2019 has seen the continuation of a healthcare trend that has been hot for many years: Patients becoming more involved in their own care, and IT that can help boost this engagement.

Patient engagement, empowerment and experience are becoming key imperatives of modern healthcare delivery. And healthcare provider organizations are reaching out to patients in many and varied ways to get them in line with their care teams to enable the best possible patient outcomes.

This year saw a variety of hospitals and health systems deploying innovative strategies and technologies in the field of patient engagement. And their efforts are achieving positive results.

Price transparency

One area in the patient experience that needs improving is price transparency before patients schedule healthcare services. In fact, the Trump Administration has even mandated that hospitals make this happen by posting the prices for “shoppable” healthcare services online.

Some healthcare provider organizations, such as University Health Care System in Augusta, Georgia, are several steps ahead of this mandate.

“Basically, price transparency is a challenge that hospitals everywhere face: How to give patients fast, accurate estimates prior to scheduling service,” said George Ann Phillips, administrative director for revenue cycle at University Health Care System. “This has historically been a complicated endeavor because prices vary according to the patient’s unique insurance coverage and also the acuity of their medical condition.”

Hospital staff at University Health typically had to sift through books of payer codes and their associated payments, with no real guarantee this information was the most current. Over the years, payers began to make this information available on their websites, which was definitely a help. But it still did not translate into a scalable solution. Someone still had to log into the payer’s website and do similar research on costs.

Robotic process automation

Health IT vendor Recondo Technology proposed to University Health a self-service online price estimator, embedded on the University Health website, that anyone could use.

A patient inputs a few pieces of demographic data, the procedure code and their insurance policy number, and an accurate estimate of their out-of-pocket cost is generated in under a minute.

“This sounds so simple, many will wonder why hospitals haven’t implemented self-service calculators years ago,” Phillips remarked. “But it is a deceptively simple solution. Behind the scenes, technology like robotic process automation and sophisticated rules engines power the price estimator, and Recondo is one of very few vendors that have been doing the back-end work for years to develop such a solution.”

For example, the vendor also has a price estimate solution that works within the EHR from Epic or other hospital information systems. University Health first used that system, which laid the groundwork for then deploying the online price estimator. It’s the same technology, but patient-facing.

Estimates accurate to within 5%

The price calculator technology so far has replaced the manual process of creating price estimates with a digital solution, transitioning staff hours from performing out-of-pocket calculations to assisting patients in understanding their out-of-pocket costs and scheduling the patient for their needed healthcare services.

“Digital estimates are highly accurate, within 5%,” Phillips attested. “And patient upfront payments have been steadily increasing year over year; since the calculator was only deployed this year, we don’t have a clear metric yet to attribute to the calculator for upfront payment increases.

However, after we deployed Recondo’s first price estimator solution, which we embedded in one of our hospital information systems and was used internally to quickly generate estimates at a patient’s request, upfront payments jumped by 50% – from $3 million to $4.5 million over a period of just a few years.”

University Health found that its patients were willing to pay at the point of service if they understood their out-of-pocket costs.

Patients’ billing preferences

Elsewhere in patient engagement in 2019, Integris – the largest non-profit health system in Oklahoma – realized that its billing processes were not attuned to the economic realities many of its patients face when managing the rising cost of care.

“We lacked granular insights into how our patients prefer to manage their billing obligations and options that meet their financing needs,” said Mike Weed, senior vice president, financial operations, at Integris. “We also wanted to improve patient satisfaction and track patient feedback about their individual experiences.”

As a community-centered, non-profit, the community is Integris’ shareholder, and it’s important for Integris to maintain healthy margins in order to give back to the people it serves through investments in community programs, such as local rescue missions, schools and outreach to seniors, or wellness initiatives, such as the provider’s mobile wellness clinic, Weed explained.

“However, the challenge for statewide health systems like Integris, with incredibly large and diverse patient populations, is that pinpointing the needs and preferences of individuals is technically difficult, costly and resource-intensive,” he said.

Quality and personalization

To make that possible, a health system the size of Integris needs tools to better understand where patients are in their lives and empower them to make the right financial decisions for themselves and loved ones.

“Our vision was to create a financial experience that rivaled the quality and personalization of our clinical encounters,” Weed said. “We wanted patients to feel that they were heard and that their perspectives could change how, when and where we interacted with them. We wanted to modernize and create a self-service experience just as good as what patients received, and expected, as consumers in their everyday lives.”

Integris selected VisitPay as the technology component of this transformation. According to Weed, the platform offered an integrated system that consolidated patient bills within a unified interface and displayed visit-level EOBs alongside each provider bill.

For the revenue cycle management team, the platform’s back-end capabilities promised seamless integration with any of Integris’ billing systems, as well as with the health system’s new Epic electronic health record, while also automatically posting all transactions back into those billing systems.

“Automated segmentation capabilities and advanced analytics allows our team to actively test, configure and personalize consumer financing strategies based on our business rules and patient preferences, monitor results, and quickly adjust and evolve strategy,” Weed explained.

Longer term, Integris wanted to integrate this platform into its call center and patient access areas, for those patients who prefer to speak with a person rather than manage bills through a portal.

28% of total patient collections

The end of June 2019 marked the health system’s go-live with the new technology. To date, the health system has registered more than 8,000 patients to the self-service portal thanks to strategic efforts of the marketing and communications team.

In September, the platform processed more than $1 million in payments and now accounts for 28% of total patient collections.

“But most important, we have realized significant improvements in customer satisfaction metrics,” Weed remarked. “Patient surveys have noted measurable rises in patients’ perception of the financial experience, including setting up payment plans, making payments, registering for self-service and signing up for text alerts.”

Integris is at work on the next phases of its financial work, including a scripting campaign for the call center and email campaigns, and innovating within the pre-service area of the health system, he added.

Reducing the no-show rate

Another example of patient engagement in action in 2019 is Eisenhower Health in Rancho Mirage, California, which serves residents of the Coachella Valley, where as many as 70% of its patients are seniors.

The health system is a healthcare complex comprising a 463-bed hospital, the Annenberg Health Sciences Building at Eisenhower, and the Barbara Sinatra Children’s Center at Eisenhower, in addition to its outpatient facilities in Palm Springs, Cathedral City, Rancho Mirage, Palm Desert and La Quinta.

The clinic division reports approximately 500,000 outpatient visits annually, including areas of oncology, cardiology, orthopedics, primary and urgent care, as well as several specialty clinics.

“One of the primary challenges faced in the clinic division was addressing a no-show rate of 8% across all outpatient services — 5% within the clinic division alone,” explained Mark Steffen, chief administrative officer, primary and specialty care clinics, at Eisenhower Health.

“Manual patient reminder calls were made by clinic employees as a service to our patients,” he continued. “Clinic administration determined that approximately only 50% of these calls were actually being performed by employees due to the other priorities within the clinics or lack of adhering to standard work.”

Hooking up with the EHR

IT vendor Well Health proposed a communication platform that would consist of both automated phone and text reminders using a bi-directional interface with the electronic health record.

With a one-time integration fee, Well Health would assist the Eisenhower Health information systems team to implement the platform with a conservative goal of reducing the no-show rate by 17%, based on the outcomes of previous installations.

“The application needed to be interfaced with the Epic EHR so that data from the EHR could feed patient demographics into Well Health,” Steffen said. “And based on recommendations from the legal team, a patient must sign consent for treatment and opt in before they can receive text messages.”

Messages were standardized throughout the organization by creating “quick responses” that staff could use, thus eliminating the need for free text. Content of messages was customizable by department and then reviewed for consistency by the project co-chair and the marketing department.

No-show rate: From 8% to 2.3%

During the first eight months after implementation, the no-show rate for patients using the new technology continues to hold steady at 2.3% (down from 8%), with the orthopedics and cardiology centers achieving a no-show rate of 0.3% and 1.5%, respectively. 73.8% of all billed appointments used the Well Health reminder system.

“Clinics that used the system reported substantial savings in the time spent calling patients,” Steffen said. “For example, the Eisenhower Schnitzer/Novack Breast Center estimated three hours per day in staff time could be allocated to other functions. The Eisenhower Imaging Center estimated a greater savings of eight hours per day.”

For the month of August 2019, 42,269 outbound automated text reminders were sent to Eisenhower Health patients, and 29,287 automated calls were made. The organization achieved a 65.37% confirmation rate by patients that received at least one automated message, and a response rate of 69.14%.

“The finance department also showed an estimated net revenue increase of $158,596 through the same time period,” Steffen reported. “Subtracting the monthly cost of system utilization, Eisenhower Health is projecting an annualized net income of more than $75,000. This revenue enhancement is projected to increase to more than $260,000 if the organization can increase utilization of billed appointments to more than 75%.”

More patient engagement innovation to come

These all are excellent examples of what healthcare provider organizations can achieve in the realm of patient engagement. And there were many more examples of great patient engagement work in 2019.

2020 is sure to be filled with more provider organizations deploying IT in new ways to encourage patients to be an active part of their care on both the clinical and business sides of healthcare.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com
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