Embracing Digital Solutions Drives Provider Success

CONNECTED HEALTHCARE: TECHNOLOGY, PROVIDER PAYMENT AND PATIENT OUTCOMES

Technology is fundamental to most aspects of our lives as we connect with artificial intelligence-driven chat bots instead of customer service, interact with smartphones to connect with friends and family, spend hours scrolling through websites or link to people thousands of miles away through wireless headsets connected to computers.

Technology impacts our personal and professional lives in ways it never has in the past, and causes a reexamination of what’s important to us personally and professionally. No matter how one looks at it, it’s clear technology is here to stay in our personal and professional lives.

“(W)e frequently hear about the physicians who declare they would not go into medicine again if they could start over. The reasons given include electronic medical records, bureaucracy, insurance company denials, information overload, long hours, declining reimbursement, and family sacrifices, to name a few,” according to Thomas W. Feeley, M.D., in NEJM Catalyst.1

Understanding how technological advances impact the financial health of the medical practice is key to long-term success. Each of the areas mentioned by Feeley impact a practice revenue cycle. It’s important to manage these challenges to ensure relevance and competitiveness in the future.

Technology is having and will continue to have a significant impact on the medical practice. Some of the changes are good, others less so. The Association of American Medical Colleges acknowledges technology is changing patient utilization and even where physicians will practice medicine in the future: “While potentially reducing service utilization and demand for physicians practicing in some settings (e.g., hospitals), new technologies might support greater use of physicians practicing in other care settings (e.g., free-standing ambulatory surgery centers) and has the potential to increase or decrease demand depending upon the specific technologies deployed.”2 To address these issues and avoid being left by the wayside, physicians must embrace technology and learn how they can use it to their advantage.

Technology will continue to increase in importance in the future and become more ingrained in society as digital natives age and new generations grow up with technology. The message is clear: Physicians must adapt.

Revenue Cycle TechnologiesResponding to and resolving financial challenges are critical to a provider’s long-term success. Many times, the challenges are rooted in technology: Technology may cause or address financial issues.

These challenges exist in several areas:

• changes in payer reimbursement and patient responsibility;

• growth in healthcare consumerism; and

• increased focus on health outcomes.

Each challenge can be positively impacted by an all-inclusive revenue cycle management solution. Revenue cycle management in the medical practice context helps the physician control every aspect of the practice’s operational health, from checking and confirming eligibility to building customer service through digital communication.

Understanding the revenue cycle—from eligibility to claims and from denials to patient financials—is critical to the success of the provider practice. Using multiple systems that don’t communicate is no longer feasible. Medical groups that implement financial solutions that “talk” can positively impact revenue and patient relationships.

2Connected Healthcare: Technology, Provider Payment and Patient Outcomes

The bottom line: If the provider office isn’t fully automated, it’s wasting a considerable amount time and throwing away money.

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As healthcare costs continue to increase, patients are saddled with more direct costs associated with their care and insurance coverage. Practices that implement revenue cycle management solutions to track patient payments, eligibility, denials, contracting issues and patient financials can benefit from communicating relevant information frequently to patients to let them know where they stand in terms of financial responsibilities.

Consistent financial communication is more important than ever, with approximately 30 percent of patients leaving the office without ever paying their bill.3

There are other financial challenges facing healthcare consumers, as well:

• A 29 percent increase in deductibles since 2015, with the average deductible in 2017 topping out at approximately $1,800.4

• Out-of-pocket costs hit more than $4,400 during 2017.5

These are real problems for providers who want to get paid, and it turns out 95 percent of patients would pay online if the practice offered the option.6 While patients are able and willing to pay for thousands of items online—from utility bills to groceries and, apparently, medical treatment—only 20 percent of physician offices say they’re ready to accept online payments, although 87 percent of providers have stated a desire to make payment easy for their patients.7

Healthcare Consumerism 2018 and BeyondHealthcare consumerism is growing in importance and acceptance among most age groups and in-tune providers can capitalize on this change. Patients spend significant amounts of money to track their health and wellness through wearables, those watch-like devices many people have strapped to their wrists. (The healthcare wearables market is about $6.8 billion today and is estimated to grow to $10 billion by 2022.8) Patients want to know more about their health and wellness and these devices allow them to do so. Much of the information is reviewed by device users, like heart rate and steps taken each day. There’s an opportunity, however, to better link this data to systems in the physician practice and create an action plan based on the information with the goal of improving health outcomes.

Understanding and acting on the information, however, is a challenge for patients. Without the physician’s insight, data is just data. The numbers have meaning, but they require an expert to decipher short- and long-term significance, and to help the patient act on the information to improve their health.

Improving Health OutcomesHealth outcomes are the intersection of technology, healthcare consumerism and payments. Through certain payment methods, such as value-based reimbursement, payers tie positive patient health outcomes with physician payment. Physicians have become responsible for a patient’s everyday health and outcomes outside the medical practice. This is a massive and growing issue for providers who are now expected to influence patient actions throughout the year with minimal assistance. Utilizing technology is one way to guide patients even when they seem to be outside the provider’s influence. Advanced technologies can track and improve patient health, push back against the uncertainty of new payment models that shift the responsibility of health outcomes to providers and potentially reduce the myriad unknowns associated with patient actions outside the physician’s control. Technologies help multiple practices to interact and share information securely, allowing all involved with patient care to understand when it’s going well, declining or incurring inappropriate costs.

Knowledge of these events helps providers better understand the clinical and financial aspects of their practice.

3Connected Healthcare: Technology, Provider Payment and Patient Outcomes

PRACTICE TO-DO’S

USE DATA TO IMPROVE PATIENT HEALTH OUTCOMES

MONITOR AND ACT ON CLINICAL AND FINANCIAL DATA

IMPLEMENT REVENUE CYCLE SOLUTIONS TO COORDINATE FINANCIAL WORKFLOW, INCREASE INCOME

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ConclusionTechnology has become the foundation of the physician’s front- and back-office, and there’s no turning back. Rather than lamenting technology’s monopoly within healthcare, physicians should consider embracing it, exploiting it and identifying new and better ways to embed it in the practice. The good news is, embracing technology today is easier than ever.

Digital solutions offer the opportunity to excel in:

• Revenue cycle management and changing payment structures;

• Healthcare consumerism and outcomes; and

• Patient financial communications.

Technology offers providers an opportunity to pursue continuous improvement of the patient’s health and healthcare experience while increasing quality interactions between physician and patient. Advanced technologies allow all stakeholders involved in the betterment of health outcomes to have the opportunities to use innovative devices, and integrate systems and processes with the goal improving health and wellness for patients.

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The difference in cost between manual and electronic transactions is staggering.

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Connected Healthcare: Technology, Provider Payment and Patient Outcomes

Advantages of Using TriZetto Provider SolutionsWe take on the complex clearinghouse process for our customers so they can do what they do best: provide care.

At TriZetto Provider Solutions, we help providers get paid quickly and accurately through solutions that offer business-critical information:

• Patient Access

• Claims Management

• Denials Management

• Contract Management

• Patient Financial

1. Feeley, T. “Why Would Someone Become a Doctor?” NEJM Catalyst. August 3, 2016. https://catalyst.nejm.org/someone-become-doctor/.

2. Association of American Medical Colleges. “The Complexities of Physician Supply and Demand: Projections from 2013 to 2025.” March 2015. https://www.aamc.org/download/426242/data/ihsreportdownload.pdf.

3. “Perspective on patient payments.” MGMA Connexion. April 2010. https://www.mgma.com/Libraries/Assets/Practice%20Resources/Publications/MGMA%20Connexion/2010/Perspective-on-patient-payments-MGMA-Connexion-April-2010.pdf.

4-7. Lagasse J. “As patient responsibility jumps 29%, providers to focus on patient-centric payment solutions.” HealthcareFinance. October 25, 2017. http://www.healthcarefinancenews.com/news/patient-responsibility-jumps-29-providers-focus-patient-centric-payment-solutions. Accessed October 31, 2017.

8. ABI Research. “A Glimpse into the Future of Wearable Healthcare: Going Way Beyond Smartwatches and Fitness Trackers.” August 30, 2017. http://markets.businessinsider.com/news/stocks/A-Glimpse-into-the-Future-of-Wearable-Healthcare-Going-Way-Beyond-Smartwatches-and-Fitness-Trackers-1002294798.

9. Health Care Payment Learning & Action Network. “U.S. Health Care System is Progressing in the Adoption of Alternative Payment Models that Promote Quality and Value.” October 25, 2016. https://hcp-lan.org/2016/10/u-s-health-care-system-is-progressing-in-the-adoption-of-alternative-payment-models-that-promote-quality-and-value/.

End Notes

About TriZetto Provider Solutions, A Cognizant company

As a Cognizant company, TriZetto Provider Solutions truly is More Than a clearinghouse. TPS leverages industry-leading solutions to provide comprehensive revenue cycle management services to help organizations with billing, analytics, appeals, clinical integration, digital patient engagement and more. Our collective expertise and global reach in healthcare technology allow for endless possibilities as we work together, with our clients, to transform healthcare.

For more information contact us at: 800.969.3666 or visit us at: TriZettoProvider.com