Traditionally, the problems that stemmed from patient leakage centered primarily on missed revenue opportunities.
Health systems not only forfeited reimbursement for the services rendered elsewhere, but those organizations that invested in clinical alignment and community physician EHR extension programs also lost the chance to strengthen relationships with their referral streams.
Today, however, patient leakage is becoming an even bigger concern as healthcare organizations pursue value-based care models. All of the historical ramifications still exist, but with additional financial risk. When patients visit unaffiliated providers and break the "system-managed" continuum of care, organizations lose the ability to manage patient care, costs, and outcomes — which impacts overall reimbursement under value-based arrangements. Furthermore, patient satisfaction and leakage are directly correlated, which also impacts value-based reimbursement.
Value-based contracts do offer advantages to providers, payers, and most importantly patients. Therefore, to successfully compete in these models, forward-looking organizations have developed true cradle-to-grave patient access and care delivery models built on optimizing the patient experience.
Historically, the patient experience was linked to loyalty and the assumption of a longer-term physician-patient relationship. The patient experience is now viewed by many organizations as a strategic initiative not just from a competitive perspective, but as a requisite for value-based reimbursement programs.
While the patient experience is broad in overall terms, there are five central areas which align patient experience with reduced leakage:
1. Patient engagement. Creating an excellent patient experience is only possible when patients are fully engaged, which in turn is only possible through clear, seamless communication across the care continuum. In fact, communication is the centerpiece of any patient engagement approach.
Consider, for example, the frustration typically felt by patients who repeatedly are asked by multiple providers for the same information. That dividing factor can be transformed into greater sense of engagement and teamwork simply by making it easier for providers to view records and coordinate care through an EHR.
2. Timely access to services. It is no longer safe to assume patient loyalty solely on the basis of past physician-patient relationships; timeliness and ease of access are now key aspects of the patient experience. Simply put: Patients who can't get the care they want quickly and easily from one organization will go elsewhere for care.
The patient who desires a knee replacement, for instance, is much more likely to search for another provider than to wait six weeks for an appointment with one particular orthopedic surgeon. Likewise, organizations that offer the speed and convenience of "one-stop-shop" call centers for multiple requests are more likely to retain patients than those that require patients to endure numerous telephone calls to arrange care.
3. Pricing transparency. The fact that patients are shouldering an increasing portion of their healthcare bills is giving rise to a new type of healthcare "consumer." Patients now "shop" for healthcare based on quality and cost, just as they do in other aspects of their lives. Consequently, patients appreciate healthcare organizations that can clearly show them their overall financial responsibility — whether upfront through estimates or on the back end through consolidated statements.
Healthcare organizations can benefit from pricing transparency as well, since patients who better understand their financial responsibilities are apt to pay more quickly.
4. Customer service. Organizations that enjoy good patient retention typically approach the patient experience with a customer service mindset. In this regard, healthcare can learn much from the retail sector.
Hospitals and health systems can easily look from the patient perspective – simulate "a day in the life of a patient," for example – to uncover opportunities to improve the patient experience. The goal should be to create an overall favorable experience at every touch point.
5. Value-based readiness. Keeping in mind that value-based care models include patient satisfaction components, hospitals and health systems should also take steps to understand their overall readiness for value-based care. These steps might include:
Understanding the organization's payer profile and its payer-specific value-based program options.
Analyzing factors such as the reimbursement risk a program might entail, how clinical documentation might need to change, and how clinical and business workflows might be impacted.
Conducting a competitive market analysis, and considering consequences to physician-hospital alignment strategies.
Assessing IT application and business intelligence needs.
Reviewing potential effects on physician compensation.
Once the value-based readiness assessment is complete, use the insight generated to understand patient experience risk areas and to drive enhancements.
Although the practical impact of value-based care models varies widely by payer mix and geography, strengthening the patient experience is not an entirely new endeavor for most healthcare organizations. In fact, improving the patient experience is always a good business strategy, especially when it comes to preventing patient leakage.
The key is to prioritize the effort. By assessing five elements — patient engagement, timely access, pricing transparency, customer service and value-based readiness — organizations can build a patient experience that brings cradle-to-grave patient retention to fruition.
Brad Boyd is Vice President for Culbert Healthcare Solutions, a professional services firm serving healthcare organizations in the areas of operations management, revenue cycle, clinical transformation and information technology.