Tag: price transparency

The pandemic dominated healthcare in 2020, but it won’t be recognized as a reason to delay complying with CMS’ price transparency mandate, which went into effect on Jan. 1, 2021. A recent study conducted by HealthAffairs indicated that 65 of the 100 largest hospitals in America had not complied as of February 2021. And new reports from CMS suggest $300 daily fines will follow if CMS warning letters have no impact, in addition to the possible public exposure of facilities failing to be compliant. There are a number of reasons why price transparency has generated so much attention – both before and during the COVID pandemic. Consumer advocates point to other transactional experiences, such as auto and home purchases, where understanding the price is complicated, but achieved. There’s been a lot of research on price transparency’s impact on patients, as well; helping consumers understand healthcare billing reduces the stress of their financial experiences. Transparent pricing makes sense in many cases for providers, too. They may benefit from patients being able to plan for the costs of care, which can result in fewer missed payments and write-offs. For these reasons and others, price transparency has been a hot topic for the last few years. The Centers for Medicare and Medicaid Services (CMS) final rule on price transparency became effective on January 1, 2021, requiring hospitals to give patients clear information about their medical costs, including a list of charges for the hospital’s 300 most shoppable services, so patients can make informed decisions. Payers are expected to provide similar pricing information beginning January 1, 2022. The spotlight on healthcare pricing seems unlikely to dim any time soon. What does this mean for providers and payers? Price transparency is here to stay There were legal challenges made against the price transparency final rule, questioning federal authority and invoking constitutional rights violations, but the DC Circuit Court dismissed the claims in December 2020. Arguments against the current mandate are not limited to disputing legal authority, suggesting that government should not interfere with private sector pricing – and that complex pricing information could create the opposite effect of confusing consumers. In fact, many providers and payers voice support for price transparency, but not as put forward by the final rule. Despite this, consumer demand for pricing clarity before delivery of services continues to grow and current government regulation is the most far-reaching attempt so far to remedy this. A few state legislatures are moving forward with their own regulations, which could prompt more local collaborations between providers and payers to clarify out-of-pocket cost estimates. Achieving the level of transparency that CMS and consumer groups hope for will be challenging, but attempts to find common ground are growing. What will price transparency look like under the Biden Administration? Since President Biden entered the White House, the trend towards transparent pricing has continued. Provider compliance has been slow – many pointing to 12 months of battling COVID as the primary reason – prompting legislative pressure to step up audits and penalties. CMS has already started issuing noncompliance warning letters and, while it may modify the ruling under a new administration, there’s no sign of any plans to reverse the policy. Consumer action groups have voiced concerns that the regulation falls short, citing the difficulty a consumer may have trying to find pricing at provider web sites. Other consumers are limited to payer-negotiated rates and have little choice but to stick with their current providers. Making information available is likely an early step toward what price transparency will ultimately look like, but making that information easy to find, understand and act on is what consumers value – and what many providers and payers say they want to provide in a more customized, less one-size-fits-all application. A marketing strategy for price transparency As patients bear more responsibility for healthcare costs, they’ve come to expect a consumer experience that affords them greater control and choice. A Pioneer Institute study found that 70% of healthcare consumers want to see pricing information before undergoing a medical procedure. Actively communicating a commitment to price transparency can be a powerful marketing strategy to attract and retain loyal consumers. Not surprisingly, this messaging resonates more with user-friendly tools to guide patients through their financial journey and make sense of charges. Many providers believe they’re complying with the final rule but may actually be vulnerable to penalties because their pricing files are in user-unfriendly formats. A web-based pricing tool can help solve for this by offering patients accurate estimates and recommended payment plans before or at the point of service. Similarly, a text-to-mobile tool, such as Patient Financial Advisor, can send automated text messages to patients with personalized estimates and bills. Keeping an eye on healthcare price transparency More tools are now available to help patients make sense of their billing and it’s becoming easier for providers and payers to create a patient financial experience that’s supportive from the start. Not only will this help patients understand their cost of care (and with that understanding likely comes better collections performance), it’ll help reduce the risk of uncompensated care ¬– and avoid penalties as the final rule takes root. The Biden Administration’s focus on consumer-friendly healthcare services will likely keep price transparency at the forefront. What that looks like over the next few years depends on regulatory and market forces, but providers and payers alike will benefit from offering solutions that make sense for their organizations and patient populations. Find out how Experian Health’s price transparency tools could help your organization with the transition.

Providers know they need to improve their digital front door to withstand the financial impact of COVID-19, but change can feel risky, especially with so much uncertainty. Experian Health’s recent patient access survey offers a glimpse of what patients hope the digital front door will look like in 2021 and beyond. But what do providers see for the future of patient access? And are those views aligned? Providers that offer the most accessible patient access solutions in a post-pandemic world will secure greater patient satisfaction and loyalty.

How has the pandemic affected consumer attitudes around patient access? What do consumers want when it comes to accessing care? These are the questions providers must answer if they are to survive the pandemic and lay the groundwork for future financial success. Experian Health’s recent patient access survey offers a glimpse of what patients hope the digital front door will look like in 2021 and beyond. Wherever you are in the digital patient access journey, there's an opportunity to improve the experience for patients to one that will not only survive the tumult of the pandemic, but also thrive in the years ahead.

Experian Health products referenced in this blog post: Patient Engagement Solutions Patient Scheduling Precise ID Patient Payment Estimates Patient Payment Solutions To access more insights and trends, download the entire white paper:  How has the pandemic affected consumer attitudes toward patient access? What kind of digital experience do consumers expect from their healthcare provider in 2021? Are patients and providers on the same page when it comes to self-service in the healthcare journey? Providers must answer these questions if they are to improve their digital front door, boost patient loyalty and withstand the financial impact of COVID-19. While we know that a satisfying patient access experience translates to a stronger revenue cycle, change can feel risky without knowing what consumers really want. Experian Health surveyed hundreds of healthcare consumers and providers to find out what each expects from patient access in 2021, and uncovered opportunities for providers to lay the groundwork for future financial success. Survey findings: 4 revenue-boosting opportunities for patient access in 2021 1. More control and convenience for consumers Nearly eight in ten consumer survey respondents want to be able to schedule their own appointments, at any time of day or night, from their home or mobile device. They can already order groceries and view their bank accounts this way – and they want the same level of control and convenience when managing the non-clinical aspects of their healthcare. Digital patient engagement solutions allow providers to offer consumers the flexibility and accessibility they crave. Patients can schedule appointments online, complete registration from home and pay bills from a mobile device. Convenience also delivers health benefits: no-shows are less likely, and patients find it easier to adhere to care plans. And while COVID-19 remains a concern, self-service options minimize face-to-face contact, keeping staff and patients safe. Automating patient access even contributes to better collection rates, for example, by reducing errors that can lead to denied claims. 2. But don’t deliver convenience at the expense of safety and security Patients want convenience, but they also want their data to be kept safe. More than half of consumers surveyed, particularly the younger age groups, say they worry about security when accessing their personal details online. Security can be challenging for providers: they need multi-layered solutions that can adapt to security threats that evolve with ever-increasing complexity, without creating cumbersome log-in processes for patients. But with the right technology, providers can  safeguard patient data with confidence. Experian Health’s patient portal security tools use leading-edge identity proofing, risk-based authentication and knowledge-based questions to reliably verify patient identities. Patients can book appointments, register for care or view their health information. Calls to IT support are likely to drop too, saving staff and patients valuable time. 3. Contactless care requirements are driving long term, systemic change While many of these changes were already simmering in the background, the pandemic has turned up the heat and accelerated the need for contactless care. Will this be a long-term trend? Both patients and providers believe self-service technology is here to stay and seven in ten providers surveyed say they don’t expect patients to feel comfortable in waiting rooms until at least summer 2021. While face-to-face care will always be important, it seems likely that a digital front door will become the default to make the non-clinical portion of the healthcare journey easier and quicker for everyone. “As providers expand the use of patient portals, there is a huge opportunity to demonstrate the true value of virtual care – and transform healthcare for the long-term." - Tom Cox, general manager, head of product, Experian Health 4. The financial conversation between consumers and providers must be based on trust, transparency and empathy When the final bill bears no resemblance to initial estimates, patients feel frustrated and misled. With deductibles and out-of-pocket expenses on the rise, patients are demanding simple and clear pricing information so they can plan accordingly. Providers that offer consumers transparency, understanding, control and convenience when managing their financial responsibilities are going to have the competitive edge. Providers can achieve this with clear, upfront and accurate pricing estimates to help patients understand their financial obligations before their visit. Next, support to check coverage and advice on tailored payment plans will provide patients with as many tools as possible as they plan to meet those obligations. Experian Health’s Patient Payment Solutions can check for patient coverage, identify a payment plan(s) that suits a patient’s individual situation, and then make it easy to pay via a mobile device. Future provider revenue hinges on investment in digital healthcare. A welcoming, convenient and secure digital front door translates to patient loyalty, which in turn can mitigate losses in challenging times. Wherever are in digital patient access journey, there’s an opportunity to improve the experience for patients and build a revenue cycle that not only survives the tumult of the pandemic, but also thrives in the years ahead.

With high-deductible health plans, larger out of pocket costs, and confusion about medical costs in general, it’s no surprise that patients today face increased financial responsibility. Unfortunately, the current pandemic has introduced an entirely new level of financial responsibility and uncertainty for both patients and providers. Like many provider organizations across the country, Yale New Haven Health was feeling the impact of the changing healthcare landscape. Patients are finding it harder and harder to pay their medical bills, and more accounts are going to debt. The organization obviously needed to be compensated for their services and improve collections, but it needed to do so in a way that matched its mission and vision of providing high value, patient-centered care. A few years ago, Yale New Haven Health turned to Experian Health to improve collections with an elevated patient experience. With Experian Health’s Collections Optimization Manager, Yale New Haven Health was able to score and segment patient accounts based on who has the propensity to pay, determine how a patient could best resolve their bill and then direct them to the appropriate resources for doing so. The organization supplemented this activity with PatientDial, a cloud-based dialing platform that offers inbound and outbound communication options to increase collections. While these efforts have improved collections for the organization in the past, they have proven invaluable for both the revenue cycle and the patient experience during COVID-19. Increased patient satisfaction. A billing indicator was included for patients that might be experiencing financial hardship as a result of COVID-19, allowing the organization to hold that particular billing statement for 90 days. After 90 days, those accounts were again reviewed and evaluated for charity care as necessary. Patients have been grateful for the extra time and flexibility for payment during such a stressful event. Continued collections. With these steps in place, Yale New Haven Health was able to maintain the regular daily statement production and movement of accounts through the revenue cycle for those not experiencing COVID-related hardship. The additional revenue supported the institution and helped to maintain collection levels as close to normal as possible during uncertain times. Improved communications. Even with the 90-day delay for select accounts, call campaigns with PatientDial continued throughout the pandemic. Connection rates have increased by 5.5% month over month from January to present. Patients are not only pleased with the communications over balances due but are more receptive to attempts to resolve debt as the organization has approached billing-related communications in a more empathetic manner.

A consumer-first healthcare revolution has been simmering for years. Despite efforts to create more human-friendly services, the industry still lags behind other consumer-centric sectors. Patients want healthcare to be simple, convenient and on-demand, but a persistent lack of coordination, accessibility and affordability leaves many struggling to navigate the healthcare landscape with ease. Is this about to change? Has COVID-19 flipped the switch? The pandemic has prompted people to engage with their own care in a way the industry hasn’t seen before, with a surge in telehealth and virtual care. Infection-control forced much of the patient journey online, while providers were pushed to find new ways to communicate quickly and clearly. Now, those with an eye on the road to post COVID-19 financial recovery are optimizing these digital strategies to meet new consumer expectations and improve patient loyalty. Embracing digital technology and automation throughout the entire patient journey will be key to patient acquisition and retention. Where should providers focus first? 4 consumer-led strategies to keep patients loyal 1. Prioritize convenience across the entire consumer experience Eighty percent of patients would switch providers for convenience factors alone – ranking ‘convenient, easy access’ ahead of insurance coverage and quality of care. Creating a digital experience that gives patients the flexibility and simplicity they desire should be priority number one in any patient loyalty plan. Providers can start by reviewing their digital platforms. Encourage patients to use their patient portal to access information, book appointments and manage their healthcare when appropriate. Telehealth and virtual care solutions can be future-proofed with reliable identity protection, so patients can safely access care from home and not worry about cumbersome log-in procedures. 2. Make patient access…accessible The patient experience shouldn’t begin with time-consuming forms, long waits and error-prone manual intake processes. Rather, providers can make it easy for patients to complete as many tasks as possible BEFORE they set foot in the office by automating patient access. Online patient scheduling lets patients book, cancel and change appointments online – which 77% of patients say is very important. It has the potential to reduce delays and no-shows, and can minimize the administrative burden for provider staff. While patients remain concerned about the risk of infection during COVID-19, providers can ease their concerns by reducing face-to-face contact with online pre-registration. 3. Respond to affordability and pricing pain points One Experian Health study found that the top pain points in the consumer journey center on the financial experience, from shopping for health insurance to understanding medical bills. Patients may be unsure what their insurance covers, whether their deductible has been met and whether they can afford the out-of-pocket costs. By providing clear, upfront pricing information about coverage and financial responsibility, providers can protect their patients from unnecessary surprises and reduce the risk of missed payments. Self-service patient payment tools can simplify the payment process too: patients can settle their bills anytime, anywhere, and get advice on financial assistance and best-fit payment plans. 4. Personalize the patient experience from end to end A one-size-fits-all approach doesn’t cut it anymore. Patients are looking for communications and services tailored to their individual needs. That used to be both technically and logistically impossible, but not anymore. Providers today can use comprehensive data and analytics to personalize the entire healthcare journey, from customer relationship management to patient collections. By combining automation, self-service tools and accurate insights into the patient’s circumstances, providers can help consumers make better decisions about their care and how to pay for it. To ensure data reliability and integrity, providers should consider partnering with a trusted data vendor, who can translate robust, multi-source consumer and financial data into a competitive consumer experience. There is no question that COVID-19 has changed the way we do healthcare, but the industry is perfectly posed to harness the change in consumer behavior and shift towards greater patient engagement. By bringing together a myriad of digital tools, providers can create a healthcare experience that’s convenient, compassionate and in line with consumer expectations. Interested in learning more about how we can help your organization welcome new patients through its digital door, and boost loyalty among existing patients?

Few of us would buy a new car or TV without checking the price tag first. Why should our healthcare be any different? Yet this is exactly what many patients are forced to do when they need medical tests or treatment. Following the breadcrumbs on a provider’s website is a time-consuming and confusing way for patients to piece together a price estimate. Even with a rough idea of the cost of care, variations in health plan pricing often bump up the final bill. The lack of transparency is stressful for patients and costly for providers, who end up chasing slow payments and losing revenue to bad debt. But could things be about to change? Many providers have been proactive in offering transparent pricing, and thanks to recent regulatory changes, this could soon be an industry-wide requirement. The CMS Price Transparency Final Rule mandates that by 1 January 2021, hospitals should publish consumer-friendly pricing information on certain ‘shoppable’ services, to help patients understand and plan their bills ahead of time. The proposed Health PRICE Transparency Act would similarly compel providers to publish real cash prices alongside rates negotiated with insurers. As households, businesses and public bodies grapple with the economic impact of COVID-19, any additional clarity around pricing that could help make a dent in healthcare-related debt is to be welcomed. Liz Serie, Director of Product Management and Patient Experience at Experian Health, says that regardless of changes to the regulatory landscape, pricing transparency is here to stay: “It’s great for the patient because they have visibility, transparency and clarity about what they owe. They can prepare financially before their visit, so they can focus on what matters most – healing. Providers are excited about price transparency tools because they let patients pick and plan payment options, reducing the total cost to collect. And with more reliable billing data, it’s a win from a decision-making perspective too.” Transparency is becoming the norm in other aspects of healthcare consumer experience, and billing should be no different. 4 steps to fast and simple patient-friendly pricing 1. Remove the guesswork with accurate, upfront pricing estimates No one wants to play detective with their deductibles. Giving patients pricing information upfront puts them in control of their payments, improving their engagement and increasing the likelihood of faster collections – a top priority for providers today as they continue to feel the effects of COVID-19 on the bottom line. A Patient Estimates tool can generate accurate, easy-to-understand estimates based on known treatment costs, payer rates and real-time benefits data. Estimates and secure payment options can be sent straight to the patient’s mobile device, improving the patient financial experience with a single text message. 2. Give patients 24/7 control through their online portal With COVID-19 pushing even more of our lives online, a 24/7 patient portal is a must for providers that want to stay competitive. Yale New Haven Health (YNHH) used PatientSimple to give patients a mobile-friendly, self-service portal through which they can generate price estimates, choose payment plans, and monitor payment information. Sharlene Seidman, Executive Director Corporate Business Services at YNHH says patients have welcomed online access: “ROI is not just tangible dollars in additional revenue, it’s patient satisfaction and improving the financial experience.” 3. Minimize delayed payments with quicker insurance checks Millions of Americans have experienced sudden job losses or changes to their insurance status in the wake of the pandemic, causing confusion about their current coverage. Payment delays and denied claims are an inevitable side-effect. Providers can help by offering fast, automated insurance eligibility verification, so patients can confirm coverage at the point of service and take the next steps with confidence. 4. Move to mobile for a more convenient patient experience Imagine if your patients could have all the information they need about their healthcare account, right there in their pocket. Patient Payment Solutions offer real-time pricing estimates based on provider pricing, payer rates and benefit information, so patients can review their bill at a time and place that suits them. There’s also the option to offer secure and contactless payment methods, so they can settle their bill at the click of a button. Estimates suggest that the average family of four could save up to $11,000 a year if they had the option to choose care on the basis of more transparent pricing. Savings on this scale mean that demand for clear information about out-of-pocket expenses is going to soar, whatever happens with price transparency regulations. Learn how Experian Health can help your organization support patients and improve collections through more transparent pricing.

The regulatory requirements for price transparency are in full effect. The Centers for Medicare and Medicaid Services (CMS) is moving forward with the OPPS Price Transparency Final Rule (CMS-1717-F2), which states that hospitals must provide transparency that will help consumers understand medical costs and make informed decisions. At this point, it is recommended that hospitals begin to form a strategy for price transparency. The concept behind price transparency is simple: provide transparency that will help consumers understand medical costs and make informed decisions. Experian Heath's commitment is simple: provide solutions that benefit the patient and the provider, that improve collections and patient satisfaction. Discover how Experian Health can help you succeed with price transparency.

Despite the majority of elective procedures being up and running again, patients are still keeping their distance. Nearly half of Americans say they or a family member have delayed care since the beginning of the pandemic, while visits to the emergency room and calls to 911 have dropped significantly. Patients are avoiding care, but it’s not for the reason you’d expect. Beyond obvious worries about catching and spreading the virus, a second concern is becoming apparent: patients are fearful of the potential cost of medical care. With so many furloughed, laid off or losing their insurance coverage, medical care has become unaffordable for millions of Americans. It’s especially tough for those who fall into the coverage gap, where their income is too high to grant access to Medicaid coverage, but too low to be caught by the ACA safety net. If patients continue to delay care, it’s only a matter of time before their symptoms worsen, leading to more complex and expensive treatment or even risking their lives. For the hospitals and health systems with revenue levels at a record low, encouraging patients to return for routine care is a matter for their own financial survival too. The answer lies in making sure patients feel safe and comfortable both when they come in for care, and when they look at their financial responsibilities. 5 ways to ease the return to routine care 1. Reassure patients about safety measures before and during their visit Patients are understandably anxious about what their visit is going to be like. Will they have their temperature taken? What should they do if they have symptoms of the virus? Will seating areas be spaced out and sanitized? Pre-visit communications and proactive information on arrival will help them feel comfortable and eliminate the shock factor of seeing more stringent infection control measures. 2. Minimize unnecessary contact by shifting patient intake online From online scheduling and pre-registration to telehealth and contactless payment, there are many ways to keep face-to-face interactions to a minimum. Not only will this help reduce the spread of the virus, it’ll make the whole patient experience more convenient for patients. Exploring a virtual and automated patient intake experience can also free up staff to work on other tasks, thus also protecting the organization’s bottom line through efficiency savings. 3. Encourage patients back to care with automated outreach campaigns With so much uncertainty at the moment, patients may be unsure if it’s even appropriate to come in for routine care. Use automated outreach to prompt them to book appointments and schedule follow up care. A digital scheduling platform can help you set up text-based outreach campaigns, to reassure patients that it’s safe (and essential!) to come in for any overdue care – without placing any undue burden on your call center. 4. Provide price transparency before and at the point of service With healthcare experts pointing to financial worries as a major barrier to care, anything providers can do to improve the patient financial experience is an advantage. Price transparency is the first step. When patients have clear and accessible payment estimates upfront, they can plan accordingly and/or seek financial assistance as quickly as possible, reducing the risk of non-payment. 5. Screen for charity care eligibility with faster automated checks Once those payment estimates have been generated, the next step is to confirm whether the patient is eligible for financial support, in the event that they’re unable to cover their bill. Checking eligibility for charity assistance is a time-suck for patient collections teams, but with access to the right datasets, it’s a perfect candidate for automation. These steps become even more urgent as providers face the prospect of a ‘twindemic’ – or a surge in COVID-19 cases colliding with flu season. By avoiding delays to care, patients can avoid the need for more serious and expensive treatment further down the line, when hospitals are likely to be under even greater pressures. Contact us to find out more about how our data-driven, automated patient intake solutions can help make your patients feel as safe and comfortable as possible, both physically and financially.