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Why your patients’ financial experience may be undermining your value-based care initiatives 

By John (JD) Donnelly 

Founder & CEO, FrontRunnerHC

Delivering quality patient care is at the forefront of every hospital and health system’s mission, and it’s the hope of every patient, or even the expectation of every patient, that the best possible clinical care is provided. While the patient’s clinical experience is widely viewed as a critical component in the industry’s shift from a fee-for-service model to value-based care, a second necessary component is often overlooked: the patient’s financial experience.  

With provider reimbursements linked to quality measures such as patient satisfaction scores and hospital readmission rates, the patient’s financial experience can significantly undermine a health system’s value-based care efforts and reduce profitability. A patient can have a great clinical experience, but an incorrect, unexpected, late, or confusing bill can sour their overall experience, causing them to skip their payment, seek care elsewhere, or even drop out of the care continuum entirely.

Inaccurate or missing patient information is often at the root of a negative billing experience, with the patient inadvertently becoming a data gap. A patient votes with their feet, and a negative billing experience can send an upset patient walking, foregoing the care they need. In fact, one study indicated that 93% of consumers say the billing and payment experience impacts their decision to return.

The American Academy of Family Physicians published the following in the FPM Journal: “To take care of your patients, you need to know who they are.”

These words are important to hospitals and health systems as well, and it costs time and money to fix errors in patient information and fill the gaps. Once inaccurate patient data is entered into the EHR (Electronic Health Record), the “source of truth” is compromised and significant efforts must be taken downstream to identify and correct the bad data, further perpetuating a negative impact on the patient experience.

Accurate patient insurance, demographic, and financial information is essential to ensuring the right bill goes to the right patient at the right address, or the right payer... the first time. It’s also essential for the success of value-based care and a patient-centric strategy that promotes greater healthcare equity. As patients move through their care journey inside and outside of the hospital walls, it’s fundamentally important to efficiently capture correct patient information and be able to instantly access it at any point on demand, especially if that information changes -- which it likely will.  

It has been estimated that over 2 million people in the United States switch insurance plans each month, and the complexity of Medicaid Redetermination adds to the likelihood of insurance errors. The ability to get the most up-to-date insurance information for a patient is critical to making sure they’re able to access needed care and receive the correct bill; it’s also critical to your ability to get reimbursed for the services provided. 

While it’s important that patients receive accurate and timely bills, it’s just as crucial that patients can afford the care they need – if not, they may forego the care which can also negatively impact clinical outcomes. A KFF survey found that “about four in ten U.S. adults say they have delayed or gone without medical care in the last year due to cost.”

Healthcare organizations can leverage technology that provides insights into a patient’s specific financial situation and propensity to pay to help patients get the necessary care and manage their medical bills. With the ability to view the patient’s insurance and financial information at the time of registration or service, organizations can offer options that work best for their patients, such as tailored payment plans, hardship discounts, or prompt pay discounts.

By implementing automated solutions that help ensure accurate patient demographic, insurance, and financial information is available on demand, hospitals and health systems can help facilitate a successful patient financial experience and support the delivery of value-based care. A recent report from the Healthcare Financial Management Association (HFMA) and Eliciting Insights found that “more than one-third of health system executives plan to automate two or more revenue cycle management (RCM) or finance functions” in the coming year.

The same report also states that “95% of health systems planning to purchase RCM or finance technology and services are open to considering “bolt-on” vendors outside of their electronic medical records (EMR) system.” This enables hospitals and health systems to expand their capabilities and also cater to the patient billing experience. 

Defining the patient experience as the clinical experience plus the financial experience fortifies your value-based care efforts, helping to ensure your patients follow the care continuum. As simple as this formula may seem, it can have a profound impact on every aspect of the patient’s healthcare journey.


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