Improving the patient financial experience

What is the Patient Financial Experience?

Financial considerations have always been a part of healthcare in the U.S., but in recent years they have become important enough to earn focused consideration from many providers and industry leaders. Simply stated, the patient financial experience encompasses all financial aspects of a patient’s healthcare experience, at every stage of the healthcare journey. For example, researching costs when learning about treatments, paying a copay at the time of care, discussing payment options with a health system financial counselor, and receiving a post-care bill for any balance due are all part of the patient financial experience.

Why does the Patient Financial Experience matter?

The patient financial experience is important for several reasons worth individual consideration, but they all relate to the fact that financial factors today often play a significant role in the overall healthcare experience, and they can have a notable impact on both patients and providers.

Rising Healthcare Costs

It’s no surprise that financial considerations loom large for many patients, given that healthcare costs have risen substantially over the past ten to twenty years.¹ At the same time that costs of many treatments, prescription drugs, and health and wellness services have increased in absolute terms, patients today are also paying a greater share of those costs directly.² This makes the impact of rising costs both greater and more visible for many patients.

The Rise of Healthcare Consumerism

Because many patients are paying more out-of-pocket for their healthcare, they may be more aware of and engaged in their healthcare spending. As they pay more (and more often) for healthcare, patients may approach these purchases with many of the same habits, preferences, and expectations they bring to other types of spending. This includes factors like researching costs; considering ratings and reviews; using digital and mobile technology; enjoying a high level of customization, convenience, and customer service; and choosing among appealing payment options. While hospitals and health systems don’t need to deliver a consumer experience on par with those of Amazon or Apple, today’s patients also may have less tolerance for limited capabilities or a poor customer experience.

Impact on Healthcare Decisions

As patients assume greater responsibility for out-of-pocket medical expenses and have higher expectations as medical consumers, financial experiences can affect their opinions and decisions related to healthcare. In some cases, concerns about high prices or difficulty covering the costs of care can lead patients to delay or decline care, or fail to follow a provider’s full recommendations. In other cases, a lack of price transparency, appealing payment options, and user-friendly technology could cause patients not to consider a potential healthcare provider. The same factors could even lead existing patients to leave a provider and try a new option, and receiving unexpected (or unexpectedly high) medical bills can negatively impact patient retention.³ Even when financial aspects of the patient healthcare journey don’t directly impact healthcare decisions, they can affect patient satisfaction and the provider-patient relationship, as when treatment is successful but balance billing comes as a surprise or collections conversations aren’t handled well.

Integrating the Patient Financial Experience throughout the Medical Journey

An effective place to start in working to provide a better patient financial experience is by integrating financial aspects of care in relevant ways at every stage of the medical journey. While each hospital, health system, or provider may define the patient journey in distinct ways, with stages varying in nature and number, all can benefit from looking closely at key touch points and thinking about what patients want and need financially at those points. For example:

Pre-appointment / Initial Contact

When patients first realize they need or want care and begin exploring their options, online research is a common way to start. During this stage, hospitals and health systems can stand out by sharing information on their websites such as pricing for common procedures and services, forms of payment and insurance accepted, patient financial obligations (expectations for payment amount and timing), and availability of healthcare financing and payment plans.

When a patient decides to make contact, often by calling to make an appointment or filling out an online form, there is an opportunity to make a strong first impression. Some of the same information patients find helpful when doing research can be shared here as well. In addition, it may be possible to share financial policies, cost estimates, and payment expectations specific to the type of appointment needed.

Appointment / Financial Discussion

During the appointment, opportunities to share financial information and provide helpful tools and resources abound. These can include traditional steps like providing printed financial policy documents and information on payment portals and financing options, posting signage like clings and posters directing patients online for more details, and having honest, supportive conversations about the costs of care and budget concerns. Having dedicated staff are available to answer questions and provide advice is beneficial, but it also pays to ensure all patient-facing staff have training and tools to help them deliver a consistent and positive financial experience for every patient.

Post-care Billing

When it comes to billing for balances due, the two priorities are preventing surprises and providing solutions. Preventing unexpected medical bills depends mostly on earlier stages of the journey, though it’s helpful when billing to provide clear information and easy access to people or resources who can help answer questions, address issues, or assist in other ways. Perhaps most importantly at this point, providing helpful options to manage payments can make a big difference in patient satisfaction, and can even impact collections. Accepting different forms of payment, enabling online and mobile payments, and offering third-party financing or in-house payment plans can all go a long way to helping patients feel better about their medical bills—and better prepared to pay them.

Keys to Success in Delivering a Positive Patient Financial Experience

Improving the patient financial experience can be a major initiative, especially for healthcare organizations as large and complex as a hospital or health system. While specific challenges, opportunities, and priorities may be unique in every case, some general keys to success tend to apply across the board and may be helpful to consider at a high level.

• Financial policies: Clear, consistent financial policies are a fundamental requirement for organizations that hope to improve the patient financial experience. It helps to take a close look at policies and processes related to things like sharing cost and payment information, handling billing and collections, and providing service and support related to financial issues. Processes should be clearly defined and documented, and communicated to all relevant stakeholders (e.g., leadership, staff, patients, partners).
• Training and tools: Establishing and communicating financial policies is an important first step, but it is also essential to ensure that staff tasked with implementing those policies are equipped to do so successfully. This often involves focused initial training, as well as periodic refreshers and reinforcement over time. Providing tools and resources specifically to help staff involved in financial aspects of the patient experience can also be helpful.
• Measurement: In order to gauge progress, it is important to define key success metrics, monitor them carefully, and analyze results regularly. While the patient financial experience is very broad, it is possible to identify relevant data points, which may vary by organization. For example, you could look at collections at time of service, participation in financing programs, accounts receivable or past due, complaints of a financial nature, and more basic measures impacted by financial considerations like patient satisfaction and patient retention.
• Conversation support: One natural but often tricky challenge lies in the fact that many people don’t naturally feel comfortable talking about money. Staff may be hesitant to share financial information or discuss costs and payments, especially if they feel the details may be seen as “bad news.” The good news, in contrast, is that patients often truly want, need, and welcome this kind of conversation, which enables them to avoid surprise bills and budget for their healthcare spending more effectively. Providing education and training for staff can help empower them to have open, honest, and supportive financial conversations with patients.
• Technology: Thoughtful integration of technology is very important. In some cases, this may mean “less is more,” especially if integration with legacy systems seems prohibitively complicated or costly, or the perceived gap between the ideal and current states is especially vast. It may help to look at ways to leverage free or low-cost online resources, partner with third-party providers who can deliver standalone solutions or integrate readily at specific points, or focus on incremental priorities. Fortunately, robust technology is less critical than strong patient relationships and a solid approach to financial matters.
• Cost transparency: Providing online cost estimates and price lists is becoming easier, driven in part by recent CMS requirements for “shoppable” service lists. The increasing accessibility of free online resources like Clear Health Costs and FAIR Health Consumer Cost Lookup can also be helpful for organizations or staff members as a starting point or quick reference, as well as options to recommend to patients for their own use.
• Payment options: Finally, even when costs are perceived as high and paying them may present challenges, it is still possible to deliver a positive experience for patients. The key is focusing on being empathetic, encouraging, and helpful. In conversation, this can mean staff members making it clear that they understand the patient’s difficulty, share their concern, and are committed to helping them find the best way forward. At an organization level, the key is providing helpful options and solutions, including accepting multiple forms of payment and offering financing or payment plans to help them fit the costs of care into their budget.