand the modern-day healthcare consumer who expects the same capabilities from her healthcare provider that she finds in retail, hospitality and banking dealings. Mobility and immediacy are of great import in society, and these values are influencing patient expectations for everyday tasks, such as appointment scheduling and bill payment.   

Although health systems are committing time and resources to their consumer engagement strategies, they are only the first few miles into what will be a long and winding road. There is still ample room for improvement today in how provider organizations build and sustain relationships with their patients. In fact, many patients have not yet seen any needle-moving changes.

"Despite all this money spent on consumer experience initiatives and the new C-suite people who have been brought in to focus on this, when we talk to consumers, only one-fifth of them feel like their experience has actually improved," said Linda Glidewell, vice president of business development for the consumer payment solutions division of Change Healthcare. "Roughly the same number of people believe their experience has actually gotten worse."

In an early November roundtable discussion made possible by Change Healthcare, Ms. Glidewell and Eric Krepfle, associate vice president with Change, set out to learn what hospital and health system leaders are doing and what they need to increase patient payment and engagement. Twenty-four hospital and health system executives, vice presidents, physician leaders and other senior-level healthcare professionals gathered in Chicago for the conversation, which touched on patients' preferred communication strategies, price transparency and financial literacy.

Here are three major takeaways from the discussion.

1. The wide range of technology available today presents risk that organizations will generalize their patients' communication preferences and miss the mark. The majority of the 340 executives from provider organizations who participated in the Change Healthcare survey believe websites are the most successful way to communicate with patients, according to the Change survey. In the same survey, consumers indicated that email was actually their most preferred way to correspond with their care teams, with the website second and text messaging third. When asked to identify their own preferred way of interacting with their healthcare provider, roughly half of executive participants in Chicago said email, half said text messages and a handful said wearable devices. Zero individuals said websites.

While technology is the dominant force through which patients connect to their health teams, the variety in the responses recorded above highlights a major challenge hospitals face. Fluctuation in preference means healthcare organizations can easily make incorrect assumptions about what their patient populations truly want or need. Communication is highly personal, meaning it is worthwhile for organizations to invest in the right research, information-gathering and consumer intelligence to best understand their patients' preferences and respond accordingly.

Executive participants also emphasized how the proper forum or method of patient communication varies based on the market and patient age, demographics and preferences. For instance, a community hospital in a major urban area and a community hospital in a suburban community will see a great difference in patient portal engagement, with the former institution seeing a lower level than the suburban entity.

A number of participants illustrated the low-tech ways in which they engage patients, and how much success they have seen through interpersonal connections that do not involve smartphones or websites. These strategies are most common in urban markets and for safety-net institutions.

"We invest in community health workers," said the executive vice president and CFO of an integrated four-hospital system in a major Midwestern city. The system, which serves as a safety-net institution in its market, launched the program with the goal to provide 75 percent of its patients with health risk assessments. The system used texted patients about assessments, but did not see the desired level of engagement from that form of communication. "These community health workers went out and found those patients in the community," said the CFO.

The COO of a six-hospital system in the West said his organization, which has a high governmental payer mix, has taken a similar strategy by turning to community health workers to build and sustain relationships with patients. "They have been incredibly helpful in serving as a bridge between the hospital and someone who lives in their area, ultimately acting as a liaison," he said.

2. Hospitals' price transparency and cost estimation capabilities are ripe for improvement, possibly because they are not yet in high demand. Conventional wisdom in healthcare says the rise of high-deductible health plans is prompting greater patient concern toward the price of healthcare services. While this dynamic makes sense on paper and may some day become a palpable demand to which hospitals must answer, studies have suggested patients are not yet banging down the door for price information.

The low demand for and low use of price estimates may be one contributing factor to why few hospitals possess the capabilities to share such information upfront. It is reasonable to deduce that patients are accustomed to not knowing prices, so much so that they are uncertain how to behave even when they do have an estimate, and healthcare organizations are not changing until such passivity becomes a major and vocal command.

When asked whether they believe price transparency and cost estimation make a different to patients, the president and CEO of a three-hospital system in the Midwest said, "Studies have shown that's not the case."

For instance, a 2017 report from Accenture found few providers offer the price transparency that 91 percent of healthcare consumers seek. Yet when they do offer cost information upfront, patients do not change their behavior. In fact, only 11 percent use such information to shop around for a different provider. A study out of California and published in Health Affairs found only 12.3 percent of beneficiaries who were offered a price transparency tool used it to conduct a price search at least once in 15 months, resulting in little change to overall healthcare spending.

Other remarks from executives underscored the challenging nature of estimating the price for services that are malleable depending on a patient's health and insurance coverage and the acuity of the procedure or service rendered. Furthermore, price transparency presents a great shift to the healthcare business model. Hospitals and health systems have not competed on price in the past, and sharing estimates for services — while helpful for patients — presents an opportunity for competitors to respond.

"Sometimes you can create packages for patients no matter what," said the vice president and CFO of a 58-bed hospital in the South. "For instance, a Stork plan has payment plans for labor and delivery. The patient knows what the price is upfront. Where you get into trouble is with some of the ancillary testing or the minutiae of nuclear medicine. What do you consider your price, and what does your competitor down the road consider their price? You don't want to be on the bleeding edge and have someone down the line undercut you."

3. It is not yet clear who is accountable for patients' financial literacy, but that isn't stopping hospitals from responding. Throughout the discussion, executives noted that few patients truly understand their health insurance policies and coverage limitations. The question that the healthcare industry will continue to confront seems to be whether patients' financial literacy is the responsibility of the health insurer providing the plans, the employer through which the individual accesses the plan (if applicable), or the healthcare provider accepting the plan.

Although this roundtable conversation did not present an answer, it did provide a constructive forum for executives to share their observations on patients' financial literacy and how it can obstruct patient payment and engagement.

"A lot of patients don't understand their insurance coverage," said the CFO of a 819-bed system in the South. Enough research exists to support this observation on a national scale.

In a 2014 Kaiser Family Foundation survey, only 4 percent of respondents correctly answered all 10 questions on a quiz about health insurance terminology. Certain questions proved especially challenging for respondents' math skills and health insurance literacy. For instance, nearly 85 percent of consumers miscalculated how much they would have to pay for an out-of-network lab test when the insurer pays a certain percent of allowed charges, and more than half of respondents mistakenly believed all physicians are in-network if they provide care at an in-network hospital.

The lack of clarity about in- and out-of-network status drives a substantial amount of patient dissatisfaction. In the past two years, 30 percent of privately insured Americans received a surprise medical bill, or a bill for which their health plan paid less than expected. In that time, 1 in 7 consumers were surprised to find a physician, lab or hospital that they believed to be in-network was actually out-of-network, according to a 2015 Consumer Reports national survey.

How are organizations responding to such a substantial industry problem? Executives shared a variety of ways and guidance. The first is somewhat simple and budget-neutral: Tailoring communication styles for patients.   

"We in healthcare speak in a more professional manner, and most patients don't understand it," said the senior vice president of network development and contracting for a 16-hospital system in the West. "I know that is a big problem with insurance and payer websites, but I also think it's a big problem with hospitals. [We should] shoot to speak in 5th to 8th grade levels." 

Another CEO in the conversation noted his three-hospital system in the Midwest has "moved all the way down to the 5th grade level for literacy."

Other leaders described the anticipatory nature of efforts to help patients finance their care. For example, rather than proceed with business as usual and leave a patient with a surprise bill that he or she cannot afford, the CEO of a 25-bed critical access hospital in the Midwest partnered up to equip her patients with more financial planning options. "We see a lot of high deductibles," she said. "We've partnered with a bank to give patients a low-cost guaranteed loan, because they otherwise aren't going to be able to pay for it."


The road to patient engagement is long, and although many hospitals and health systems have made substantial progress in the past five to seven years, there's still a long way to go. As organizations' payment options, literacy efforts, communication methods and price transparency capabilities grow more sophisticated, they are likely to confront several of the questions and observations detailed in this article, which the 24 discussion participants raised in Chicago. Whichever way organizations proceed, one message applicable to all from this conversation is that healthcare organizations must invest to procure insights that truly reflect patients' preferences and needs to better meet them where they are and help them stay the course.

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