Health IT integration may seem like a function that only connects back-end office applications that are hidden from the patient, but that is far from accurate. Integration and data connectivity have a major impact on a patient’s overall experience with your health system. This is especially true when it comes to the patient’s financial experience.
Health systems have different technologies that support different functions. There are EHR systems, patient accounting systems, systems to generate price estimates and billing communication, payment processing tools, financing technology and more. Without a reliable, integrated patient payment solution across the technology ecosystem, it’s difficult for healthcare organizations to keep all these point solutions in sync. It’s no wonder patients struggle to understand and manage their healthcare expenses.
Let’s consider a real world scenario. Suppose a patient receives a price estimate before his hospital visit. Then, he pays a portion of his cost upfront. After his visit, the patient receives a bill. The insurance adjustment is reflected, but the payment made before treatment is not reflected in the balance. Then, the patient calls the hospital business office. To try to explain the bill, the team member has to cross reference various technology platforms to find the pre-service estimate history, the patient’s payment prior to service, and the insurance filing and payment.
An integrated payment platform can address these problems. Let’s examine some other common challenges that an integrated approach can help solve.
Common Challenges Integrations Help Address:
Barriers to Interoperability
Nearly every healthcare organization has adopted an EHR system because of the Meaningful Use incentive program enacted under the HITRUST legislation. There are more than 500 EHR vendors to choose from, but many large health systems use Epic or Cerner. Together, Epic and Cerner make up more than 50% market share of the acute care market. Combined with Meditech, the three make up almost 75% of the market.
Although many healthcare organizations use the same vendor across their various facilities, many EHR systems are not integrated in real time. Similarly, the technologies that schedule patients, check insurance eligibility, generate price estimates, and accept and process payments are not integrated. Complicating matters further, healthcare organizations oftentimes have more than one EHR system in place. After a merger or acquisition, some newly combined entities choose to stay on separate EHR systems rather than migrating to a new system. Large healthcare organizations may even use one EHR system for their physician groups and another for their hospitals. Lastly, health systems almost always tailor their one-size-fits-all EHR systems to their own specifications, making each instance of the technology slightly different from others.
An Example: Denials
These nuances make it hard for RCM team members to obtain the right information in a timely manner. Let’s say a patient visits his primary care physician. From there he is referred to a specialist for surgery within the same health system. Different EHRs within the health system can make it difficult for a team member to gather the full registration information needed. These data points include a patient’s demographic information, insurance carrier, policy number, and even potential prior authorizations needed from the primary care physician. Without this information, the provider could receive denials by the insurance company. Therefore, the provider could potentially interpret the visit cost as a patient liability. These denied claims result in increased inaccurate patient liability, contributing to a poor patient experience.
No Single Source of Truth
In the prior example, the health system may have corrected the issue and resubmitted the claim. However, without an integrated patient payment solution, it’s difficult to view up-to-date bill balances and statements. For patients, visibility into their liability status is beneficial. It creates a sense of transparency and earns their loyalty. Within many organizations, there’s no single source of truth for patient payment activity. This can lead to discrepancies in what the patient sees and what your RCM team sees, keeping health systems from mutual understanding and collaboration with patients to address their financial needs.
An Example: Lack of Visibility
To illustrate this, imagine if a patient makes an online payment the morning of a scheduled visit. At check-in, a team member asks the patient to pay that same amount because they do not see the patient’s prior payment activity. This lack of visibility makes it difficult to answer the patient’s questions or offer the right support. Additionally, sorting through the various tools and workflows to locate this information in a patient’s account takes time. It could even delay the care they anticipate at this scheduled visit. This is frustrating for both team members and patients.
Without a single source of truth, patients are also more likely to discover mistakes or discrepancies in their EHR portal. These mistakes can erode trust. A recent survey by the Kaiser Family Foundation found that 1 in 5 patients spotted an error in their electronic medical records. Of those, 9% said their medical history was incorrect, 5% said their personal information was incorrect and 1% noticed billing errors.
These errors impact how patients perceive their healthcare provider. A Surescripts survey revealed that patients would be significantly more likely to recommend a provider to a friend if the healthcare organization showed competency with managing their health information. When patients doubt their personal information is being managed effectively, they may not trust their provider to manage their health condition.
A One-Size-Fits-All Patient Financial Experience
A seamless financial experience means it’s easy for patients to understand their care. It also means it’s easy for patients understand what costs they are responsible for. Patients should be able to do this from their preferred device. To deliver this seamless experience, healthcare organizations need an integrated platform that connects data from various sources.
An integrated platform connects the dots between different IT systems, including the EHR, estimator tools, insurance information, and more. Think about it this way – before smartphones, you left your house with your wallet and keys. Perhaps you had a map, GPS, notebook with a list, or written directions to your destination. Today, you can just carry your smartphone, which provides directions, contact information, lists, and even your credit card information for contactless payments. An integrated payments solution is like that smartphone. Patients can view their up-to-date bill balance, review a price estimate or their payment history, message their provider and more – all from one place.
Integrations also allow health systems to capture a patient’s communication preferences for a more tailored experience. By leveraging this preference data, along with other real-time data, health systems can personalize the patient experience. They can use data, like bill balance amount and prior payment history to tailor outreach and payment options to each patient. This helps patients find a payment option that works with their budget. For instance, health systems can encourage a patient who has a large bill balance to sign up for a payment plan with messaging on their bill. Meanwhile, you can influence a patient with a smaller bill balance to pay in full with a prompt payment discount.
Power Better Patient Financial Care
For busy RCM teams, helping patients navigate their financial responsibilities can seem manual and time-consuming. However, it doesn’t have to be. Integrated patient payment technology can solve the complex challenges that stand in the way. You can deliver a more transparent, personalized financial experience for your patients and improve revenue cycle outcomes for your organization. All you need is an integrated patient payments partner.