Access Management Experts Rule!

in the New World of Consumer Directed Healthcare
John Holton, President/CEO, SCI Solutions

Consumer Directed Healthcare is the most talked about topic in the U.S. healthcare industry. In response to severe medical cost inflation over the past four years, employers are sponsoring Consumer Directed Healthcare insurance plans that emphasize high deductibles with a catastrophic safety net to cover long hospitalizations. The government is accelerating this trend by offering Health Savings Accounts (401K-type plans for healthcare) as a mechanism to make this transition easier for employees.

Unlike the elusive prospect of the electronic medical record or legal importation of Canadian drugs, Consumer Directed Healthcare is here today. Major corporations are implementing Consumer Directed Healthcare insurance plans now. They are certain to transform healthcare delivery in the same way that 401k investment plans revolutionized retirement benefits and spurred the realignment of the financial industry in the ‘80s.

Without question, the 76 million aging baby boomers and the U.S. healthcare system are on a collision course—and something will have to change. With history as our teacher, it is clear that this offspring of America’s “Greatest Generation” (as Tom Brokaw refers to them) are pervasive in number and relentless in their collective pursuit of service and convenience in their lives. Other industries know it all too well—consumers want it all. We have come to expect service, convenience, selection, quality and, of course, a fair (read low) price in everything we buy. Now that “boomers” are directly responsible for paying a much larger portion of their healthcare expenses, they are certain to pay more attention to how that money is spent.

Advocates for Consumer Directed Healthcare believe that by encouraging employees to take an active role in purchasing their healthcare, healthcare providers will be forced to compete for their business. This competition will result in dramatically reduced costs for similar quality and significant improvements in the service levels rendered by healthcare providers. That is the essence of the consumer Directed Healthcare movement.

It makes sense to this baby boomer. We will  want to comparison shop, reviewing quality indicators such as how many malpractice suits a doctor has had, the mortality rates of a hospital (the Leapfrog initiative already scores hospitals on quality), the price of routine procedures (California law mandates publicly posting each hospital’s charge master) and, of course, good customer service by combining comparative quality and cost data. Patients will increasingly choose the hospital they prefer. As hospitals adjust their pricing and institute more quality measures, service will become the important differentiator.

To reinforce this notion, a recent study of savvy healthcare executives revealed that they believe the biggest healthcare breakthroughs in the next few years will come from advances in three areas:

• Drugs
• Medical Equipment
• Administrative

Administrative breakthroughs?

Our healthcare leaders clearly see Consumer Directed Healthcare as a major force in the near term and are preparing their institutions for the changes in service levels required to be competitive in tomorrow’s world of Consumer Directed Healthcare.

Current service levels leave much to be desired. Challenges in getting an appointment, delays in registration, long waits at the provider department and then deciphering the hieroglyphics of the billing world all add up to a frustrating patient experience. Hospitals that solve these issues and raise their service level, comparable to the retail and hospitality industries, will be tomorrow’s winners.

Healthcare CEOs and CFOs know they are on the cusp of a new era. By efficiently attracting, servicing and satisfying demanding consumers like the Baby Boomers, executives see an opportunity to grow their top line and, equally important, save money on the bottom line.

So what are today’s health system leaders doing to prepare? Many things. Top among them is to elevate their service levels and focus on what these new consumers want. They are improving their Access Management strategies—otherwise known as their “Front Door.” It’s not the literal front door, but the many ways in which customers first interact with their health system.

Health administrators are asking themselves these questions:

• How easy is it for physician referrals to do business with my hospital?
• How many phone calls does it take to get an appointment?
• On average, what is the lead-time to get a routine radiological exam done?
• Can our customers interact with the hospital 24x7 over the web to schedule services, complete mandated, seemingly redundant forms, and pay their co-pays or outstanding balances?
• How well are we positioned to compete with retail healthcare storefronts in malls and specialty radiology centers that offer pick-up and delivery services?
• Can our customers go directly to the point of service without having to interact with the registration system?
• Do we know if we are going to get paid for the services that we are about to render?
• Do we offer patient self-service capabilities such as payments and registration through the web and kiosks?

According to a recent HFMA survey, 56 percent of CFOs said they intend to focus on their front-end revenue cycle processes to decrease their denial rates. These are the kinds of challenges on which a new breed of Patient Access Management companies are focusing. Technology solution providers are developing web portals for physicians’ offices and consumers to schedule/request appointments, complete all necessary registration information, and pay their bills conveniently over the web. By providing these patient self-service applications, which also run on kiosks, hospital patients can go directly from the front door to their point of service without additional paperwork, an experience similar to shopping at any retail mall.

These forward-thinking CFOs are also focused on checking medical necessity, insurance eligibility and authorizations up front—at the time of scheduling and prior to the patient’s arrival. They know in advance whether they will get paid for their services, with no surprises at the time of the visit. The new breed of Access Management companies are beginning to help providers better market their services, target their customers and navigate the inevitable comparisons about trade-offs between cost and quality that will undoubtedly be measured.

The Pre-encounter processes that these Access Management companies address have become too important to leave to the monolithic HIT vendors with their one-size-fits-all philosophy. For many, Patient Access Management is a core health system process that is better left to the experts.

---

« previous page

client quote:

“With SCI we reduced our lab monthly denials from $23,000 to 0, and increased utilization from 400 average orders a month to 3,230, as well as improved patient, physician and staff satisfaction.”

Eisenhower Medical Center

	Sign up for a free Webinar
	Watch our 3-minute PowerView summary
	Request an SCI Patient Access consultation
	Put the SCI Superheros to work for you