6 Market Trends Leading to Patient Access 2.0

As an Engineer, I love seeing and experiencing major change. One of the things that most excites me right now is the dramatic reinvention that organizations are undertaking in pre-service departments. Long the bane of many providers and patient’s existence, with necessary but mundane transactions that often make patients cringe (asking an 87-year-old grandmother if they might be pregnant for example), these functions are going through a renaissance of sorts in many organizations. This bodes well for both patients and associates alike.


Here are 6 trends that we are seeing emerge for pre-service departments:


1. The Purpose is Changing – The purpose of “Patient Access” has largely been viewed as a transactional one of registration, insurance verification and possibly pre-certification and possibly collection of patient due portions. Now it is seen as a much more core element for organizations and being understood for its impact on network management (leakage), patient satisfaction, physician satisfaction and revenue yield.


2. Departments and Tasks are being Consolidated – To accomplish the change in purpose organizations are beginning to consolidate the key functions across the organization to create one-stop pre-service shopping for customers. In some cases, this is a physical consolidation, in others it is virtual. Tasks / departments being consolidated include:

  • Order Management
  • Scheduling
  • Pre-Registration
  • Insurance and Demographic Verification
  • Pre-Cert / Authorization
  • Patient Collections and Financial Counseling


3. Automation and Technology are Creating New Options and Roles – Technology and automation are being added at a rapid pace. Automation of the verification and demo checks and auto-dial technology increase efficiency and lower error rates. Self-scheduling, email, texts and chats and provide patients more options, allowing organizations to meet them in the way that the patient prefers. The other additions that hold great potential are CRMs, which dramatically increase the customer service aspect by improving the rapid identification of customers, their preferred providers and service histories. Even more they can enable outbound contact with customers to support preventive care.


4. Skill Requirements are Becoming Significantly Higher and More Broad – Technology is rapidly removing the simple repetitive tasks from humans, which means that the remaining tasks require higher skill levels to complete. This includes educating customers about their insurance benefits and what that means with respect to their patient due portions. Add to that the mindset and methods of customer service and you have an entirely new culture and skillset emerging with broader job roles for associates.


5. Pre-service Departments are Being Recognized as Revenue Impacting – The ability of the pre-service organization to impact revenue is becoming a significant topic. Keeping patients in network requires in part, rapid, easy access for both patients and physicians. Payers are aggressive in some areas of the US and are contacting patients before services to redirect them to lower cost facilities. Combined with a cumbersome entry process, why should patients be loyal? This leakage is estimated to be 10-20% for most organizations. Potential for lowering costs in the risk-based world and generative revenue in the fee for service world also exist with good preventative care outreach which can be managed through the pre-services organization if the infrastructure is designed to support the effort.


6. Yield Impact is Being Measured and Managed – Patient portions can range from 4-8% of net revenue. Denials for authorizations can easily be 10% of the total charges so the impact of the pre-service functions are significant just for these two elements. Being able to measure them precisely and break them down to understand the errors is critical to have in the infrastructure for success.

Opportunities to drive major change abound in the current pre-service areas. There will be even more change required in the future for these areas as more and more risk is incurred by providers.

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