Patient Access as a Brand Enhancing Service – The Next Step?
In numerous conversations with healthcare provider systems, there is a common theme in progressive organizations: A fundamental shift in thinking regarding the revenue cycle and patient access. Gains in automation, ranging from bot usage to leveraging HIPAA EDI (X12) transactions and smart worklists are enabling an overall reduction in cost to collect and an ability to rethink Patient Access regarding its role and staffing.
In many organizations the revenue cycle is running on “operating system 1.X”, meaning Patient Access is mostly a task focused department for registrations, insurance benefit verification, and managing authorizations and schedules. In other words, while we would like for it to be customer service oriented, it in fact is mostly a financial transaction focused endeavor. Even with that definition, many challenges remain that must be resolved. Patient bad debt is increasing with rising deductibles, and time of service collections don’t seem to be able to keep up. High denials continue to be an issue, with ever changing requirements by the payers. Network losses abound, and issues of proper schedule management to support physician productivity are all mounting issues in many organizations.
Adding to the issues from operating system 1.X, we need to address the demands of revenue cycle 2.0, with clinical integration, episodic care through our network, and in some cases enabling disease and risk management. All of this requires a topnotch Patient Access operation.
Going from 1.X to 2.0 is difficult. The current environment is complex and changing a complex system can disrupt the fragile stability of the status quo. Staff skill levels have to go far beyond transactional competency and must include being a trusted advisor as well as teacher of terminology and financial decision making. It is shocking to realize that less than 10% of the US general population understands the terminology of their insurance benefits, much less what it means from a healthcare decision making standpoint. The Patient Access processes are not designed to provide automated support, so that the energy of the patient interaction can actually be focused on the patient. And all of this in an environment of high staff turnover.
As it happens so often when a major shift needs to take place, the first thing we should do is to take a big step back and consider fundamental questions. Otherwise we may just engage in a game of whack-a-mole. In this case: What is the purpose of Patient Access?
We believe that the time has come to redefine Patient Access. It represents the bookends of any service encounter, by being the front door to services, and with a big imprint on the last step, the bill. Patient Access will have the primacy (“It was very difficult and complicated to get an appointment”) and recency effect (“I thought I would owe $1,200 and now I get a bill for $1,900?”). This has significant brand implications.
Brand? What does brand have to do with all this?
Brand can be practically defined as, “The immediate image, emotion or message when thinking of a product or service”. So, what immediately comes to mind when we think of the provider institution in this case? Branding obviously plays a big role in an increasingly competitive market, and needs to be managed.
The challenge with managing the brand is that it requires every touch to be executed flawlessly, or the negative experience will become the memory (image, emotion, message) and thus taint the brand. This is the point where a redefinition of Patient Access becomes critical.
To be successful today, and in the future, we need to redefine Patient Access as a brand enhancing service. We need to rebuild Patient Access to deliver to a fundamentally different purpose than the one associated with a transactional environment and we need to deliver an experience.
In working with organizations undergoing this journey, the description of what Patient Access feels like becomes enlightening. For example, for one provider organization, the patient feel was described as:
“I am confident you are addressing my clinical issues, because you made the right resources and services available to me, at a convenient time”.
Another one was “I have a knowledgeable partner that helps me personally by removing and managing all barriers”.
Or, how about what Patient Access feels like for physicians: “My schedule is correctly managed by filling the time slots correctly, assuring patients are properly prepared and ready for services”.
In each case, it was a journey to move from Patient Access 1.X to Patient Access 2.0. It had to be done by reaping the financial benefits residing in Patient Access 1.X (reducing patient bad debt and denials) and pay for the journey. It was achieved by applying a rigorous transformation approach based on re-engineering, and fully engaging everyone in the organization. It was completed in 6-9 months, and created a new definition. Each journey is different, we invite you to contact us for a personal dialog to discuss what yours may look like at email@example.com.
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