In our fall newsletter we talked about how self-pay can be turned in to a provider advantage through “consumerization.” We also discussed how Salud organizes around the patient-as-consumer via an organization-wide commitment to provide revenue cycle managed services that are “connective, predictive and prescriptive.”
This consumerist outlook was bolstered by the work of two major organizations, the Healthcare Financial Management Association (HFMA) and the Health Information and Management Systems Society (HIMSS). HIMSS has painted consumerism with a broad brush as a bold restatement of industry mission, while HFMA has adopted a more focused, actionable strategy. These approaches align, but we at Salud see a need to go further to ultimately satisfy the requirements and promises that both organizations have made to adopt a patient-centric approach in revenue cycle.
HIMSS’ ‘digital front door’
At HIMSS’ 3rd Annual Patient Experience Forum last year, sponsored by its Southern California chapter, “the patient is the center of everything” was the bold keynote statement that became the theme throughout. As an active member in both HIMSS and HFMA local and national organizations, I attended all three HIMSS patient experience conferences and was able to contrast its take with how HFMA is framing the issue.
HIMSS articulated a cumulative strategy for a “digital front door” for patient self-directed capabilities.
Multiple presentations dissecting the topic proved there’s not just a single patient engagement ecosystem, but an “ecosystem of patient engagement ecosystems.” Those include patient financial self-service, clinical self-service, wellness self-service, convenience self-service and proactive self-service. Application programming interfaces (APIs) and Fast Healthcare Interoperability Resources, or FHIR, arguably facilitate a virtual best-of-breed and potentially a self-funding patient engagement ecosystem. Also embraced were “convenience apps” such as Uber “orders” built into physician order sets, and ultra-realistic WayFinder tools so patients and family can navigate the provider premises smoothly and smartly.
More aspirational, “proactive” wellness tools such as real-time wearable monitors, patient-specific nutrition “pushes” and chronic illness interventional capabilities are available, but similar initiatives over the last decade haven’t shown much ROI.
Monetizing the path to consumerism
HFMA just recently produced a whitepaper and introduced an online tool that makes the aspiration of a patient-centric digital future “actionable.” This 34-page document, entitled “Maturity Model Measurement Tools for Consumerism in Healthcare,” includes tools to benchmark a provider’s or an entire health system’s consumerism Maturity Model Index Score (MMIS).
Where HIMSS described holistic capabilities for an end-to-end, tech-enabled, and patient-centric, self-service future, HFMA has organized its Consumerism Maturity Model into four components that will have great leverage for providers from a self-pay perspective: consumer interaction channels, quality and accuracy, consumer experience and measurement.
Salud’s services delivery model – connective, predictive, prescriptive – is a strategy that ties both to HFMA and to HIMSS, and thus satisfies the tactical as well as the strategic for our clients.
Leveraging the surge in patient pay
Salud’s hypothesis is to deploy the “patient as self-service payer” strategy in such a manner that is sustainable financially but funds in part or in whole the complete patient engagement/patient loyalty strategy for the larger enterprise.
Rev cycle innovators should be at the table in all discussions and to act as the greatest funding source and development lab for further patient engagement advancements.
Salud intersects with the four pillars of HFMA’s consumerism maturity model, exemplified as follows:
- Consumer interaction channels. Connect into current highly utilized patient channels (e.g., scheduling, results, physician communications). Add capabilities to make patient payment more understandable (estimates), convenient and affordable (self-risk-adjusted prescriptive payment plans).
- Quality and accuracy. Focus on integrity of patient data from sources of truth, deliver efficient bill generation and produce clean claims. Robust feedback should propel a self-improving cycle.
- Consumer experience. Incorporate quality ratings utilization, implement consumer feedback methods, and consider guarantees on price estimates provided as well as overall patient satisfaction.
- Measurement. Utilize HFMA MAP keys, to include insurance verification rate, service authorization rate, cash collected as a percentage of patient service revenue, aged A/R over 90 days, and discharged not submitted to payer. Factor in HCAHPS “would recommend” score. Add Net Promoter Score.
Salud improves the overall digital patient engagement experience our clients are seeking, by starting in self-pay, but with the goal of “funding as we go” for broader engagement strategies.
Salud connects the dots of the tactical urgencies of exploding patient pay balances, to the outer ring of HFMA’s consumerism maturity model, to ultimately achieving the retail experience contemplated by HIMSS’ “patient at the center of everything” superstructure of the future.