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July 28, 2015
Re-Imagining the Patient Financial Experience
Learning Objectives 1. Identify market forces creating the need to re-evaluate our legacy
approach to revenue cycle management
2. Articulate HIMSS Task Force vision for the Patient Financial
Experience of the Future
3. Explain how to get involved in the conversation
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Agenda
• Market Drivers Affecting Revenue Cycle Management
• Introduction to HIMSS Revenue Cycle Improvement Task Force
– Purpose
– Membership
– Work Completed to Date
– Assumptions
– FY16 Activities
– Opportunities for Pilot Projects
• Group Discussion
• Next Steps
Consumer healthcare payment patterns
1 – 2013 MadPow Consumer Survey, commissioned by Aetna
patients compare their provider’s bill to their health
plan Explanation of Benefits (EOB)1
71%
consumers preferred to pay healthcare
bills online1 69%
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Current provider collection experience is time-consuming According to a 2013 survey of health care providers:
– Doctors and hospitals often wait 75-150 days for payment
– 50% of patient obligations go unpaid
Projected financial impact for providers
In 2011, patient non-POS Write-offs totaled $102 billion
Billed
Collections
Patient Write-Off
POS
Collections
By 2019, patient non-POS Write-offs are estimated
to exceed $189 billion
Patient Write-Off
Billed
Collections
POS
Collections
Source: Citi analysis, based on 2011 data from the U.S. Dept. of Health & Human Services
and Center for Medicare & Medicaid Services.
Patient obligations are growing
• Patient payments averaged 30% of revenue in 20121
• 13% of providers interviewed state higher copays and co-insurance are most pressing payment issues2
Sources: 1 Citi analysis, based on 2011 data from the U.S. Dept. of Health & Human Services and Center for Medicare & Medicaid Services. 2 Citi analysis based on client interviews, conducted by Boundary Information Group (June 2013)
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Patient obligations are growing
Bad Debt is Increasing
• McKinsey - Bad Debt is increasing over 30% each year in
some hospitals.
• Yet, the McKinsey study found that 74 % of insured
consumers indicated they are both able and willing to pay
their out-of-pocket medical expenses up to $1000 per year.
• The survey respondents indicated that a lack of options for
payment plans, poor timing of bills and difficulties coping with
confusing statements or policies were major barriers to
paying.
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And billing experience is important to overall patient satisfaction…and to providers
Greatest Opportunity in RCM
• The Patient Financial Experience
• Current state is fragmented
– every process is different, even within the same health system
• High dissatisfaction with the financial process
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HIMSS Vision & Mission
HIMSS is a global, cause-based, not-for-profit organization focused on better health through information technology (IT). HIMSS leads efforts to optimize health engagements and care outcomes using information technology.
HIMSS Vision
Better health through information technology.
HIMSS Mission
Lead global endeavors optimizing health engagements and care outcomes through information technology.
Society Today
• 52,000+ Individual Members of which 2/3 work in the field
• 600+ Corporate Members
• 250+ Non-for-profit Partner Organizations
• 100+ committees, task forces, work groups and roundtables
• 56 Chapters
• 5 Strategic Business Units, over 200 staff
• Offices:
– US: Chicago (IL), Arlington (VA), Ann Arbor (MI), Burlington (VT),
Portland (ME)
– International: Brussels, Leipzig, Berlin, London, Singapore
• Top 5 largest healthcare conference in US; largest HIT conference in U.S.
• Top 50 largest conference of any kind in US
• $40+ million annual budget
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Strategic Framework
Three Goal Areas:
• Goal 1: HIMSS ensures all stakeholders are engaged in the
transformation of health and healthcare through IT and management
systems
• Goal 2: IT and related health policies of all stakeholder entities
reflect transformational knowledge, experiences and best practices.
• Goal 3: Healthcare stakeholders have the knowledge, tools,
experiences and best practices to make optimal decisions regarding
the development, acquisition, deployment, use and value of IT and
management systems.
HIMSS Revenue Cycle Improvement Task Force - Purpose
Convene innovative stakeholders from across the healthcare
industry to create a vision for the next generation of revenue
cycle management business processes and tools that will keep
administrative cost containment, interoperability and consumer
engagement front and center.
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HIMSS Revenue Cycle Improvement Task Force - Rules of Engagement
• Leave your industry hat at the door
• Suspend your beliefs about what you know to be true
• Engage in possibility thinking
• Actively participate in discussions and creation of deliverables
• Be open to participating in pilot projects aimed at moving us closer
to execution of the vision
HIMSS Revenue Cycle Improvement Task Force – Membership Composition
76 members and growing…..
• Providers
• Payers
• Financial Institutions
• Retail Clinics
• Mobile Providers
• Revenue Cycle Vendors/Consultants
• Other industry associations (HFMA, HATA, WEDI)
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HIMSS Revenue Cycle Improvement Task Force – Work Completed To Date
1. Developed Vision for the Patient Financial Experience of the
Future (focused on what, not how):
• Consumer focused
• Keeps cost-containment, interoperability and consumer
engagement front and center
• Revenue cycle management moved from back-end to front
• Decision-making processes automated and centralized
2. Created an infographic and white paper to articulate vision
• www.himss.org/hbs
HIMSS Revenue Cycle Improvement Task Force – Assumptions in Vision
• RCM of the future will be consumer-centric
• Widespread fully functioning HIE
• Widespread consistent approach to patient matching
• Full healthcare price transparency
• Uniform quality of care metrics
• One central “source of truth” for distribution of patient satisfaction
surveys and a standardized process for sharing with affected
parties
• Technology will fully support sharing of information between
providers, payers and financial institutions
• Reimbursement methodologies will not complicate the patient
financial experience
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HIMSS Revenue Cycle Improvement Task Force – FY16 Deliverables
1. Deliver road map for moving industry to next generation
revenue cycle management tools and processes;
2. Develop infographic depicting case study involving multiple
providers and points of service;
3. Secure two or more Task Force participants for pilot or
prototype project; and
4. Continue socializing vision
– Webinars
– Media interviews
– Collaborative events
A member’s perspective
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HIMSS Revenue Cycle Improvement Task Force - Rules of Engagement
• Leave your industry hat at the door
• Suspend your beliefs about what you know to be true
• Engage in possibility thinking
• Actively participate in discussions and creation of deliverables
• Be open to participating in pilot projects aimed at moving us closer
to execution of the vision
• A strong focus on greater operational efficiency could result in
as much as a 35% reduction in the cost to collect – McKinsey
• Provide a consistent patient experience AT EVERY POINT.
• To do this, everything must be integrated into one system.
(Health Data Intelligence Hub)
So how do we improve?
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HIMSS Revenue Cycle Improvement Task Force – What’s in it for me?
1. Be a master of your own destiny
• Proactive vs. reactive
• Redefining patient healthcare financial experience
(we’re all consumers when it comes to healthcare)
• Networking
2. Exposure
• Pilot projects
• Speaking opportunities
3. Insider knowledge
Open Discussion
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Pam Jodock, Senior Director
HIMSS Health Business Solutions
Bird Blitch, CEO
PatientCo
Michael Rawdan, PhD, Director of Revenue Cycle & Patient Experiences
St. Luke’s Health Systems
Contact Information
