In a fireside chat hosted by VisitPay CEO Kent Ivanoff at the Becker's Hospital Review 7th Annual CEO + CFO Roundtable, Todd Craghead, vice president of revenue cycle at Intermountain Healthcare, recounted the health system's decade-long journey toward a patient-centric financial experience.
The story begins in 2008, when the Salt Lake City health system made the auspicious commitment to fundamentally transform the payment experience for patients. "Little did we know what was going to happen in the healthcare space between 2008 and 2013," said Mr. Craghead.
From 2008-13, Intermountain noticed self-pay balances and receivables ticking up. This proved to be a microcosm of larger national trends. The historically modest and manageable self-pay population exploded. Within a few short years, patients collectively comprised the largest non-government payer group in healthcare.
This seismic change had — and for many health systems, continues to have — two primary side-effects. First, a significant number of patients struggled to manage medical obligations that have grown to the size of a mortgage payment. Second, health systems began shouldering significantly more bad debt — and had few consumer-friendly tools at their disposal to carve a pathway to manageable reimbursement. Working within already tight margins, this whiplash change in healthcare financing represented an existential perfect storm.
Waking Up to a New World
Intermountain was working with a vendor to create propensity to pay scores, a methodology used to determine a consumer's likelihood to meet their financial obligations. However, the vendor didn't offer a way to seamlessly incorporate this information into the health system's workflow or make it actionable. Complicating matters was the fact that Intermountain was undergoing a major implementation of a Cerner EHR system.
"The accelerated pace of patient responsibility really introduced an interesting dynamic," Mr. Craghead said. Following up to collect from self-pay patients became a beast in its own right. "We could only throw so many bodies after some of this work."
Meanwhile, VisitPay, the developer of a revolutionary, cloud-based patient financial experience platform, was helping a neighboring health system grapple with similar issues.
"It was clear that there was this new dynamic emerging and that enterprises like Intermountain Healthcare were a bigger lender in the markets they serve than regional banks that were built for that purpose," Mr. Ivanoff said.
Scoring and segmentation were part of VisitPay's arsenal, but the platform differentiated itself with ability to address other challenges Intermountain identified: Consolidated digital billing to help patients understand and manage bills for themselves or their families; advanced analytics that went beyond propensity-to-pay to help the health system apply a personalized approach to payments; and workflows that aligned with and optimized Intermountain’s EHR investment.
"There are some health systems that do the same thing for everybody," said Mr. Ivanoff. By contrast, Intermountain takes a different approach, applying analytics to data drawn from Intermountain's own systems of record to identify the different approaches individuals take to managing their billing obligations.
Intermountain knew that it wanted to give patients a tailored financial experience, so it formed a partnership with VisitPay.
Into the Breach
This ethos of consumer individuality has driven many of the health system's decisions around payments. Here are four ways Intermountain and VisitPay have updated the patient payment experience for the individual consumer:
1. Engagement and insight early on. The health system uses propensity-to-pay scores on the back end to understand how to best engage with patients to help satisfy financial obligations, and it is actively working with VisitPay to move even more of this work upstream.
Intermountain works to provide patients with estimates of their financial responsibility as soon as possible by creating a payment plan based on patients' credit. For elective procedures, the discussion on financial liability begins six days before the scheduled service.
A comprehensive approach to patient payments helps patients understand what they owe and provides the tools they need to make incremental and manageable payments. This not only improves a health system's yield and cash flow, but also positively impacts non-economic metrics, including patient satisfaction and Net Promoter scores. In addition, the right approach reduces the risk of patients avoiding necessary care simply because they’re worried about cost or how they can pay.
2. Tailored payment plans. Intermountain's philosophy is to engage the patient, understand their needs and set up a payment plan that is meaningful and flexible. The health system had offered payment plans prior to engaging with VisitPay, but the process was manually driven and inefficient, according to Mr. Craghead. The VisitPay platform has enabled them to better define and set exacting parameters around consumer situations, while still providing a unique experience. "We are trying to meet consumers where they're at, and then offer solutions that makes the most sense for both the health system and the patient," Mr. Craghead said.
With a better understanding of patient types and the use of VisitPay's advanced analytics, Intermountain can configure sustainable, longer-term financing strategies that meets patients' needs, while remaining fully compliant with THR’s credit risk policies and national regulations.
Choice extends even to whether patients use the VisitPay platform at all. Patients are effectively "pre-registered" for digital payment, but they must opt in to activate their account. Intermountain currently provides patients information on how opt in on patient statements, but also continues to offer more analog payment options for patients who prefer not to use the digital platform.
3. Online account management. Once patients opt into Intermountain Bill Pay (the whitelisted VisitPay portal), they have better visibility of their financial responsibility. Here are a couple items the account helps automate:
- Benefits reconciliation. For members of Intermountain's Select Health plan, the system is able to present the explanation of benefits inside VisitPay so patients can easily reconcile charges with their health plan. St. Luke's Health System in Boise, Idaho, one of VisitPay's first clients, has embedded EOBs for 900 payers, and every one of their bills goes out within the platform, according to Mr. Ivanoff.
- Financial assistance. Intermountain charges interest for long-term payment plans except if patients have had financial assistance in the past. The VisitPay system streamlines this process by identifying and incorporating information for patients who have submitted a manual charity application or who qualify for presumptive charity.
4. Consolidated statements. The VisitPay platform can capture all charges under the Intermountain umbrella for a guarantor in one place.
This allows parents in Utah with large families to see a consolidated bill that includes charges for every family member that received care, including adult children and aging parents, in a single place. "That's very difficult to do inside of our system today unless we have a tool like VisitPay, which gives us the opportunity to do that in a controlled, secure environment with permission on both sides," Mr. Craghead said.
Results
Intermountain, powered by its partnership with VisitPay, has been able to meet the self-pay challenge by offering consumers more options to pay their bills that make sense to them. With easy online access, the system delivers insight into patient liability early on, offers flexible payment plans and delivers visibility across a consolidated statement. This transparency, flexibility and convenience is driving results. "The bad debt rates we're seeing coming through the VisitPay platform are well below our rates from before," Mr. Craghead said.
The system has seen nearly 30 percent yield improvement on patient payment, when risk-adjusted for propensity to pay. The best part? "There's not a collection call involved in that," Mr. Ivanoff said.
With the help of the VisitPay patient financial engagement platform, Intermountain discovered that a better billing experience translates into better bill-pay results and patient satisfaction.