Consumerism and the Empowered Patient Experience
By: Laura Anderson, senior vice president, RCM Product Management
There is a fundamental shift happening in healthcare. Increasingly, patients are becoming active, empowered consumers, shopping for care just like they do for any other good or service. They’re looking for quality and value. As an industry, we have the opportunity to adapt and help enhance the patient experience by providing necessary tools and information to empower the consumer, leading to better outcomes for patients, providers, and payers. Healthcare leaders who choose to cling to the old ways do so at their own peril.
As healthcare costs rise exponentially, so too do health insurance premiums and deductibles borne by patients. A study by the Kaiser Family Foundation found that since 2010, deductibles have risen by 111% and family premiums have gone up 55%. Meanwhile, workers’ earnings have risen by just 27% and inflation by only 19%.
Rising out-of-pocket costs are turning once passive healthcare consumers into active ones. They’re spending more time researching care costs and seeking value for their dollar. More and more, consumers are making healthcare decisions much like they make decisions related to other purchases—they are shopping around on the internet and evaluating quality, convenience, and value. Given the reams of data available for every other purchase they make, patients have understandably heightened expectations of how much information they should have about their healthcare providers’ quality and prices.
The transformation in how patients interact with the healthcare system has the potential to improve the industry as a whole. Across industries, engaged consumers drive better quality at lower costs. In healthcare, consumerism encourages leaders to deliver higher quality care at a lower cost to ensure consumer demands are met. This pressure benefits us as patients, it benefits healthcare providers, and it benefits healthcare payers.
Just as the travel, retail, and financial industries have done, we can leverage technology in healthcare to make it easier for patients to access services and accelerate the transformation to a more consumer-friendly system.
First, using tools such as Change Healthcare’s forthcoming Care Cost Estimator—which analyzes the millions of transactions that happen on our platforms—we can tell patients upfront what their out-of-pocket costs will be, based on their insurance coverage and deductible status. Using this information, providers can offer discounts to patients who pay their part in advance, or offer payment plans. Healthcare leaders can also think about packaging services or bundling services into a single bill. This not only improves the patient experience by offering predictability and lessening stress, but also helps providers’ revenue cycles by reducing cases of late or nonpayment.
The federal government is already mandating that hospitals publish their rates. It seems likely this is just the first step in what may be a sustained governmental effort to provide healthcare price transparency. As an industry, we shouldn’t wait for onerous and inefficient regulatory action; we should be leading the way in telling patients what they need to know.
Before visits to the physician, we can give consumers access to referrals, schedule appointments, and ask patients to complete all their registration forms and check-in with their phone, tablet, or online—whichever platform they’re most comfortable with. Patients’ preferences vary, so providers can and should personalize their experience as much as possible.
For many of us, the most complex and confusing aspects of care come post-episode of care.
Deciphering what we owe, what our health plan covers, and how that is determined can confound even those of us who work in healthcare. There’s also an issue with information overload; that is, receiving a stream of communications related to a single bill and receiving multiple bills from multiple sources all related to the same visit or episode of care. We can and should do better.
We know the design and wording of patient statements affects comprehension and compliance. These elements must be tailored to demographics and enunciated in simple terms so everyone can understand them. We can also offer consolidated bills, which eliminate the confusion of multiple bills for the same service. And lastly, many patients prefer to view and pay their bills online. It’s more convenient and eliminates paper; and frankly, it’s what everybody else in IT is doing outside of healthcare. Let’s just imagine a patient’s surprise when they receive an email with one bill that includes all the services that they received from multiple providers, coupled with the facility charges, with straightforward calculations of insurance coverage, deductible, and total amount owed.
Many changes related to consumerism and price transparency seem simple but are huge steps for the healthcare industry. Healthcare leaders who are willing to invest in patient engagement to make all these things possible will reap the benefits. The return on investment will be obvious for the patient, the provider, and the payer. Ultimately, these steps will make the healthcare system work better for us all.