The next BriefingsDirect healthcare finance insights discussion explores ways that healthcare providers can become more proactive in financial and cost transparency from the patient perspective.
By anticipating rather than
reacting to mandates
on healthcare
economics and process
efficiencies, providers are becoming more competitive and building more trust and satisfaction with their patients -- and caregivers.
Listen to the podcast. Find it on iTunes. Read a full transcript or download a copy.
To learn more about the
benefits of a more proactive and data-driven approach to healthcare cost
estimation, we are joined by expert Kate Pepoon, Manager
of Revenue Cycle Operations at Baystate
Health in Springfield, Mass., and Julie
Gerdeman, President of HealthPay24
in Mechanicsburg, Penn. The discussion is moderated by Dana Gardner,
Principal Analyst at Interarbor
Solutions.
Here are some excerpts:
Gardner: We are
at the point with healthcare and medical
cost transparency that the finger, so to speak, has been pulled out of the
dike. We have had mandates
and regulations, but it's still a new endeavor. People are feeling their
way through providing cost transparency and the need for more accurate
estimations about what things will actually cost when you have a medical
procedure.
Kate, why does it remain
difficult and complex to provide accurate medical cost estimates?
Pepoon: It has
to do with educating our patients. Patients don’t understand what a chargemaster is, which,
of course, is the technical term for the data we are now required to post on
our websites.
For them to see a spreadsheet that lists 21,000 different codes and costs can
be overwhelming.
 |
| Pepoon |
What Baystate Health does, as
I’m sure most other hospitals in Massachusetts do, is give patients an option
to call us if they have any questions. You’re right, this is in its infancy. We
are just getting our feet wet. Patients may not even know what questions to
ask. So we have to try and educate as much as possible.
Gardner: Julie,
it seems like the intention is good, the idea of getting more information in peoples'
hands so they can make rational decisions, particularly about something as
important as healthcare. The intent sounds great, but the implementation and the
details are not quite there yet.
Given that providers need to
become more proactive, look at the different parts of transparency, and make it
user-friendly, where are we in terms of this capability?
Gerdeman: We
are still in the infancy. We had a race to the deadline, to the Centers
for Medicare and Medicaid Services (CMS) [part
of the U.S. Department of Health and Human Services] deadline of Jan. 1,
2019. That’s when all the providers rushed to at least meet the bare minimum of
compliance. A lot of what we have seen is just the publishing of the chargemaster
with some context available.
But where there is competition,
we have seen it taken a bit further. Where I live in Pennsylvania, for example,
I could drive to a number of different healthcare providers. Because of that competition,
we are seeing providers that don't just provide context, they are leveraging
the chargemaster and price transparency as competitive differentiation.
Gardner: Perhaps
we should make clear that there are many areas where you don’t really have a
choice and there isn’t much competition. There is one major facility that
handles most medical procedures, and that’s where you go.
But that's changing. There are
places where it’s more of a marketplace, but that's not necessarily the case at
Baystate Health. Tell us why for your patients, they don't necessarily do a lot
of shopping around yet.
Clearing up charge confusion
Pepoon: They
don't. That question you just asked Julie, it's kind of the opposite for us
because we have multiple hospitals. When we posted our chargemaster, we also
posted it for our other three hospitals, not just for the main one, which is Baystate
Medical Center (BMC). And that can create confusion for our patients as
well.
We are not yet at the drive to
be competitive with other area hospitals because BMC is the only level-1 trauma
center in its geographical area. But when we had patients ask why costs are so
different at our other hospitals, which are just 40 miles away, we had to step
up and educate our staff. And that was largely guiding patients as to the
difference between a chargemaster price and what they are actually going to
pay. And that is more an estimate of charges from their particular insurance.
We
have not yet had a lot of questions from patients, but we anticipate it
will definitely increase. We are ready to answer the questions and
guide our patients.
We have not yet had a lot of
questions from patients, but we anticipate it will definitely increase. We are
ready to answer the questions and guide our patients.
Gardner: The chargemaster
is just a starting point, and not necessarily an accurate one from the
perspective of an outsider looking in.
But it began the process to more
accurate price transparency. And even while there is initially a regulatory
impetus, one of the biggest drivers is gaining trust, loyalty, and a better customer
experience, a sense of confidence about the healthcare payments process.
Julie, what does it take to
get past this point of eroding trust due to complexity? How do we reverse that
erosion and build a better process so people to feel comfortable about how they
pay for their healthcare?
Gerdeman: There
is an opportunity for providers to create a trusted, unique, and personalized
experience, even with this transparency regulation. In any experience when you
are procuring goods and services, there is a need for information. People want to
get information and do research. This has become an expectation now with
consumerization -- a superior consumer experience.
 |
| Gerdeman |
And what Kate described for
her staff, that's one way of providing a great experience. You train the staff.
You have them readily available to answer questions to the highest level of
detail. That's necessary and expected by patients.
There is also a larger opportunity
for providers, even just from a marketing perspective. We are starting to see healthcare
providers define their brand uniquely and differently. And patients will start
to look for that brand experience. Healthcare is so personal, and it should be
part of a personalized experience.
Gardner: Kate,
I think it's fair to say that things are going to get even more challenging. Increasingly,
insurance companies are implementing more co-pays, more and different deductibles,
and offering healthcare plans that are more complex overall.
What would you like to see
happen in terms of the technologies and solutions that come to the market to
help make this process better for you and your patients?
Accounting for transparency
Pepoon: Dana,
transparency is going to be the future. It's only going to get more … transparent.
This infancy stage of the
government attempting to help educate consumers -- I think it was a great idea.
The problem is that that did not come with a disclaimer. Now, each hospital is
required to provide that disclaimer to help guide patients. The intent was
fantastic, but there are so many different ways to look at the information
provided. If you look at it face-value, it can be quite shocking.
I heard a great anecdote
recently, that a patient can go online and look at the chargemaster and see
that aspirin is going to cost them $100 at a hospital. Obviously, you are taken
aback. But that’s not the actual cost to a patient.
There needs to be much more
robust education regarding what patients are looking at. Technology companies can
help bring hospitals to the next level and assist with the education piece. Patients
have to understand that there is a whole other layer, which is their actual
insurance.
In Massachusetts we are pretty
lucky because 12 years ago, then-Governor Mitt Romney [led a drive
to bring
health insurance to almost everyone]. Because of that, it’s reduced the
amount of self-pay patients to the lowest level in the entire United States. Only
around two to three percent of our patients don’t have insurance.
Some of the benefits that other states see from the published chargemaster list is better engaging with patients and to have conversations. Patients can say, “Well, I don’t have insurance and I would like to shop around. Thank you to Hospital A, because Hospital A is $2,000 for the procedure and Hospital B is only $1,500.”
But Massachusetts, as part of
its healthcare laws, further dedicates itself to educating patients about their
benefits. MassHealth, the
Medicaid program of Massachusetts, requires hospitals to have certified financial
counselors.
Those counselors are there to
help with patient benefits and answer questions like, “Is this going to cost me
$20,000?” No, because if you sign up for benefits or based on the benefits you
have, it's not going to cost you that much. That chargemaster is more of a definition
of what is charged to insurance companies.
The fear is that this is not so
easily explained to patients. Patients don’t always even get to the point where
they ask questions. If they think that something is going to cost $20,000, they
may just move on.
Gardner: The
sticker shock is something you have to work with them on and bring them back to
reality by looking at the particulars of their insurance as well as their location,
treatment requirements, and the specific medical issues. That's a lot of data,
a lot of information to process.
Not only are the patients shopping
for healthcare services, they will also be shopping for their next insurance
policy. The more information, transparency, and understanding they have about
their health payments, the better shopper they become the next time they pick
an insurance company and plan. These are all choices. This is all data-driven. This
is all information-dependent.
So Julie, why is it so hard in
the medical setting for that data to become actionable? We know in other businesses
that it's there. We know that we can even use machine learning (ML)
and artificial
intelligence (AI) to predict the weather, for example. And the way we
predict the weather is we look at what happened the last 500 times a storm came
up the East Coast as an example that sets a pattern.
Where do we go next? How can
the same technologies we use to predict the weather be brought to the medical data
processing problem?
Gerdeman: Kate
said it well that transparency is here, and transparency is the future. But, honestly,
transparency is table stakes at this point.
CMS has already indicated that
they expect to expand the pricing transparency ruling to require even more.
This was just the first step. They know that more has to be done to address
complexity for patients as consumers.
Technology is going to play a critical role in all of this, because when you reference things like predicting the weather and other aspects of our lives, they all leverage technology. They look back in order to look forward. The same is true for and will be used in healthcare. It’s already starting to.
So [patient support] teams like
Kate’s use estimation tools to provide the most accurate as possible costs to
patients in advance of services and procedures. HealthPay24 has been involved
as part of our mission, from pre-service to post-service, in that patient
financial engagement.
But it is in arming providers
and their staffs with that [predictive] technology that is most important for making
a difference in the future. There will always be complexities in healthcare. There
will always be things happening during procedures that physicians and surgeons
can’t anticipate, and that’s where there will be modifications made later.
But given what we know of the costs
around the 5,000 knee replacements some healthcare provider might already have
done, I think we can begin to provide forward-looking data to patients so that
they can make informed decisions like they never have before by comparing all of
that.
Gardner: We
know from other industries that bringing knowledge and usability works to combat
complexity. And one of the places that can be most powerful is for a helpdesk.
Those people are on the other end of a telephone or a chatbot from consumers --
whether you are in consumer electronics or information technology.
It seems to me that those
people at Baystate Health, mandated by the Commonwealth of Massachusetts, who
help patients are your helpdesk. So what tools would you like to see optimally in
the hands of those people who are explaining away this complexity for your patients?
How to ask before you pay
Pepoon:
That’s a great question. Step one, I would love to see some type of education,
perhaps a video from some hospitals if they partnered together, that helps
patients understand what it is they are about to look at when they look at a chargemaster
and the dollar amounts associated with certain procedures.
That’s going to set the stage
for questions to come back through to the staff that you mentioned, the
helpdesk people, who are there ready and willing to respond to patients.
But there is another problem
with that. The problem is that these are moving targets. People like
black-and-white. People like, “This is definitely what I’m going to pay,”
before they get a procedure done.
We have heard of the comparison
to buying a car. This is very similar to educating yourself in advance, of looking
for a specific model you may like for a car, of going to different dealers,
looking it up online, seeing what you’re going to pay and then negotiating that
before you buy the car.
That’s the piece that’s
missing from this healthcare process. You can’t yet negotiate on it. But in the
future – with the whole transparency thing, you never know. But it’s that
moving target that’s going to make this hard to swallow for a lot of patients
because, obviously, this is not like buying a car. It’s your life, it’s your
health.
The future is going to have
more price transparency. And the future is also going to bring higher costs to
patients regardless of who they are and what plan they have. Plans 10 years ago
didn’t have deductibles. The plans we had 10 years ago that had a $5 co-pay, and
now those plans have a $60 co-pay and a $5,000 deductible.
That’s the direction our healthcare
climate is moving to. We are only going to see more cost burdens on patients.
As people realize they are going to need to pay out more money for their own
healthcare services, it’s going to bring a greater sense of concern.
So, when they do call and talk
to that helpdesk, it’s really important for all of us in all of our hospitals
to make sure that we are answering patients properly. It was an amazing idea to
have this new transparency, but we need to explain what it means. We need to be
able to reach out personally to patients and explain what it is they are about
to look at. That’s our future.
Gerdeman: I would
just like to add that at HealthPay24 we work with healthcare providers all
across the country. There are areas that have already had to do this. They have
had to be proactive and jump into a competitive landscape with personalized
marketing materials.
We are starting to see educational
videos in places like Pennsylvania using the human touch, and the approach of, “Yes,
we recognize that you’re a consumer, and we recognize that you have a choice.”
They have even gone to the extent of creating online price-checkers and charge-checkers
to give people flexibility from their homes of conveniently clicking a box from
a chargemaster to determine what procedure or service they are to be receiving.
They can furthermore check those charges across multiple hospitals that are
competing and that are making those calculators available to consumers proactively.
We
are starting to see educational videos using the human touch. The
providers recognize that you're a consumer and that you have a choice.
They have created online price-checkers to allow people from their homes
to determine the procedures and pricing.
Gardner: I’m sensing a building urgency around this need for transparency from large organizations like Baystate Health. And they are large, with service providers in both Western Massachusetts as well as the “Knowledge Corridor” of Massachusetts and Connecticut. They have four hospitals, 80 medical practices, 25 reference laboratories, 12,000 employees, and 1,600 physicians.
They have a sense of urgency
but aren’t yet fully aware of what is available and how to solve this problem.
It’s a big opportunity. I think we can all agree it’s time now to be proactive
and recognize what’s required to make transparency happen and be accurate.
What do you recommend, Kate,
for organizations to be more proactive, to get out in front of this issue? How
can vendors in the marketplace such as Julie and HealthPay24 help?
Use IT to explain healthcare costs
Pepoon: There needs
to be a better level of education at the place where patients go to look at
what medical charge prices are. That forms a disclaimer, in a way, of, “Listen,
this is what you are about to look at. It’s a little bit like jargon, and
that’s okay. You are going to feel that way because this is raw data coming
from a hospital, and a lot of people have to go to school for very long time to
read and understand what it is that they are looking at.”
And I think if there has to be
a way that we can have patients focused and able to call and ask questions. That’s
going to help.
For the technology side going
forward, I am very interested to see what it’s going to look like in about a
year. I want to see the feedback from other hospitals and providers in
Massachusetts as to how this has gone. Today, quite frankly, when I was doing
research for us at Baystate I reached out to find out what are the questions
patients are asking. Patients are not really calling that much to talk about
this subject yet. I don’t know if that’s a good thing or a bad thing. I think
that that’s a sentiment most hospitals in Massachusetts are feeling right now.
I don’t think there is one
hospital system that’s ahead of the curve or running toward the goal of
plastering all of this data out there. I don’t think everybody knows what to do
with it yet. IT companies and partners that we have -- our technical partners
like HealthPay24 – can help take jargon and put it into some version that is
easily digestible.
That is going to be future. It
ties back to the question of: Is transparency going to be the wave of the
future? And that’s absolutely, “Yes.” But it’s all about who can read the
language? If me and Julie are the only two people in a room who can read the
language, we are letting our patients down.
Gardner: Well,
engineering complexity out is one of the things the technology does very well.
Software has been instrumental in that for the past 15 or 20 years.
There
is a huge opportunity to look at technology and emerging technology
today to provide new levels of clarity, reduce complexity, and to become
more proactive.
Julie, as we end our discussion, for organizations like Baystate Health that want to be more proactive, to be able to answer those patient phone calls in the best way, what do you recommend? What can healthcare provider organizations start doing to be in front of this issue when it comes to accurate and transparent healthcare cost information?
Gerdeman: There
is a huge opportunity to look at technology available today, as well as emerging
technology and where it’s headed. If history proves anything, Dana, to your
point, it’s that technology can provide new levels of clarity and reduce
complexity. You can digitize processes that were completely manual and where
everything needed to be done on the phone, via fax, and on paper.
In healthcare, there’s a big opportunity to embrace technology to become more proactive. We talk about being proactive, and it really means to stop reacting and take a strategic approach, just like in IT architectures of the past. When you take that strategic approach you can look at processes and workflows and see what can be completely digitized and automated in new ways. I think that’s a huge opportunity.
I also don’t want to lose
sight of the humane aspect because this is healthcare and we are all human, and
so it’s personal. But again, technology can help personalize experiences. People
may not be calling because they want access online via their phone, or they
want everything to be mobile, simple, beautiful, and digital because that’s what
we increasingly experience in all of our lives.
Providers have a great
opportunity to leverage technology to make things even more personal and humane
and to differentiate themselves as brands, in Massachusetts and all across the
country as they become leading brands in healthcare.
Listen to the podcast. Find it on iTunes. Read a full transcript or download a copy. Sponsor: HealthPay24.
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