By PatientMatters

Like it or not, the health care industry has experienced a significant shift over the past few years and will be dealing with major changes in the years to come. There are several reasons for this, including: financial pressures, declining volumes, staffing and leadership.

While some hospitals have found ways to thrive, others have struggled. In some cases, their challenges stem from a slow or inadequate response to the changing role of the patient as a consumer. A hospital’s internal and external culture can been a major factor in resisting change to position the patient as a consumer. Instead, these hospitals continue to see payers as the only meaningful purchaser of health care services — and the only way to influence cash yield.

As patient obligations approach 50 percent of a hospital’s total receivables, this behavior is no longer acceptable. It is imperative that hospitals help patients become fully informed consumers. Hospitals need to play a role in changing the common mindset that the patient’s financial responsibilities will be taken care of by someone else.

Hospitals must work proactively with patients to help them understand their services, financial obligations and payment options. Here are four ways hospitals can drive the cultural change needed to prepare an organization for consumerism — at least in regards to its patient-facing financial experience.  

1. Implement staff personality trait assessment and training
Staff is on the front line of a hospital’s patient access. They are essential to any efforts centered on improving the hospital’s patient financial engagement culture. Assessment of the patient access staff identifies members’ strengths and weaknesses and allows an organization to tailor training accordingly.

For example, PatientMatters uses a unique ‘BIRD’ program assessment, grouping staff into one of four categories: dove, owl, peacock or eagle. Once the assessment it complete, we tailor the support needed for staff members to assist them in becoming more comfortable with patient financial conversations. The next step is to develop custom scripting and training to build upon staff strengths and to further develop specific areas for the best possible patient communication.

2. Analyze patient financial behavior
Historically, the health care field has enabled patients to not pay their bill, delay their financial responsibilities or negotiate discounts, in large part because patients came second to insurers with regard to payments. To ensure the hospitals collect patient cash and in a timely manner, it is critical the hospital understands its patients’ financial behaviors.

A 360-degree view into the individual patient’s financial attributes, coupled with a detailed history on the past relationship with the hospital and its associated physicians and clinics is required to determine the following:

·         What is the patient’s ability to pay?

·         What is the patient’s propensity to pay?

·         What payment and/or coverage sources are available for the patient?

Many hospitals attempt to accomplish this though the deployment of siloed technology. While there are multiple technology solutions on the market today, most fall short of delivering a complete understanding of the patient. Many technology solutions are transactional; that is to say, they address specific activities associated with a pending or current episode of care. Furthermore, many technology solutions are either under-utilized or unreliable due to staff turnover at the hospital or flaws in the vendor’s service/support model.

Hospitals should look for a solution that integrates into the Hospital Information System. The PatientMatters’ platform is preloaded with a minimum of one year of historical patient data, charge master data and payer contract parameters. This data, coupled with real-time insurance eligibility, address and identity verification, patient estimation and credit databases, identifies the key patient financial attributes and trends.

When fully deployed, whatever technology solution a hospital selects should turn data into actionable information to drive the patient’s financial options and underlying conversation between hospital staff and the patient. Patients should be informed about their obligation, and staff should offer custom options and a clear expectation of payment communicated professionally, while expressing the appreciation a demanding customer expects.

3. Establish patient financial care plans
Once a hospital understands a patient’s financial behavior, the hospital can then work with that patient to establish a financial care plan. Clinical care plans have been around for a long time, with goals, interventions and outcomes as key elements. A financial care plan should be structured in a similar manner. For example, if the hospital has a good estimate of what will be owed and the hospital understands the patient’s ability and propensity to pay, payment arrangements can be made to fit patients and actually let them pay their obligation.

Patients matter, they always have and always will. In many segments of the country, the patient is now the third largest payer. To ensure patients and hospitals experience favorable financial outcomes, the hospital must work with the patients, insured and uninsured, to access all available coverage sources to establish a payment method that works for both parties.

By doing this, the hospital will be seen as an advocate for the patients financial well-being, resulting in improved patient satisfaction scores and improved patient loyalty. 

4. Ensure visibility, monitoring and accountability
When hospitals are all-in on changing their internal and external patient engagement cultures, how do you ensure its success? Visibility, monitoring and accountability.

Visibility implies that the hospital leadership is able to access real-time performance data to ensure all elements of the program are working. For example, through training and scripting, implementation of accurate patient estimation technology and segmenting the insured and uninsured down the right financial journey, it is fair to expect that the front line access employees will collect patient cash where appropriate and assist those patients that need assistance with ways to pay. Should opportunities be missed, it is imperative that the leadership has visibility and addresses this quickly if the internal culture is to be changed.

Access to best practices, benchmarking and real-time reports and dashboards provide visibility, monitoring and insight into the patient access processes. 

For any program of this scale to be successful, accountability from all stakeholders is essential. The hospital’s access team members and leadership need to buy in to the program and be accountable to their roles. Executive leadership, physicians and board members need to be supportive and act as sponsors of the program.

Closing thoughts
Changing culture is a big deal. It is not something that should be done lightly or something that can be done overnight. However, embarking on an internal and external patient engagement cultural transformation may be the thing that keeps the hospital viable in its community for the future.

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