There's a lot of talk about Business Intelligence (BI) -- over the past decade it's changed the way nearly all industries approach the market; the way businesses capture and sustain customers, and now, is being evaluated by hospitals for most every department....everywhere from risk control to the management of clinical outcomes.
Even more recently, BI is moving into the hospital business office, aiding decision support in areas previously run by intuition, available human resources, and arcane policies and procedure -- yes, BI is even available, actually...necessary, for self pay account management. But why? And importantly, how?
Historically, all responsible parties received the same letters, the same two or three statements, and all at the same time intervals before being sent to a collection agency. Some business office managers would get creative, segmenting accounts above certain balances - usually $5k - to make outbound calls, with no real knowledge or understanding of the responsible party's unique characteristics or the best way to approach them to increase the odds the patient would pay, and the hospital would collect.
As time passed, some of the more progressive among Patient Financial Services (PFS) professionals began scoring accounts (typically using a credit service), to segment accounts according to a soft-credit check score, and then... intensifying the collection effort on accounts with higher scores, and expediting lower scoring accounts directly to collection agencies.
Overall, significant emphasis was not placed on internal efforts for self pay recovery because, in the bigger picture, the numbers weren't big enough to justify innovating or doing things differently. So, what did most community health systems do? They stuck with the status quo.
But then something happened. After the ACA came into effect, more patients had bigger deductibles and co-pays, increasing self pay receivables and causing a real impact on hospital profits.
A few things became apparent. PFS professionals needed a better way to increase recoveries and manage collection agency fees while sustaining or building a better patient experience with the hospital's billing processes. Innovation is now no longer something to justify. It's a necessity.
Evident is that all responsible parties are not created equal – the thornier problems include: being able to discern which individual attributes are predictive of the likelihood of a self pay patient to pay, and how to scale the appropriate workflow efforts tailored for these guarantors without having to hire an army of full time employees to manage the process.
Fortunately, a group of smart scientists and PFS professionals were ahead of the curve and after many years of research, system design, testing, and actual performance in 200+ hospitals, introduced a software and service hybrid that allows hospitals to take advantage of applying BI to the self pay niche of their accounts receivable.
This innovation gives the hospital the ability to look at each individual guarantor and understand his ability and willingness to pay. The solution also leverages smart technology to determine what combinations and permutations of possible and new workflows could render the optimal recovery from each guarantor.
Using big data and analyzing hundreds of thousands of payment activities for guarantors, discreet patterns emerged enabling these scientists to develop predictive algorithms specific to a hospital's service area, incorporating unique guarantor attributes to solve the problem.
By leveraging advanced analytics, intuitive software and high touch service to increase active self pay recovery; meet ACA and Medicare compliance requirements, and improve the self pay patient's payment experience at the same time; hospitals using this innovative approach and solution to self pay are experiencing remarkably better results than their status quo peers and competitors.
Bryan is the Co-founder and Managing Principal of IVAR, LLC and Creator of CaptureNet™. Mr. Healy started his career at the world's largest consulting firm, Deloitte & Touche. While there, Healy led comprehensive operational assessments of large ERP systems (SAP R3, Oracle Financials) for Fortune 500 Companies consisting of identifying gaps in existing processes and workflows and aligning technology to close the gaps and maximize efficiencies.
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