The Vision of “One Call” for All—How Health First, Inc. Strengthened Relationships with Patients and Physicians, While Improving Its Bottom Line
An interview with Michelle Fox, HealthFirst, Inc.
Health First, Inc. operates three not-for-profit hospitals and multiple outpatient facilities on Florida’s East Coast. Its 20 medical practices represent more than 70 physicians who together schedule an average 13,666 procedures each month. Like many large, multi-facility healthcare organizations in 2004, Health First’s patient Access Management system comprised various nonaligned components. It was disorganized, inefficient, difficult to use and prone to error.
Patient scheduling—including appointments, pre-registration, and insurance and medical necessity checks—was done by phone or fax in four or five separate systems. Patient and physician satisfaction suffered from long call wait times, unavailable schedulers, busy fax lines or the need to make multiple calls. Physician orders that were faxed in were often lost, illegible, or inaccurate. The existing system was unable to place patient reminder calls, costing Health First an estimated $500,000 each year in lost revenue opportunity from a 15 percent no-show rate. Automated insurance eligibility, medical necessity or authorization could not be checked efficiently at the time of appointment scheduling. Employee usage of multiple scheduling and verification systems led to high staffing levels and expensive ongoing training.
The Vision
When Michelle Fox was hired as Patient Access Director, she had a vision for implementing a top-flight patient access program for Health First. She wanted to streamline all pre-arrival services to strengthen Health First’s relationships with patients and physicians, while improving the organization’s bottom line. Fox says, “To achieve this, I needed a seamless system that let us do what we needed to do before the patient’s service with one call—schedule, collect, check insurance, financial aid counsel and then send an appointment reminder.
Foremost, Health First sought to make it easier for all its customers—clinicians, patients and clinical departments. Close on the heels of improving simplicity and satisfaction, came the objectives of optimizing reimbursement and creating accountability for authorization. When Fox was brought in to revamp patient access, there was no central scheduling process or pre-certification. “We had a lot of room for opportunity—especially in reimbursement,” she reflects.
Fox began her quest by forming cross-organizational committees and researching closed-loop Access Management systems used by similar healthcare organizations. To her surprise it was a challenge to find an integrated enterprise software package that met her “one call for all needs” vision.
“We knew to be successful Patient Access needed the support of the clinical departments. We met with them and made it clear that this effort was to be a partnership, beneficial to both groups, not a bureaucratic top-down hospital decision,” Fox explains. “This approach, a huge mental shift for our health system, made all the difference.”
After a lengthy evaluation, Health First chose SCI Solutions’ suite of web-based technologies: Schedule Maximizer, Order Facilitator, Revenue Accelerator, Provider Portal and Patient Portal.
The Improvements
Since going live with the new Access Management solution in January 2008, Fox has noticed significant improvements. One is increased referrals. Fox gives an example of how this happens. “At Mr. Smith’s annual exam, his physician determines he needs an MRI. With our new system, the physician’s office staff can self-schedule the test online or over the phone and give Mr. Smith a complete appointment itinerary, directions to the diagnostic facility and the necessary preparatory instructions—all before he leaves the office. We’ve just helped our referring physician care for Mr. Smith and eliminated the need,to chase him down after the fact to schedule his test. And our hospital’s diagnostic center sees a patient who is well prepared for his test and pre-screened for medical necessity. It’s a win-win for everyone.”
With its user-friendly Provider Portal, Health First expects to decrease call volume to its central scheduling office by 20 percent. And, in conjunction with Order Facilitator, orders are now accurate, legible and electronically signed. If a provider prefers a CT with contrast, for example, the system facilitates the office’s precise directions. Insurance authorization and medical necessity checks are now performed at the time of scheduling with one call. Better reimbursement, patient-driven workflow, fewer reworks, and reduced write-offs immediately translate into better profit margins. Fox says, “I like knowing that Provider Portal gives physicians more time to deliver quality care instead of concentrating on logistics required to coordinate that care.”
Flexible reporting features built into the system allow Health First to compare itself to industry benchmarks, while monitoring internal goals. For example, the Access Management audit trail helps the organization manage medical risk.
The Results
Prior to adopting its new Access Management solution, Health First’s 15 percent no-show rate equated to 15,600 lost visits. The new system automatically sends a HIPAA-compliant reminder call, letter or email according to patient preference. The hospital expects this reminder to cut its no-show rate in half and return $436,800 to its bottom line. In addition to appointment date and time, reminder calls inform patients that all copayments must be paid prior to service or the appointment will be rescheduled. As a result, upfront collections have increased. In the first month, appointment reminders contributed to increased collections of $55,000 in captured revenue.
Health First is anticipating proportionate results from its new self-scheduling functionality. Beginning in 2009, its Patient Portal will enable patients to self-schedule mammograms. Because 70 percent of all Health First’s 164,000 annual procedures are mammograms, the organization expects the impact on its central scheduling department to be significant. Call waiting, call volume and fax processing times will be cut dramatically. At the same time, patients are given more control over their own healthcare, improving satisfaction and building hospital loyalty.
Health First plans to widely promote the self-scheduling and online pre-registration options. “This is yet another feature that enhances our community reputation for patient-driven care,” says Fox.
The Recommendation
By streamlining the Access Management enterprise system, Health First patients and physicians experience fewer healthcare hassles. “In fact, our patients have a good experience with us before they even walk through the door,” Fox says. Health First also increased referrals and loyalty through the improvements in its scheduling and order processes. “We’re pleased to be able to provide premiere ‘one call’ service without a staff increase.” And Fox attributes Health First’s enhanced revenue stream directly to its new ability to effectively manage patient access at any point of care.
customer quote:
“I like knowing that Provider Portal gives physicians more time to deliver quality care instead of concentrating on logistics required to coordinate that care.”
Michelle F., Patient Access Director HealthFirst, Inc.
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