Managing revenue cycles in today’s healthcare environment requires running a tight ship from the second a patient picks up the phone all the way to the final billing statement. There are many changes that are making revenue cycles more difficult to manage, but one specific driver is the rise of high deductible health plans (HDHPs) and out of pocket expenses. Industry data suggests that by the end of this year, the vast majority of employers with workforces of 1,000 employees or greater will offer at least one HDHP1. Consumerism is also driving HDHPs through health exchanges that now enable patients to select, from many options, the health plan that best fits their needs.
At the end of the day, this shift represents a very real change to how practices, networks, and enterprises of all shapes and sizes approach their revenue cycles. During a peer-to-peer discussion that I led today at CentricityTM Live with revenue cycle managers from across the country, the challenges associated with the rise of HDHPs and out of pocket payments were discussed in depth. Here’s what I learned:
- HDHPs and out of pocket payments are a major concern for provider practices, and capturing these revenues represents a challenge that is vital to maintaining a healthy top line.
- There are varying levels of sophistication and proactiveness in how provider organizations are managing the shift. It is clear, however, that a mix of software, services, and workflow enhancements are needed to effectively tackle the challenge.
- The shift is significant and requires education on multiple levels. Patients are often resistant to the concept of paying, sometimes large out of pocket amounts depending on the case, at the point of service and those are difficult discussions for staff members to have without the proper training and knowledge.
This is not a challenge that will be overcome overnight; as the percent of out of pocket payments continues to increase, patients and practices alike will have to evolve. Provider practices that are having early success point toward proactive patient engagement as a key success factor. Similar to how clinical discussions are being driven with patients earlier in the care process, financial discussions must also become a priority earlier. Educating patients on what their costs will be and offering personal financial counselling from the initial point of contact will help enable higher net collections and more informed, more empowered patients. Both are positive outcomes.
1 -The 18th Annual Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Health Care, March 2013