At long last, healthcare is starting to act on the realization that we must embrace a consumer approach to the healthcare financial experience. While the concept of revenue cycle consumerism has been discussed for years now, 2020 is the year when we might finally see the adoption of real solutions. That’s because next year promises to be dominated by the theme of “transparency.”
The recent White House executive order and the final rule released by the Centers for Medicare & Medicaid Services (CMS) are intended to stimulate greater consumer price transparency on the part of providers and payers. With effective dates beginning Jan. 1, 2021, we’re likely to see an enormous number of resources in the coming year aimed at driving price transparency. From a provider perspective, the letter of the rule is the key challenge, specifically the requirement that they make public their proprietary negotiated rates.
Making this information visible to both competitors and health plans is a competitive significant issue for providers — and there’s a legal fight looming. The other reality, though, is that this information will be confusing for patients and of little value in isolation, therefore making it difficult to achieve the market dynamics desired. Mapping between these published lists and a given patient’s out-of-pocket impact will require a byzantine calculus related to the specific features of the plan and the current state of his or her deductible. Forward-thinking healthcare organizations will look to overcome this challenge by taking transparency to the next level and providing patients a personalized estimate prior to care.
To achieve such true transparency requires end-to-end financial visibility — which is something few healthcare organizations currently possess and can only be achieved via a consistent and standardized process and an end-to-end technology and operational partner. The consolidation we see throughout the industry makes this more difficult with distributed technologies and processes that decrease visibility with each new acquisition introducing new data and process silos.
From a digital perspective, an increasing number of organizations might find that the most effective way to achieve full visibility across the revenue cycle continuum is with technologies and centralized operational processes that sit on top of — and thereby unite — existing disparate solutions. By enabling more complete and holistic data capture, these solutions can help organizations better gauge their outcomes and support higher quality revenue capture.
Such technologies and operational approaches will also allow providers to extend the end-to-end revenue cycle process into patient-oriented financial tool. This can jumpstart the consumer experience, an area that has been traditionally underfunded given the historical focus on payers versus patients as health systems’ key revenue driver. Patient-specific price estimation, self-scheduling and mobile check-in are a few examples of opportunities to go above and beyond the price transparency baseline and differentiate on consumer experience.
By connecting existing technologies and alleviating integration issues, healthcare organizations further put themselves in a position to adopt centralized revenue cycle management (RCM) best practices capable of actually achieving economies of scale. That’s important for the many chief financial officers pressured to find greater returns on their digital RCM investments.
In the coming months, we’ll likely see more healthcare organizations taking a thoroughly practical look at the type of technology partners with whom they work. Those touting breakthrough machine-learning or artificial intelligence solutions that don’t yet deliver value might find themselves falling short of what can be achieved using robotic process automation that explicitly addresses the high cost of labor in today’s RCM. Sooner or later, sophisticated vendors attuned to executives who feel underserved today will begin to answer the call for truly value-aligned solutions that produce substantive bottom-line results.
As the new year dawns, patients will continue to shoulder increasing amounts of their healthcare financial responsibility. That means healthcare organizations will have to think differently about RCM. In 2020, as healthcare organizations seize new opportunities to reduce friction in the patient payment process, the concept of consumer-focused transparency may now become a reality.
About the Author: Chris Ingersoll is the vice president of product development at R1 RCM.