Leveraging technology and humanity to meet multiple needs
The numbers are sobering. Two-thirds of medical debt for Americans is the result of a one-time or short-term medical expense arising from an acute medical need, with 18% to 35% of consumers now faced with medical debt in collections. And as the portion of healthcare costs that falls to patients continues to grow, this problem will only get worse. The situation puts healthcare providers in an unsustainable position—seeking to serve their mission of providing the highest quality care to their communities, while struggling to capture revenue critical to their financial viability as margins constantly shrink.
As patient volume increases to catch up on care postponed during the pandemic, 96% of CFOs and revenue cycle VPs strongly agree that there is, or will be, additional strain on revenue cycle operations. That’s in addition to the strain from persistent labor shortages — 90% of revenue cycle leaders report they are experiencing a labor shortage, with up to 50% of their roles currently vacant. Taken together, it’s a perfect storm. Patient financial responsibility will continue to increase rapidly, and health systems won’t have the capacity to collect that revenue or deliver consistently positive patient experiences.
Historically, patient responsibility was a smaller portion of revenue which meant managing insurance reimbursement was a much higher priority. For patient balances, healthcare providers attempted to get patients to pay via a portal solution, which is less costly and less work for staff. Uncollected balances were then sent to early-out services to collect as much as possible before sending accounts to a collection agency or writing them off as bad debt. In today’s environment, that approach is fraught with issues that often result in higher costs, lower returns and misalignment on patient experience.
Misaligned incentives erode effectiveness
The standard approach for early–out service providers is to take over a pool of patient accounts that are early on in delinquency and attempt to collect balances. As more service providers have entered the market, it has become a commodity with few differentiating points except for price. That leaves a lot of leeway for how vendors operate to ensure profitability. Here are three common issues health systems experience:
More focus on the easiest accounts
Since they are paid a percentage of the payments collected, they have more incentive to skim for the easiest accounts. Plus, they often use unsophisticated tools, such as spreadsheets, to assess propensity to pay and manage accounts, putting even more focus on the easy-to-collect balances. Early–out providers are typically regionally focused, so they lack the ability to scale or to employ global delivery for client organizations with higher volume needs. When results are poor, health systems often bring in additional vendors, leading to ongoing haggling over pricing and services — time and money wasted with little return.
Little incentive to facilitate digital engagement
Another consideration is that many health systems offer digital payment capabilities, either through a patient portal or using a patient financial engagement platform. Even though the digital approach is more efficient and saves on labor costs, early–out vendors have no incentive to help patients adopt these tools. In addition, in some cases, providers may pay duplicate fees when a patient uses self-service, depending on how contingency fees are structured.
Disjointed patient experience
Lastly, with multiple entities involved, the patient experience feels confusing or disjointed. Instead of feeling known, valued and educated, patients may encounter an early–out provider that has little access to their records, making it difficult to provide details about services provided, insurance payments, deductibles, etc. This can undercut the health system brand and negatively affect the patient relationship a health system works so hard to establish. In addition, early–out providers don’t track patient satisfaction or net promoter scores — information critical in today’s competitive environment.
Change the dynamic with a holistic approach
Working with a strategic RCM partner, health systems have a new opportunity to change the dynamic completely. Patient Resolution seamlessly integrates with R1’s market-leading revenue cycle management platform delivering operational excellence and scale in servicing patient accounts. With patient account servicing under one umbrella, this holistic approach enables healthcare providers to address the entire patient obligation pool in a way that’s proven to increase revenue capture and improve patient satisfaction. At the same time, clients alleviate labor challenges and reduce operating costs.
The key difference is how specifically defined performance metrics are aligned to deliver strong digital engagement, higher payment rates, higher efficiency and productivity and improved net promoter scores. These metrics intersect the entire patient journey, and the health system maintains control at every step. Instead of starting the revenue cycle process at the time of billing, the process starts up front.
With best-practice processes and patient-centric technology in place, complete registration information and intake forms can be captured before the visit and prior authorizations can be secured before scheduling, making billing and payment faster and more efficient. At each point in the process, professional, compassionate service agents are available to assist patients who need help to validate insurance, understand current coverage, consider additional coverage options that may be available or understand payment options.
When health systems engage patients early in the process, they can consistently meet them where they are with both digital and human interactions. For some patients, the digital-first approach is not only comfortable but also preferred. They easily fill out pre-registration and intake forms, take care of payments and manage accounts for their entire family on their own. They may only call the service center for very complex situations. For patients who are less tech-savvy, compassionate and knowledgeable agents efficiently explain balances, verify insurance and answer questions, while offering a guided tour of the digital platform to encourage future digital engagement.
Leading with intuitive, digital self-service tools and supporting patients with personalized customer service when needed drives more digital engagement. With this patient-centric approach, our health system partners double digital self-service adoption, reach a first-call resolution rate of 85% and achieve a patient satisfaction rate of 90%+.
Ultimately, R1 is dedicated to supporting each health system partner’s brand promise of delivering compassionate care while building patient loyalty with a cohesive experience from intake through payment.
