How Improving the Patient Experience = Better Outcomes Medically and Financially

Imagine having to order dinner at a restaurant without knowing the cost of each dish. That’s what we’re still asked to do with our healthcare. This is a result of archaic systems. As patients become healthcare consumers, they will demand more transparent pricing, payment options, and qualitative ratings. How will hospitals and clinics keep up?

So you are at a restaurant, and as the waiter tells you about the night’s specials, you realize that there are no prices on the menu. When the waiter finishes his spiel, you ask him how much the chicken francese is. He looks at you like you’re nuts. You ask him how much the lobster risotto special is; again, a blank stare. Has this ever happened to you? Yeah, me neither.

Like every other business, restaurants list their prices. When choosing a restaurant, we all make an almost unconscious calculation in our heads, measuring perceived quality, price, and value. The Affordable Care Act required restaurants with over 20 locations to list the calories in each menu item. Chains have complied with this regulation without much hoopla, and we as consumers are now empowered with more information to help us eat healthy (or not!).

Now think about the last time you visited a medical clinic or hospital. Did you have any clue what the services provided actually cost (aside from your copay)? How did you determine whether you were getting a good value? Most likely, you couldn’t. Yes, the healthcare system is a lot more complicated than the restaurant industry. But suffice it to say, price transparency in healthcare remains a pipe dream.

Prices for medical procedures aren’t usually listed on a legible menu; when hospitals do list prices (as they are now required by law to do), they are often buried in an impenetrable table on their website. And despite the legal requirement, the fines for noncompliance are minimal, so many hospitals don’t bother. With staffing shortages, ICUs full of COVID-19 patients, and overwhelming amounts of paperwork, it’s often not on the top of the list of urgent tasks.

But as an industry, we need to do better. Working at Change Healthcare, I have the opportunity to talk to many hospital CFOs, CIOs, and CROs. Always resource and time constrained, they have to make hard choices. What I’ve learned is that to break the grip of constant revenue cycle pressure, health systems need to automate more tasks, always with an eye on improving the patient experience. It may seem counterintuitive—using artificial intelligence and machine learning to humanize a process—but that's just what can happen if implemented correctly.

Archaic systems lead to disengagement

Indeed, that paperwork is part of the problem. Many hospitals are managing their claims manually—millions and millions of complicated transactions, each needing to be dealt with individually, without the automation that most industries take for granted.

These factors are among the many that wreak havoc on provider revenue cycle management—patients with no idea of what they’ll owe, lags in when bills actually arrive (and illegibility when they do)—all leading to an inefficient, grinding process, a process which leads to delays in payments or defaults, dissatisfied patients, and ultimately, higher costs for everyone.

Organizations unable to streamline these processes and provide a better patient experience are going to suffer. That’s because there are emerging tools to improve interaction with patients, from scheduling to pricing to aftercare. And as patients start acting more like consumers-which they will because they are paying a larger share of their healthcare costs than ever before–they will begin to vote with their feet. Providers who can provide seamless service will benefit; those who don’t will wither.

Those providers will also have slower collection cycles and more unpaid bills. It’s common sense—patients who have been engaged throughout their care journey are not only more likely to come back to the same provider but also to pay more promptly.

Crawling before walking

A successful transition to AI in healthcare won’t be easy. Widespread concerns about data security and privacy won't simply evaporate. Furthermore, health systems are not uniform so a one-size-fits-all approach would surely fail. Effective product customization requires time. Digital health companies must listen closely to consumers, investing in long-term partnerships with stakeholders. Finally, the move will require ongoing vigilance as the tension between how much companies want to control their own data versus outside organizations controlling it will always exist.

Using technology to create a better patient experience won’t happen overnight for most providers. But it is important to get moving-crawling leads to walking leads to running. Beginning to automate repetitive claims and billing tasks, using app or text-based software for scheduling and follow-up, providing pricing information and payment options up-front, any one of these measures begins the necessary journey.

Healthcare has lagged behind other industries when it comes to empowering consumers with information, choice, and flexibility. There are lots of reasons this is so–from HIPAA and privacy concerns, to the unique interplay between public and private payers, providers, and patients-but the tools we now have at our disposal, like AI and machine learning, can finally allow us to deliver more information, more clearly, to more stakeholders.

Software can determine in seconds what a patient will owe on a given procedure, based on what kind of insurance they have. Trying to do this manually takes exponentially longer and is completely impractical. We can deliver this information in a personalized way to each patient, which puts them back at the center of their own care.

It perhaps goes without saying that when a patient comes to the hospital or clinic, it is often at a stressful moment. Don’t we owe it to them to match the extraordinary care they’ll receive with a simplified, empowering transaction experience? In this way, we create loyal customers and more efficient revenue cycles; and we improve healthcare for everyone.