Jackson Hospital, in a rural area of Montgomery, Alabama, is not immune to the significant shift taking place in healthcare finance.

THE PROBLEM

Lower insurance payments are transferring much of the financial responsibility to patients. At the same time, patients and families impacted by the COVID-19 pandemic, through job loss or furlough, are being forced to absorb more costs for even minor and routine services. 

The patient is now the third-largest payer, behind Medicare and Medicaid, said David Ralston, vice president of revenue cycle at Jackson Hospital.

"Jackson Hospital's financial risk created by these changes had to be addressed," Ralston said. "We sought to adopt modern ways to reach and engage patients early regarding financial responsibilities and financial payment options and to make arrangements.

"With our organization, we were not able to effectively reach the patient by using traditional methods of communication," he continued. "We needed capabilities that best fit the patient's communication style. We lacked the technology to communicate and conduct business with patients via the advanced technologies they demand – digital engagement."

So Jackson Hospital sought ways to communicate patient balances and payment options for services delivered that would positively impact patient collections. Goals included reducing collection costs and increasing patient satisfaction.

"Jackson Hospital is a $1.2 billion, not-for-profit, independently governed, acute care hospital in a blue collar region, populated by hardworking individuals," Ralston noted. "Our patients have an average credit score of under 600, and our population payer mix is 56% Medicare, 11% Medicaid and 6% self-pay."

When he arrived at Jackson Hospital in 2019, Ralston quickly realized the facility was many years behind in revenue cycle processes and technology. It did not have patient-friendly statements or a robust patient engagement process, and it lacked digital engagement capabilities.

"We are beating our performance metrics, and our patients are more satisfied with the services before, during and after their care is received. Embrace the change. Your patients and community are ready for it."

David Ralston, Jackson Hospital

"The organization was falling short of the industry standard for best practices in patient billing, follow-up and collections processes," he recalled. "We needed to act quickly and boldly to make transformational changes to continue to effectively provide services to the population that we serve."

PROPOSAL

Ralston turned to Firstsource, the vendor of the MGagement digital patient-engagement solution. The vendor proposed its full-service solution, which includes technology and support services.

"The plan included the collaboration of building and delivering a digitally based, patient-focused financial service center that would make Jackson Hospital the provider of choice for the community by offering an efficient, high-touch, low-impact patient service and collections process," Ralston said.

The plan aimed to:

• Leverage effective communication capabilities that would improve and increase the right-party contact rates, drive patient engagement and improve patient satisfaction, pricing transparency, ease of use, cash collection and performance.
• Provide multiple methods of patient payment, and provide payment options.
• Enable access to deep-dive analytics of the data, which helps identify additional sources of payment (such as disability, worker's compensation or third party liability).
• Improve cash flow performance that meets and exceeds financial targets through a collaborative partnership.

Jackson Hospital deployed MGagement as a complete solution, with both technology and service-model support.

MEETING THE CHALLENGE

The hospital quickly moved to stand up and deploy digital patient outreach through text and email to engage patients.

"The marketing team created a communication and education plan to inform patients and families of the opportunity to engage with text messaging and email using phones and tablet devices," Ralston explained. "Compliance ensured policies for digital engagement were updated, reviewed and in place."

The IT organization jumped in to provide the requisite patient demographics from the Allscripts EHR and to ensure all security components were addressed and compliant.

"Patient financial services rallied around this initiative and embraced Firstsource," Ralston noted. "We knew we needed to modernize our processes.

"The technology and engagement strategy brought us the capabilities and outreach to improve the customer experience and financial outcomes necessary for us to continue to thrive and grow in our community, and grow the services lines that are needed for our population that we serve in the River Region."

RESULTS

"The results we are seeing include a multi-pronged solution that brought us up to the latest technology to communicate with patients about their balances. It is a differentiator within our market from larger hospital systems by providing digital communication and a high-tech service center with one business solution," Ralston said.

"We wanted to be the first with this type of technology to show that we can provide high-tech communications to go along with the advanced, high-quality healthcare treatment that we provide," he added.

Financially, Jackson Hospital has experienced a reduction in the overall cost to collect. The program gave the hospital the ability to track communication patterns that best fit the generational demographics of the patient, he said.

"We have realized an overall net-cashback of 33.5% over the last 13 months for patients with a balance after insurance, for patients managed through the digital self-serve technology, with an increasing trend month over month," he reported.

"A surprising benefit has been with digital collections for Medicare balance after insurance," he added. "High participation using the digital technology has provided a 29.5% net cash back, and for self-pay payment plans we are experiencing a 40.5% net cash back. This performance has contributed to a reduction in the overall volume of accounts sent to bad debt collections by 31% over the last 12 months."

The hospital has reallocated three employees to support internal business functions and created an improved and dedicated patient-focused financial assistance program and outreach to the community. This effort has increased overall patient collections by more than 40% from the traditional communication methods of just letters and phone calls.

ADVICE FOR OTHERS

"We faced an interesting situation at our hospital that needed to be addressed quickly, and was previously neglected," Ralston said. "The mantra I had with our CFO was, 'Change or die.'

"I urge organizations seeing greater financial responsibility moving to their patients to overhaul their patient engagement capabilities to what addresses the current trend of the population."

Meet patients in the ways they communicate most efficiently and effectively by reaching out to them with the digital capabilities they use in their daily routines, as well as their preferred means of retail interactions, he advised. Let them interact with the organization with the technologies at their fingertips, such as text and email, he added.

"Our financial performance has gotten stronger," he concluded. "We are beating our performance metrics, and our patients are more satisfied with the services before, during and after their care is received. Embrace the change. Your patients and community are ready for it."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.