How Revenue Cycle Can Change Patient Loyalty. January 20, 2014

Transcription

1 How Revenue Cycle Can Change Patient Loyalty January 20, 2014

2 Agenda The Healthcare Cycle Latest Consumer Research The Business Side of Caring at Gwinnett Turning the Healthcare Cycle Positive

3 Healthcare Lifecycle Classic View Value-Based Health View Pre-Reg. Treatment Coding Billing Self- Pay Healthy Living Clinical Need / Schedule Self-Pay Collection Treatment Commercial Collection Coding / Billing

4 Healthcare Cycle and Customer Satisfaction Revenue cycle may play a key role in a positive lifecycle Healthy Living Clinical Need / Schedule Revenue Cycle Engagement Scheduling Balance due Insurance coverage Eligibility and enrollment teams Financial counselors Billing letters Outbound calling campaigns Customer service teams On-line portals Collection agencies and others Self-Pay Collection Commercial Collection Coding / Billing Treatment Nurse/physician communication Staff responsiveness Pain management Medicine communication Discharge communication Room cleanliness and quietness Overall rating Likelihood to recommend

5 Customer Satisfaction and Dissatisfaction Customer Satisfaction and Dissatisfaction Customers who rate satisfaction 5 (very satisfied) are six times more likely to buy again Twice as many people are told about a bad experience as a good one 1-5% of customers will escalate their complaint to a local manager or headquarters 50-75% will complain to the front-line personnel It takes 10 good experiences to make up for one bad one Satisfied Customers More profitable Lower cost to serve Accelerate growth Dissatisfied Customers Drive up operating costs Increase growth barriers.and so on

6 Agenda The Healthcare Cycle Latest Consumer Research The Business Side of Caring at Gwinnett Turning the Healthcare Cycle Positive

7 Connance Customer Satisfaction Survey September respondents 91% insured Fourth year in a row 2010/11/12/13 Hospital experience within last year Insurance coverage at time Understanding of the hospital bill Satisfaction with billing process Use of and usefulness of billing question support Satisfaction with clinical experience Likelihood to recommend hospital Likelihood to recommend physician

8 Customer Satisfaction with the Billing Process Customer Satisfaction with the Billing Process 29% rank 5 51% rank 3 or less Very Satisfied (5) More than Satisfied Satisfied (3) Less than Satisfied Dissatisfied (1) Source: Connance Consumer Survey September 2013

9 Customer Satisfaction with Billing Satisfaction better among BAI, but still not what we would aspire for BAI: 30% rank 5 and 50% are 3 or less Uninsured: 66% rank 3 or less and 23% rank 5 Uninsured (n=44) Balance After Insurance (n=456) Very Satisfied (5) More than Satisfied Satisfied (3) Less than Satisfied Dissatisfied (1) Source: Connance Consumer Survey September 2013

10 Customer Satisfaction with Billing by Amount Owed Balances of $100 appear to be the break point, the point where consumers really focus on performance 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Satisfactions with the Billing Process By Balance Due <$100 $100-$500 $500-$1000 >$ Very Dissatisfied Satisfied Very Satisfied Source: Connance Consumer Survey September 2013

11 Customer Payment Pattern Vs. Billing Satisfaction Dissatisfaction and failure to pay are clearly connected Payment Pattern By Satisfaction with Business Office (Balance Due >$100) 100% 90% Don't Intend to Pay 80% 70% 60% Not yet But Intend To Pay 50% 40% Paid Some But Will Not Pay All 30% 20% Paid a Portion and Intend to Pay in Full 10% 0% Fully Satisfied More than Satisfied Satisfied Less than Satisfied Very Dissatisfied Paid in Full Source: Connance Consumer Survey September 2013

12 Billing Satisfaction and Net Promoter Score Those satisfied with billing are excellent promoters but those dissatisfied with billing are detractors Fully Satisfied with Billing (5) Middling on Billing (2,3) Dissatissfied with Billing (1,2) *The Net Promoter Score is obtained by asking customers a single question on a 0 to 10 rating scale, where 10 is "extremely likely" and 0 is "not at all likely": "How likely is it that you would recommend our company to a friend or colleague?" Based on their responses, customers are categorized into one of three groups: Promoters (9 10 rating), Passives (7 8 rating), and Detractors (0 6 rating). The percentage of Detractors is then subtracted from the percentage of Promoters to obtain a Net Promoter score (NPS). NPS can be as low as -100 (everybody is a detractor) or as high as +100 (everybody is a promoter). Source: Connance Consumer Surveys

13 Billing Experience and Hospital Recommendation When billing is unsatisfying, recommendation level falls precipitously for both hospital and clinical 100% 80% 60% 40% 20% 0% -20% -40% -60% -80% -100% Of Those Fully Satisfied with Billing (5) Clinician Hospital 100% 80% 60% 40% 20% 0% -20% -40% -60% -80% -100% Of Those Dissatisfied with Billing (1,2) Clinician Hospital Recommend Go Elsewhere Source: Connance Consumer Survey September 2013

14 Intent to Return and Satisfaction with Billing Another measure of satisfaction, willingness to return connected to satisfaction with the billing office 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Billing satisfaction and Intent to Utilize Facility for Non-Emergent Care (>$100 Balance Due) Would Choose Hospital Again for Non-Emergent Care Would NOT Choose Hospital Again for Non-Emergent Care 1 Very dissatisfied 2 3 Satisfied 4 5 Very satisfied Source: Connance Consumer Survey September 2013

15 High Cost / Low Value Situation Creating a negative cycle which will be even more costly in tomorrow s accountablecare environment Cash later and lower yield rates Complaints and strains with physicians Motivation to seek care elsewhere Issues in the community grape vine More letters, postage cost More inbound calls More accounts to bad debt Higher vendor fees More customers with attitude More first-time patients / fewer repeat users

16 Agenda The Healthcare Cycle Latest Consumer Research The Business Side of Caring at Gwinnett Turning the Healthcare Cycle Positive

17 About Gwinnett Hospital System Lawrenceville Campus Acute care SNF Outpatient centers Neuroscience/stroke center Open heart Trauma Level 2 Pain management Infusion Centers Duluth Campus Acute care Inpatient rehab center Outpatient centers Bariatrics Orthopedics Orthopedic ASC Concussion Center Infusion Center

18 Gwinnett Hospital System Stats Volume Statistics: Beds 553 Discharges: 27,049 ER visits: 140,470 Ambulatory Surgery: 26,233 OP Diagnostics: 201,594 Gross Revenue: $1.85 billion Net Revenue: $572 million

19 Comments from Statewide Focus Group (not Gwinnett specific) Those people in that back office are demons I went back and forth with hospital, telling them they were billing me incorrectly, and they absolutely refused to look at it. The red tape and the difficulty in the billing office. The whole billing system is the problem. The hospital didn t file it appropriately so the insurance didn t even pay it. So I paid it, on the terms that they would get it filed appropriately and they would reimburse me. Of course, once I paid it, they never did anything else about it.

20 Questions for the Business Side of Care Do we run off patients after a good clinical experience? What do we do to help educate our patients during care about what happens next? How can we connect the dots for patients/guarantors about their bill, their insurance, what they owe? How can we make it easier or at least appear easier and more logical? What process will the consumer think is simpler? How can we make it feel more personalized?

21 Why in 2013? New Customer Potential Addition of Open Heart Program More resource focus to insured populations Support Patient Loyalty Desire to make billing experience obviously different Billing experience should NOT run our patients off

22 Program Design Principles Personal contact front & back end Operate as a connected unit Bedside approach focused on sharing financial responsibility information, not collecting Post-Discharge approach focused on how the patient and hospital can work together to resolve patient s financial responsibilities Personalized experience for our patients

23 Outline of Program Population: Bedded patients with non-government insurance Criteria: Bedside interviews by roaming Financial Counselor Communicate role of Financial Advocate in the billing office Some token of recognition for paying as requested Patients to have option to contact Financial Advocate directly (not through customer service phone line) Financial Advocate reaches out to patients proactively when insurance pays or denies Begin at Lawrenceville facility, then expand to Duluth facility Have joint meetings of this connected group of associates

24 Let Us Assist You Card

25 Customer Appreciation

26 Process Metrics: January 1 June 30, 2013 Financial Counselor Bedside Visits 1673 Patients who made a payment 23% Patients Who Declined to Pay 58% Requests for a Payment Plan 17% Requests for financial assistance 2% Collect average of $722 per patient at the bedside Collect average of $100,000 per month from these same patients after insurance pays Financial Advocate arranges average of $350,000 in payment plans per month Bad Debt has not increased for this population of insured patients as high deductible plans have risen

27 Measuring the Impact Telephone survey calls by Management Team Key Question: Did this new process give you a better billing experience than you have had with us before OR with another hospital system? No 11% Not Sure 3%

28 Survey Questions Did you have a positive interaction with our Financial Counselor who visited you in your hospital room? Yes - 100% Were you provided a Let Us Assist You card? Yes 78% Don t Remember 22% Do you find value in having the name of a Financial Advocate in the billing office? Yes 92% Don t Remember 4% Not Yet 4%

29 Survey Questions Did you contact your Financial Advocate after discharge? Yes - 61% No 39% Comments about this new process? Seemed to be less confusion Felt like the hospital was organized Felt like the hospital cared about helping the patient Obvious you want to assist us in every aspect of care Alleviates the worry on how I can pay One person will know your situation Personal contact Makes things easier

30 Survey Questions What else can we do to improve the business side of your care experience? Keep everyone on the same page Give the honest world an honest answer Keep the patient informed Have one person to go to Keep doing what you are doing Bill faster Be able to bring own meds Give more financial assistance Lower your prices

31 What s Next Reorganization of Team Structure Merge the two teams into one department with a dedicated Supervisor Sponsor Best Practice Sharing quarterly lunch meetings for the team Identify Process Improvements Incorporate HFMA s Best Practices for PFIs Design a personalized statement cycle for these patients Explore the idea of a call your insurance expert team Analyze Return on Investment Assess additional ways to thank patients Is Shop in Gwinnett card accomplishing its purpose? Determine if more resources are warranted Measure Duluth facility results Focus on more segmentation of the metrics Determine how to expand resources if warranted

32 Looking Back What was hardest to accomplish? Convincing my team that money was not the focus Setting up the metrics process What would I do differently next time? Have a fully designed plan before the start, instead of establishing process on the fly (hard on my team) Design a new job description for this group Recruit specifically for this mindset of a Social Worker Financial Counselor (we were lucky and had the right team)

33 In The End The billing experience today is a pre-registration for tomorrow visits. Our mindset must think this way! Hospitals must change from an encounter philosophy to a relationship philosophy. Satisfied patients are more likely to use a provider s services in the future as a direct result of a positive experience that exceeded their expectations. This leads to loyalty and long-term commitment.

34 Agenda The Healthcare Cycle Latest Consumer Research The Business Side of Caring at Gwinnett Turning the Healthcare Cycle Positive

35 Rise of the Consumer as Payor Patient responsibility cannibalizing within commercial plans 18 Non-Government HSA / HDHP Enrollment (Covered Lives) 16 ~8% of US Covered Lives in Private Plans (<65 yrs old) Other Large Group Small Group Individual Market Source: AHIP 2013 January Census

36 Replacing Commercial Revenue with Patient Replacing commercial revenue with self-pay has cash flow impact All Commercial Payer Paid Small Balance Self-Pay Mix Large Balance Self- Pay Mix Net Revenue $1,000,000 $1,000,000 $1,000,000 Collection Assumptions % Paid By Commercial Payer 100% 0% 0% 90% yield / cost to collect 4% Self-Pay Composition Impact of Commercial Payor Revenue Shifting to Self-Pay Number of $100 S-P bills % yield / cost to collect 5% Number of $500 S-P bills % yield / cost to collect 8% Number of $1,000 S-P bills % yield / cost to collect 11% Cash Collected $900,000 $675,000 $562,500 Cost to Collect $36,000 $42,000 $40,800 Net Cash $864,000 $633,000 $521,700 Source: hfm Magazine, Acknowledging the Importance of BAI Accounts, September 2011

37 New Exchange Patients Plans under insurance exchanges include significant patient portion Health care accessed: Hospitalized, 3 doctor visits, 20 PT visits Bronze (enrollee pays) Silver (enrollee pays) Gold (enrollee pays) Platinum (enrollee pays) Deductible $3,000 $2,000 $600 $0 Inpatient (after deductible) 50% $1,500 / admission $1,500 / admission $500 / admission Physician visit (after deductible) $50 $30 $25 $15 $5,150 $4,190 $2,675 $845 Patient Responsibility Analysis by Center on Budget and Policy Priorities, June 2013, Total Out of Pocket Expenses

38 Turning the Cycle Positive To deliver a more satisfying billing process: 1. Patients are not all healthcare billing experts 2. Deliver billing support that meets the unique needs of the patient, e.g. segment and focus 3. Root-out process breakdowns, ensure basic process integrity 4. Close the loop between business office and clinical events

39 1. Patients Not Healthcare Experts Language What s an EOB? Communications How visually attractive are you bills? Can someone not in healthcare understand them? How many different bills will a patient receive for a single visit?

40 2. Billing Process Segmentation Consumers have different familiarity and attitudes toward healthcare and healthcare bills Experienced Vs. New Proactive Vs. Reactive A few predictable payment patterns Approach should balance needs of consumer and hospital

41 2. Billing Process Segmentation Segmentation makes sure that each process feels different to the patient, consistent with their needs and hospital interest Deliver 20-30% cash Lowers operating costs Segmentation Grid Segment-Tailored Process Segment-Tailored Messages Segment Four Patient Repayment Behavior Self-Directed Day Activity 0-10 LTR A Reminder Msg Reluctant Payor Low High LTR A PT Dialer LTR A7

42 3. Process Integrity Multiple handoffs over many weeks, months or years Hospital Billing Pinball Machine Single guarantor with bills in different locations Collection Agency Biz. Office Breakdowns, confusion common and accepted Eligibility ~13% of inventory with vendors has reconciliation issue with hospital

43 3. Process Integrity Deliver more consistent patient experience end-to-end, resulting in more cash while improving process integrity Data flowing both ways Account-level Financial and activity Integrity in information across vendors Common definitions Retained Reconciled Accessible Reporting and analysis platform Exception-driven Rule driven Push up breakdowns, concerns Uncovers gaps Eligibility Vendors MVA / Work Comp Business Office Early Out Vendors Vendor Network Secondary Bad Debt Vendors Primary Bad Debt Vendors

44 4. Closing the Loop Relationship not encounters Business office is pre-registration to a next visit Connect back process to front activity Payment patterns (cash value, business office support requirements, etc.) Clinical context (recurring, patient vs. guarantor, etc.) Continuum of opportunities E.g. Free parking on next visit E.g. loyalty program E.g. Integrated clinically-based collection processes. and many others Self-Pay Collection Patient 2 Healthy Living Commercial Collection Patient 1 Clinical Need / Schedule Coding / Billing Treatment

45 Turning the Revenue Cycle Into a Strategic Asset Patient Responsibility is accelerating - Affordable Care Act (ACA) - High Deductible Health Plans (HDHPs) Organizations have an opportunity to improve Patient Engagement - Simple, clear communications - Leverage segmentation technology to differentiate your approaches - Streamline processes - Close the loop Revenue Cycle impacts are significant - Increase cash - Reduce costs - Improve productivity - Enhance the patient experience

46 Questions? Steve Levin Chief Executive Officer Connance Cathy Dougherty Vice President, Revenue Cycle Management Gwinnett Medical Center