Beyond price transparency: How to harness patients' financial profiles to boost the bottom line / HealthChoice

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welcome everyone to today's webinar i'm taylor ross with becker's healthcare we will begin today's webinar with a presentation and we'll have time at the end of the hour through a few questions and answer session you can submit any questions you have throughout the webinar by typing them into the q a box you see on your screen we look forward to hearing your questions this session is being recorded and will be available after the event you can use the same link you used to log into today's webinar

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by accessing the reporting at this time it is my pleasure to start today's webinar by introducing our presenter julie forty director of strategic partnerships at zolt data systems few people have the ability to move an organization from where it is to where it wants to be julie has been able to do just that and has been a driving force for growth throughout her career with a knack for discerning what customers value she's been instrumental in finding

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solutions that foster success and create strong roi julie greatly expanded market share and profitability for a medical coding company by embracing innovation in response to challenges related to the shift from fee to service to value in other roles she grew an indirect sales channel by 535 percent led year-over-year growth for an emergency medicine startup and helped triple the membership of a non-profit

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today julie serves as the director of strategic partnerships for zolt data systems by harnessing the unique data mining and predictive analytics capabilities of dole ar boost solution she develops partnerships that enable health systems and provides and providers to realize more revenue decrease bad debt and increase operational efficiencies at this time i am pleased to turn the floor over to julie to begin today's presentation

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well taylor thank you very much and um really happy to be here and to be able to engage with all of you around this idea of price transparency and our revenue cycle functions and how the two interrelate how we're going to meet the challenges and how perhaps we can actually find some opportunity and some silver lining within a regulation that frankly presents us with several challenges so

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let me just start with how you found this webinar today um what we described for you is that we were going to go beyond price transparency and talk about how harnessing the patient's unique financial characteristics both drive satisfaction and improve your bottom line and what we described for you in our abstract was this idea that across the country clinicians seek to obtain a complete history an exam

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a diagnostic workup before treating the patient in fact no clinician would develop a treatment plan without really understanding the individual patient's medical history and their background and their comorbidities and what brings them who are provider yet when it billing we treat every encounter the same we walk through a line that ultimately leads to the patient receiving a bill

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and often only when we hear from the patient which is rare do we begin to ask about his or her financial situation but what if we flip that what if we completed a financial diagnostic of the patient prior to sending the bill what if we actually did that prior to the encounter when we first engaged with that patient how might patient-centric workflows fall out of that how might an individualized financial

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treatment plan impact their patient satisfaction impact our ability to receive appropriate and compliant revenue and how might it help us in this era of price transparency in consumerism where we see the patient seeking more and more information from us as a health and a provider so we've promised you that as you leave today's webinar you will hopefully be able to assess

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your organization's ability to respond to the increasing uninsured population you'll be able to leverage automatic screening of patients for insurance coverage prior to the encounter identify opportunities and ways to intelligently segment your patients and move beyond just propensity or likelihood to pay that you might be able to discover the benefits of presumptive charitable screening and adaptive financial assistance and

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explore innovation solutions that allow you to meet that demand of consumerism positively shift your payer mix and increase your overall average patient collection so with that let's dive in here there is a wide volume of articles around price transparency today this is just one of many um this was in forbes by jeff gork and he suggests that he helps america's demystify the financial

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aspects of health care and i think we would all agree it is fairly mysterious how this all interplays even for those of us who understand well the interplay between coverage and payer and patient and provider and negotiated contracts and um allowable amounts and denials and appeals and all of it it is quite mysterious how it all comes together ultimately in patient financial responsibility

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he goes on to say that while a sound move forward transparency is currently contemplated is a long way from solving the issue we have started to crawl in what will be a marathon and i would have to agree with him and he describes the reason for these challenges he says healthcare pricing transparency has always been a challenge for patients who often receive treatments without a clear picture of what those treatments will cost recent innovations by

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initiatives by the cms are aimed at increasing transparency the end goal is to create a market where patients can compare pricing at different healthcare providers and make an informed decision about where they will receive care experts argue that transparency will drive higher quality lower cost care for patients but he asks is it enough to make a significant impact on health care and he goes on saying that transparency isn't a silver bullet

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for out of control health care costs he's found that there's a big difference between what a hospital charges and what a patient ultimately pays negotiations between hospitals providers and insurance companies complicate the pathway between the treatments listed price and what shows up on the patient's bill unless a patient understands how their specific treatment and provider interact with their insurance company there is no way to know what their final bill could look like in other words what you are charged and

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what you pay off caring on one another and this is where he says transparency is a step in the right direction but it's not enough if patients don't have all the answers to make informed decisions about their care and i would agree with that this is a it's kind of for us in the revenue cycle arena even we don't know for weeks or even months what a patient's ultimate responsibility is as we deal with allowed amounts

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denials appeals requests for more information review of medical records and then ultimately get to this place where we have distilled down to the patient financial responsibility and yet we're being charged with this regulation that wants us to give consumers a picture of what the price will be for a number of procedures and um that in and of itself is an enormous challenge

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that's not all we're facing if we look at our environment today we know that our payer mix is shifting and it's shifting because of the vast number of individuals who have recently become unemployed the kaiser family first foundation published in april a overview of what's happening to the american family and then what is happening to insured status if we look at the average pair mix across the country and of course this is going to vary by specialty it's going to

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vary by geographic region but we see that roughly 43 percent of folks have commercial health insurance medicaid around 16 or 15 percent medicare around 30 percent other less than five and uninsured 6.1 well that was before covid if we look now what we see in the foundations report is that between february and may 21.9 million workers

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lost their jobs or left the labor force of those 5.4 million became uninsured as a result previously the most significant insurance that we saw in uninsured adults was between 2008 and 2009 when 3.9 million non-elderly adults became uninsured and what we've seen this year is more than 5.4 million nearly half of those are in five states california texas florida new york and north carolina

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the foundation estimates that nearly 78 million people live in a family that experienced a job loss well why is that important well obviously we have more folks moving to a self-paced status but also we have a population that's going to grow in health care health related difficulties because they are like four times as likely to delay or go without care because of the cost so all kinds of downstream consequences here this is just a visual

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representation everywhere that you see that really burnt orange darker orange those are states where over 20 percent of the non-elderly population is uninsured your payer mix is shifting and not for the good additionally you're dealing with volume challenges elective procedures being declined just can you make it if you are a practice a recent survey showed that

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twenty percent of primary practices predict that they may need to close within the next four weeks according to a survey from altrum the healthcare sector lost 42 500 jobs in the month of march kovit is having a incredible impact on all of our lives but in particular in our health care sector as we must meet the demands of covid with less overall revenue coming in the door

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due to the results of loss in volume and loss in elective procedures if you are a provider you are also facing a likely decrease in the 2021 fee schedule as all of those who do not use the outpatient and office codes on the provider side will likely see a decrease due to the increase being afforded to the office outpatient codes next year so as

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you are all like me you look at this and these are not positive indicators it is a difficult environment to operate in and it makes me think of a quote by john f kennedy he said that the chinese used two brush strokes to write the word crisis one brush stroke stands for danger and the other for opportunity and he was making the point in a crisis be aware of the danger but recognize

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the opportunity and that is what i would like us to do together today there is a crisis in health care and that crisis has been brought on by the shift to high deductibles and cost shifting that really is what's driving this need for price transparency as the patient has become the payer as they are responsible for more and more of their health care even when they are insured they need better information they need an opportunity to understand

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the financial impact of their health care situation and so we both need a solution and we need some true self-paced strategies not just price transparency but how do we come alongside these patients whose responsibility is increasing if we look at the data cost shifting to patients has resulted in an average of 29.4 percent increase in deductible and out-of-pocket maximums

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over half of adults in america today would be challenged to handle a small-scale financial disruption of over 400 dollars and if you think of that nearly everything that we do in healthcare comes with a patient responsibility of greater than four hundred dollars our traditional collection solutions are no longer helping us drive margin and when you add to this all the macro economic challenges that we've just discussed

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everything is exacerbated we know that 91 of uninsured and 56 of insured out-of-pocket expenses go unpaid and the reality is that is simply untenable for you as a health care system and a healthcare provider so what can we do as we come alongside this move and this regulation for price transparency how can we capture the opportunity here and both help the patient understand

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their responsibility meet their responsibility and ultimately receive appropriate revenue for the services that we provide well i think the best way to do that is to harness the patient's unique financial characteristics the more we understand about the patient the better situation we're in to optimize the experience both for them and for the provider and so some ways we're going to talk about doing that today

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tools that help us to get their demographic enhancement insurance verification insurance discovery charitable care programs adaptive financial assistance and all of that comes together in dynamic workflow for claims our goal is going to be to eliminate the assembly line claims processing methodology where we simply take that patient information we dump it

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into our billing software we spit out a claim we deal with the payer and then we go pursue the patient and maybe even sometimes unfortunately litigation we want to move away from that assembly line approach where every claim is treated in the same fashion we want to look at each claim for its particular financial characteristics but most importantly look at that patient as an individual and how can we best come alongside them

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in a way that improves their experience and also helps us achieve our goal of appropriate and fair reimbursement so our first area to talk about today is demographic enhancement and insurance verification well why does this matter well it actually is fairly significant if we don't have the right information around the patient we're going to have a very difficult time providing them with appropriate pricing information and even more of a difficult time

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getting a clean claim out the door and getting payment both from the patient and their appropriate payer and so currently many of us either go through a clearinghouse function or manually verify who the individual is as well as what their insurance status is and what i'd like to suggest to you is that we can do better we can do better through tools that come alongside and automate this process but most importantly

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tools that come alongside and correct the errors that are natural to this process and what kind of errors do we have well we have patients who give us incorrect information we have patients who forget their insurance card we have patients who give us a partial address we have patients who aren't aware they have insurance we have patients who give us an old card an old address on their driver's license all of that incorrect information really

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poses problems in the reimbursement cycle it causes costly manual labor costs it costs delay it cash flow and there is a better way when you use the clearing house function you take the demographic profile that was given to you by the patient and the registrar you send that off and you receive a yes or no yes we found that patient or no we didn't here's their coverage and what i would suggest to you is that there's a better way

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and that is to utilize a tool that is going to take that initial profile that you receive or that you and took and vet it and verify it enhance it perhaps you didn't receive a date of birth through a tool through a data solution you're likely going to receive a date of birth maybe the address is only partial you can receive a full address maybe they didn't give your social security number you can get that social security number and when you do you now have a far

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greater likelihood that the information you receive back in insurance verification is going to be of higher accuracy and a more value to you so look for a demographic and insurance verification solution that is beyond a clearinghouse that in real time is going to enhance the information that you have often a really strong tool will do as many as 13 dynamic searches so we go out with that basic profile we now have a date of birth we're going to

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go out with that we got a better address we're gonna go out with that we're just gonna get better and better information nationally we see an enhancement of approximately 55 percent that the identity of the patient the accuracy around the patient's demographic profile is enhanced by 55 here's a sampling a random sampling of 12 500 uninsured claims from a national staffing group 59 of the encounters

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received some level of enhancement the next tool i want to talk about is insurance discovery so often particularly when the patient is coming through that outpatient door of the hospital which we know on national average accounts for 40 percent of our admissions really significant revenue dollars and lines of service to the hospital many times the patient did not know they were coming to the er today they don't have their information with them and

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as a result the registrar denotes them as being self-pay because they didn't provide insurance information today but often that patient may very well have insurance but if you don't have information you're going to be collecting after the patient pay population is going to be in large erroneously and you're going to be missing valuable dollars and in the area of price transparency when that patient comes to your price transparency portal

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if they don't have their information you're going to have a very difficult time giving them an accurate picture of their costs you might lose procedures in an era of consumerism simply because you don't have the right information around the patient so there are tools that in real time will go out search for insurance bring that back to you you want to look for a solution that will do so look for retroactive medicaid discovery you also want to look for a saloon it is

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going to provide a confidence scoring around wine it's going to share with you how confident are they that this is billable coverage whether it was primary secondary or tertiary and you also want to look for a solution that does indeed segment for you the primary the secondary and the tertiary best in class tools will do this they will also generally find active coverage on 20 of your encounters

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what does that mean for you well really important here because when i migrate a patient who is erroneously identified as self-pay to medicaid medicare commercial i'm receiving far more optimal reimbursement than what i'm collecting from the patient self-pay to medicaid about a five-fold increase to medicare about 10

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to a commercial payer 20 to 25 fold increase i do apologize for my coughing that is really significant and again this is appropriate compliant reimbursement the patient has coverage you simply were not made aware of it through your inbound process at the point of registration as the patient was taken in the ambulance

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during the pre-surgical environment and it really does represent significant loss dollars so if we look at an average emergency department across the country they have an average self-pay percentage of about 15 percent or 4 500 encounters when we apply an insurance discovery tool that's utilizing that enhanced verification information that's doing multiple dynamic searches in real time

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often in emergency medicine we will see his lift as high as 40 percent of the self-pay population having a commercial and or government payer that is billable and appropriate just on the professional side alone that represents on an annual basis for that 30 000 ed over half a million dollars imagine what it does across all of your specialties as a health care system obviously each of those has a different applicable self pay percentage

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but you have patients who have not provided their information who may not be aware of their information for a variety of reasons and you simply want to do your best to find that coverage in a seamless and easy way if you are a private practice i noticed in our attendees we have a number of folks who are here from the private practice sector in a routine payer mix across the country that's going to be about a 10 self-pay population for an average sized practice that's

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going to be around 4 600 encounters a year even at that lower billable charge of an outpatient average claim we're going to see a lift of over 30 000 just from migrating folks who didn't bring their insurance information who haven't provided that insurance information in this case on average in a private practice for just a primary care physician you're going to be able to migrate about

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11 of the patient population that was previously identified erroneously as self-pay to either a government or a private payer again just a substantial lift a side note here for those of you in the health care systems part of the hersakova 19 uninsured program one of the requirements is that you must verify the uninsured status before submitting the claim an insurance discovery tool will check

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this box for you it's one of the few ways to truly check the box that the patient has given you accurate information we know sometimes the patient simply doesn't and the hersa program is requiring you to verify that they are uninsured before you send that claim in this is a really an ideal and easy way to do that through an insurance discovery tool another tool for you as we look for this self-paced strategy to maximize and improve reimbursement

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is deductible monitoring real-time automated deductible monitoring tools exist they create logic around acceptable filing windows for you as a care system and provider it helps you drop the claim surgically we tend to have a goal of a certain number of arbitrary days and as we have financial information around the patient i can begin to surgically drop claims drop claims at the point that is

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most optimal given this patient's background and characteristics one of those being the deductible i want to counteract that shift from patient responsibility and costly self-pay collection activities 60 of patients fulfill their deductible within 17 days of an inpatient or outpatient admission depending where i am as a provider or health system if i monitor that i can be dropping my claim

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after the fulfillment rather than before and now i'm not having to go through the costly collection efforts to collect from the patient so this is a tool that's available it is a tool that makes a difference and we move beyond that mindset of i've got an assembly line and i'm going to drop a claim within a certain number of days to i'm going to drop a claim at the optimal point to assure appropriate and compliant reimbursement here's where this really begins to make a significant difference

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insurance discovery moves the needle in a powerful way the deductible monitoring really can move the needle for you but what begins to get really exciting in this consumerism marketplace is being able to do charity care and adaptive financial assistance what if the patient financial engagement could be customized in the same way that clinical treatment is adjusted to meet the specific attributes of the patient if i have this financial diagnostic

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before the counter occurs at the time the encounter occurs i now can have a real-time interplay between my two programs between the patient's responsibility in a transparent environment i can offer them both the true price and any assistance they might compliantly uh be available to them and where this really becomes exciting is with adaptive financial assistance the key premise here is that patients do

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not pay when financial assistance is insufficient either because they can't or because they elect not to however if the amount of financial assistance is targeted precisely to the patient's circumstances and that's the key not just that you have a program but you have a program that is targeted to this patient and their financial circumstances they are more likely to play in full given their own behavioral and affordability characteristics

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and their payment plan levels will help providers achieve the highest possible revenue so here's how this interplay works i have the information of an insured patient i have their probability of payment i have the price that i wish to charge for this procedure that is our charge for this procedure and what i expect to receive from the patient

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and there is an interplay here as the price is adjusted to meet the financial character traits of the patient their likelihood to pay improves their likelihood to meet their responsibility improves and so i'm actually billing smarter not necessarily more i might actually be billing less but i am receiving more because the patient sees their ability to participate

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they're not immediately put off by my ask my ask is appropriate to their ability and that has been based compliantly on the information that i received around the patient and therefore it meets the requirements for a charitable and discounting program so what does this look like in results in a study afa generated 83 per account revenue increase for

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uninsured patients and 22 for the insurer for their responsibility in other words when i ask the patient for a specific amount that has been tailored to that pinpoint of their ability to afford and the charges for the procedure i now am greatly increasing their likelihood to fully meet their obligation and in fact an 83 percent increase for the uninsured

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and a 22 for the insured around their responsibility what ultimately is a doubling and a for the insured and a quadrupling for the uninsured this has a powerful impact what it tells us is that it's not simply asking for a payment plan that makes the difference it's not simply offering a discount that makes the difference but offering a payment plan and or a discount that reflects the patient's actual

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characteristics their ability to pay we're going to have a higher likelihood that we're actually going to receive that payment and maybe by asking for less we actually are receiving more which is what we see in this study how do we do this well you've got to determine a baseline and your lift opportunity you've got to swap your existing aid calculation for a mathematically enhanced one you're going to move from a small segmentation of high likelihood to pay low likelihood to

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pay to a number of categories a significant number of categories that really dive into where the patient is financially the resulting determinations are operationalized over the existing infrastructure and applied consistently just as they are now so you're utilizing the same functions but you're doing so with better information with augmented segmentation with better information around the patient and a more surgical approach to the patient's

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balance and responsibility in a large top five non-profit academic center in the northeast these practices increase performance over a five-year period by 41.9 million dollars the lift is extraordinary when you ask patients for a responsibility level that aligns with their ability to afford and pay for the care improve collections by over 35.8 million

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while also reduced to collect and then this solution incorporates the finding through the insurance discovery that saw an additional 6.1 million in insurance payments so you can see how when we bring all this together and we harness that information around the patient we ask them to partner with us in a way that they're able to approach we really do see a lift in our overall revenue in this case 41.9 million dollars

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over a five-year period and this is of course a large academic center with all of the conundrums challenges political struggles that all of us have in our health systems it can be done in deep benefit and it absolutely is worth looking into it's a powerful tool so let's talk about how we bring all of this together so i've done the insurance demographics i've verified the coverage i've discovered alternative coverage i was unaware of

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i monitored the deductible and i have a program for adaptive financial assistance where i am pre-screening either at the point of price transparency engagement or at the point of registration or procedure scheduling and that is allowing me to reap the benefit well it also allows me to do a little bit more i now can create dynamic workflows around this rather than following

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an assembly line approach to billing and getting a claim out the door i'm going to have if then scenarios if a patient is of a certain social economic level i'm going to migrate that claim into retroactive medicaid cycle i'm maybe going to run that for four weeks if a patient hasn't fulfilled a deductible i'm going to route that through deductible management i'm going to have chosen a timeline i'm going to keep looking at that deductible

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and i'm going to drop it at a certain point or when the timeline is exceeded i'm going to look at things such as because i have all this wonderful information around the patient's financial background their behavioral economic profile if they're really really low and just absolutely not likely to meet their responsibility i might move that off earlier to collections therefore i might save on the percentage

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that i send out because i'm sending it out earlier i'm getting a better better rate with my partner i also can see this person is in the window where they're very likely to create a payment and all the way through fulfillment so i'm into the payment plan sector i can see that someone else actually doesn't need a payment plan they're likely to pay in full today if asked so all of this information

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around the patient that comes in that deeper profile of the um self-pay analyzer that comes as a part of these tools i now have the ability to move the claim into the cycle that is most efficient that is least costly to me both in labor and resources and that results in optimal gain from a reimbursement perspective

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so what are the foundations of a customized financial engagement solution well i need to have that diagnostic financial analytics right i've got to have the tools i've got to have the insurance demographics i've got to have the insurance verifier i've got to have a self pay analyzer i've got to have work through my workflow and then because of that i have data driven evidence-based workflows that show me that making this action step is really going to result in a better

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circumstance for both the patient and myself the provider and then i need to measure all of that right i need to have a really strong business intelligence performance system that's going to provide me with the reporting and the metrics to be sure that those data-driven workflows are indeed the right step right so a foundations of a foundational level a customized financial engagement solution when i'm really wanting to harness interest preparation

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i've got to procure tools those tools have got to be data driven and provide me with evidence-based workflows and then i've got to have the metrics around it to measure am i truly being more successful am i truly achieving better gain what are the benefits when i do that what we see is we look at these tools nationally increase provider health system revenue expectations there is absolute lift like we saw with the

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academic center in the northeast seeing over 41.9 million dollars in five years like we saw with just the uh private practice seeing an over thirty thousand dollar lift or the emergency department group seeing over half a million dollar lift on an annual basis we really see that lessened effects of systemic don payment lower collections cost lower efforts in what you've got to do

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to collect from the patient we see increased patient satisfaction if you've given me a better perspective of what i'm going to owe if you've met me in a way that represents me as an individual you understand my situation i have tangible evidence that you care about me you're aware of my situation and just like you were wonderful my clinical treatment and brought a treatment that was focused on what i needed you now i've done the same financial

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treatment you come to me you know that i can partner with you rather than just beating me over the head about this bill or this responsibility that i haven't yet paid and so what you see is just healthier financial relations between the providers and the patient and the payers because we have better information up front in our claims we have a lower denial rate there's all kinds of downstream benefits to getting the information correct from

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the beginning to having the right information around the patient and leveraging that information to benefit the entire reimbursement process so let's talk about what this would look like in just a flow i would start with that demographics right that very first point the patient gives me information i'm going to be sure it is correct and i'm going to enhance anything i might need to i'm then going to verify their coverage i'm going to go out and look for

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additional coverage through discovery as appropriate i'm going to monitor those deductibles i'm going to look at presumptive charitable care for that remaining patient responsibility how can i partner with this patient along the guidelines of our charitable giving program at our health system let's take this a step even further i might do adaptive financial assistance really target that financial assistance to the exact level that is optimized for that

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particular patient and that's when i'm going to present a bill to the patient and certainly these are key steps and it can seem like a lot but the reality is it is possible for all of this to happen in real time simultaneously with price transparency as you are building your price transparency solutions and you're moving towards providing information to the patient that really allows them

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to make an educated decision these are the pieces of the puzzle that you need to give them correct information you need to fully understand who they are you need to fully understand their payer relationships who are the payers what coverage do they have and what is their responsibility and once you know their responsibility you need to understand their ability to meet that responsibility and how can you best partner with them all of that

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can happen in real time in the background with a price transparency solution and even without price transparency solutions for those of you who are just on the provider side you can reap the same benefits from having this unique individualized information around the patient as you're walking through your reimbursement process in a recent healthcare innovations article they noted in the title a revenue cycle revamp

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why new transparency mandates will drive chain this is going to drive change within our industry and i hope that you won't just recognize the requirements of the regulation but you will take this regulation and you will utilize it as an opportunity to have discussions around your health system to talk about how you really can move towards giving the patient the consumer the information they need to make an educated decision

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in doing so you're likely to increase the number of patients who choose you because you're giving them the information they need that is especially true if you partner with them in a way that reflects their financial situation you make it affordable and possible for them to take care of their responsibility if you'll recognize this opportunity and re-tool and look at these kinds of innovations it can and will improve both patient

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satisfaction and your overall bottom line one of my favorite quotes is from thomas edison and he said most people miss opportunity because it is dressed in overalls and looks like work i know that there are challenges in this regulation i know that retooling your process from an assembly line to dynamic workflows will take work but i really do see the

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opportunity and the benefit here both for you as a health system and a provider and our patients i welcome the opportunity to answer any questions you have around this i've also asked james zadorian to join us for the q a it is his case studies that were presented from ar exchange where they've actually put these principles into place and seen real lift so with that i just thank you for your

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time today and welcome any questions that you might have awesome thanks julie for a great presentation uh we actually have had some questions coming in um throughout which is which is awesome um and thanks again james for uh for joining us on the q a portion james again james dorian from ar exchange first question actually came in from dave bernworth you want to know the five percent of self-pay patients are likely to have um are likely to have seems unreal given that most practices drill

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down pretty seriously when a patient is first seen in an office how do you explain this and this came from earlier in the presentation i think around slides like five or six sure so practices do drill down very specifically patient provides them what i would share with you is the patient or the patient's guarantee or doesn't always have accurate information sometimes in the case of a minor they're unaware of coverage having been purchased by

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someone else sometimes they forget they have coverage i mean one of the most striking things to me was that just by the act of people receiving a new insurance card we see an uptick in in provider encounters and utilization in other words you send me a card in the mail and i go oh that's right i have insurance and i utilize it um and so we have personal dynamics where i come to an encounter and i may not bring all of my information

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i may have forgotten that supplemental coverage i may not be aware i meet the criteria for coverage i think that's particularly true with the number of folks who've just moved from insured to uninsured but what we find is that by enhancing that demographic information having the best information around the patient and then going out and looking for coverage we do find coverage and even in those practices where

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the group really feels like our registration clerks are getting everything from the patient it simply is the case that patients don't always bring everything or provide everything and errors in that process mean that insurance goes undiscovered perfect um one for you julie came in from antoinette um i understand that patients should not give a social security number or social security for security reasons how do we get social security numbers when the patient declines to answer

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such a question so there are a great deal of data repositories and so when you have a partner who provides you with a tool in that larger data data repository and there's regulation around this you must be a healthcare provider to access this data you've got to provide that information before it will be shared with you you are able to get demographic profiles that often do include the social security number

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or even correct a social security number all right we have another one came in um this one actually for james how difficult are time resource consuming is it to set up a customized financial engagement solution yeah thank you it usually takes by the time we collect data from a health system or a physician practice um it really doesn't take uh it takes probably about two to three weeks to kind of do the analytical work to understand what the economic abilities

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of those patients are and then map that back to the expected revenue in relation to those economic capabilities and then from that we start building models in terms of what the optimal uh discounts or price points should be or finance plans for each patient and that takes collectively uh matt about two to three weeks to go ahead and do that and then operationally uh we simply just take those uh algorithms and then embed them into the existing workflows so if folks

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were to come in uh tomorrow to a physician practice or a health system and we had did that work uh that i referenced a minute ago uh the output every patient would have a uh flag relative to his or her uh you know idealized treatment strategy and adjusted um payment plan or finance option or even strategic discount to the extent uh they're eligible for one and they would be operational immediately thereafter and uh the whole thing sits on top of the existing rcm assets so you don't have to

50:39

and it works in an epic system or athena system etc so you don't have to go ahead and you know work out of two different systems so it's about two to three weeks to go ahead and do the analysis set the modeling and then thereafter we're operational uh uh uh you know immediately thereafter awesome thanks jim um a question came in from stacy robertson i have found that private practice providers are reluctant to name a cash or self-pay price for services why do you think that is and what do you suggest

51:12

well i think that there's a lot of concern and misunderstanding around the regulatory environment and what we are able to do in discounting and not able to do in discounting and so a provider who doesn't feel really confident that is perhaps going to shy away from that one of the wonderful things is that by obtaining the

51:43

self-pay analyzer information and embedding that into your charitable giving program your discount program and making that public you have met the regulatory requirements the key is that if someone presents with the same characteristics they receive the same kind of discount the problem is not counting discounting without an established criteria without treating each patient the same as in taking them through the same

52:15

process to come to result that if i present with identical information i'm going to receive an identical charitable discount result and so for a lot of providers if they're not aware of that they've gotten very scared by false claim act and other items that are widely spoken about in compliance arenas and those are important um but they were never meant to keep clinicians and health systems from partnering with someone who had a financial need there is a compliant way

52:46

to give a discount for payment immediately at the time of service even just a cash discount that has to be published it has to be tied to the costs associated with collecting on a claim it must be reasonably tied that's just i could give that to anyone based on paying cash at the time of service and that can be compliant or perhaps someone meets the criteria for our charitable giving program and we're going to walk them through that and come to a result both of those are compliant ways to

53:19

handle discounting and give a patient a specific and clear price provided you've got the information available to you if i could just add to that i appreciate the sensitivity on the physician provider side but uh you know all candor it's becoming increasingly difficult not to go ahead and meet folks where they are relative to their expectation to have visibility into price and you know just everyday consumer

53:49

activity going to the grocery store or going to you know any type of transactional activity it's impossible to really make a good decision if you don't have visibility into that so more and more consumers are requiring prices of fundamental you know right or literacy when they're coming in for their care and i think the key to julie's point is is working through the mechanics of how do you go ahead and provide the right prices in a way that the consumers can afford them and our bet is that you know the health systems and physician practices that take that you know as a core competency moving

54:20

forward are going to be best suited to go ahead and compete retain and attract new business and ultimately be able to understand what their consumers can afford and thereby work with them financially in such a way that you have a great financial outcome awesome thank you both for for comment on that one um one uh comment actually came in from uh below thomas um just wanted to make a comment actually 100 sure about that insurance card in the mail it's it's definitely validating because i think we've all been there um getting that card in the mail or we don't know it's in the mail coming to us

54:53

um i had a question in here from donna what has been your experience with media or medishare or christian ministry services as paying for services or holding patients responsible for non-payment so what i would share with you is that i am aware of them as a payer they have unique policy provisions that their [Music] members agree to and in a very similar

55:30

fashion if we have that information we can find out the information around what they are willing to pay agreeing to pay and then get to a place where we understand what the patient's financial responsibility is and then all of these same parameters apply so a little bit different kind of a payer but still the same kind of scenario that the key is let's make sure we've got the right information around the patient find out the right information around the patient's benefits

56:00

and then determine how to walk with that patient through their responsibility awesome thank you julie a lot of questions here we're trying to get through as many as we can so please keep adding and just you know if we don't get to your question we will try to find your email and email you directly with an answer another question came in from dr brenda in a scenario where there is a shift towards self-pay how can we facilitate discount categories without affecting the revenue target

56:32

is it advisable to cater to different financial category of patients at the same provider how can transparency be catered to in such scenario john do you want me to take a shot at that absolutely have at it when you think of discounting as a strategy uh or what we call right pricing right it does no good to assign a price or send out a bill if the patient's got a low probability of paying and ultimately doesn't pay and then you've got a whole variety of

57:06

back end collection uh you know activity that ultimately doesn't result in much in the way of of revenue right so the way that uh we suggest that if you think about on the acute side charity care or presumptive charity care there's lanes in which patients fall into relative to their economic means and those lanes for those folks on the acute side understand those are based on economics relative to family size and household income and then you get a category a categorical discount relative to where you fit what we've realized is that those

57:38

categories are too broad and not really defined to the individual so to answer the question very specifically what you're doing is you're looking at your patient population economically as a whole and then you're looking at the means and ability for folks to pay and you're putting those people into these more tailored discounts uh and the the premise behind the discounting is if you're actually discounting someone you have a greater chance of grading uh creating greater revenue so it's a little bit paradoxical in that regard but people will opt out and not pay for a amount they

58:09

simply can't seem to to afford but they're more likely to pay at a lesser amount it's something that's within their reason and as a result of that you've got two options from an economic perspective you can build at the full amount and expect zero or you can bill at maybe a fifty percent discount and expect a hundred percent of them paying at that fifty percent discount so economically it makes sense and from a discounting perspective you're simply using the same methods that are used on the acute side and the charity and financial assistance uh lane and you're simply creating greater degree of precision in terms of how to define

58:40

those categories sliding people into those categories relative that are economic means and then creating a you know a mechanism for them to go ahead and meet those obligations either through tailored finance or a customized payment plan and when you do that you know you get back to those statistics julie reports earlier you know 83 in overall payment 22 on the insurer 83 on the uninsured so it's really a tactical strategy that you want to play put in place relative to meeting your patient's obligations and then getting the greatest degree of

59:10

revenue confidence associated with it awesome thanks jim on that one another question we're going to try to hit a few quick ones here um there are quite a few pieces to financial optimization slide you showed are there solutions available that cover most if not all of them that's a great question and and yes there are there are solutions available that bundle the demographic verification the enhancement the insurance discovery

59:42

deductible monitoring and then move beyond that even and get into the adaptive financial assistance so i'm happy to share those with you in a dialogue um privately and but there are solutions out there that are effective that are cost effective and truly it's amazing to me you can get back all of this information in about 45 seconds and so it doesn't in any way delay your clinical care and it also works really well in a website

01:00:14

and um you know there are their best practices to look at when you're looking at these solutions but there are a number of solutions on the market today and we'd be happy to help walk you through those awesome thanks julie and one other one here um from kelly um this is uh kind of specific on on counseling but it says who pays counseling that is caused by cps um she's raised grandkids and now they are put back with um it looks like a parent possibly she wants to know who would actually be paying that counseling caused by cps who

01:00:46

would be doing do we have an answer for that one by chance so that's a little bit beyond your general insurance benefits if if the patients care is met medical health provision of coverage then the coverage would cover it for example if the patient has a diagnosis of anxiety depression and you have mental health coverage then likely the payer would provide for that otherwise it's like everything else if your insurance plan does not cover that in

01:01:18

the benefits overview then it would be an out-of-pocket expense for the patient's guarantee or unfortunately now that's the best information i can give you around that one and apologize for that difficult situation that's very hard yeah um it looks like i believe we're out of time on that so taylor i'm going to send it back over to you to kind of close us up thank you so much i want to thank julie uh for your excellent presentation and

01:01:50

gold for sponsoring today's webinar i hope you enjoy the rest of your day and we look forward to having you join us for future fun and webinars thank you thank you you

Beyond price transparency: How to harness patients' financial profiles to boost the bottom line

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