Front-end RCM strategy

Good afternoon and welcome to today's program titled recalibrate the patient experience for improved financial outcomes My name is Brian Rhodes, and I will be your emcee for today's webinar. Today's webinar is sponsored by Optum. Thank you to our sponsor and to you and our audience for giving us your time and attention.

Our program today will be 60 minutes in length. Note that an on demand version of this program will be available approximately one day after the completion of the event, and can be accessed using the same login link that you used for the live program. Before we get started, I have a few housekeeping details.

First, to ensure that you can see all the content for the event, please maximize your event window and be sure to adjust your computer volume settings and or PC speakers for optimal sound quality. Second, you will find a resources list for today's webinar on the upper right side of your screen. Here we have listed the webinar slide deck and additional resources for you to interact with.

Third, at the bottom of your console are multiple widgets you can use. To submit a question, click on the Q& A widget. It may be [00:01:00] open already and appear on the left side of your screen. You may submit questions at any time during the presentation. However, please note that it is likely that your questions will not be answered until the Q& A portion of the program.

Should you experience any technical difficulties during today's program and need assistance? Please click on the help widget, which has a question mark icon and covers common technical issues. Finally, it is my pleasure to introduce our speakers for today's program. Morgan Haynes, Vice President, Advisory Services with Optum, and Sunay Shah, Executive Director, Product and Strategy of RCM Services, also with Optum.

Thank you both for joining us today, and with that, the audience is yours. All right, thanks so much, Brian, and thank you to the audience for joining us for this webinar. We are really excited to Jump into the content that we have teed up for you today And quick run through the agenda We're going to start off pretty high level covering some of the market challenges and opportunities that have driven I think [00:02:00] some of the changes and opportunities that we're going to be Talking about today.

We'll jump into that for the majority of the webinar where we talk about where and how we see opportunities to improve the patient experience. We'll spend a couple of minutes talking about emerging innovations that we're keeping an eye on and focused on, and we'll wrap it up with reimagining the patient experience.

And then, of course, we'll leave a few minutes towards the end for Q and a so without further ado, let's jump into the high level overview of some market challenges and opportunities that we're keeping an eye on. When it comes to our overall health system and the economic realities that we're being faced, both from a macro and a micro level there's no question that, there's been significant financial burdens being placed on our industry.

We think that there was some healing underway that we think that, some revenues are rebounding in, in certain pockets across the country. But there's no question that expenses, inflation are still having a detrimental impact on the financial [00:03:00] success of health systems. We think labor shortages continue to persist.

We still see that in pockets throughout the country. And all of that is leading to just financial pressures across health systems that, anecdotally we hear are the most difficult and complex that some CEOs have experienced in their entire career. I think a recent number that I saw was very telling in terms of just what the macroeconomic changes and the reimbursement challenges that organizations are facing.

And that is that from 2021 to 2023 the inflation rate was 12. 4 percent with a Medicare reimbursement rate. Great improvement of only 5. 2%. That data in and of itself shows you the financial obstacles that many in our organization are trying to deal with. Let's couple that and I'll move on to the next slide here.

With what we see in terms of a patient responsibility and the impact on, more let's call it high deductible health plans and what impact that's having not only on patients but also on health systems and needing to focus on ensuring that there's robust processes in place to educate patients.

And we're going to talk a lot more about that as we get through this conversation. But the key takeaway on this slide is. As the burden of costs from an out of pocket perspective continue to grow for patients, there is a direct correlation between the likelihood of patients paying their bills in full and on time with their satisfaction rate.

In fact, the key bullet on the bottom left there is that satisfied patients are 72 percent more likely to pay their bills in full. And so we think that's a great data point to. I encourage organizations to take a patient centric approach to drive patient satisfaction because there's a direct correlation to successful financial outcomes by focusing on the overall patient [00:05:00] experience.

And we know that there's a continued need for focus on the patient experience as I jumped to the next slide. And you see just the experience from a patient's perspective and how fragmented and disjointed it really feels. when a patient is seeking care and the different hoops and hurdles that they inevitably need to jump through.

And they feel that a lot of this burden is on themselves and they're climbing uphill and they're in their entire journey and trying to seek care. And, we think there's a better way to. You organize and engage patients that puts the patient at the center and then connects the dots across the different steps in the journey in a seamless, frictionless way, making that entire care acquisition process more streamlined, more patient centric, improving their [00:06:00] satisfaction.

And I think improving their overall retention and. financial success for our organizations. This is none more relevant. And I think none more timely as you'll see throughout the conversations that we're going to be having that putting that patient at the center is going to be critical to success for the patient as well as the organization.

Digging a little bit deeper about what it means to listen to our patients and put systems and processes in place to align with patients. Let me orient everybody a bit to this slide. And then we'll, then, and then we'll talk about some of the key insights that we can take away from this slide. So this was a survey that Optum conducted with over a thousand patients throughout the country.

This particular slide breaks up our survey population across three demographic ages. And you look at, we, the question that we asked was, what channel are you currently receiving appointment reminders? versus which channel would you prefer to receive appointment [00:07:00] reminders through. In an ideal world, if we had this perfect, the green and the purple bars would be at the same height.

In fact, that would mean that we are delivering the appointment reminders through the very channel that a given patient would like to receive that notification. When you look across the age groups across the first cohort of 18 to 34 and the middle cohort 35 to 54, you can see that we've got a little bit of work to do.

And then, even when you look at age 55, we've got gaps there as well. And to me, what this says regardless of the channel, whether you're looking at text messages or mail, that we have an opportunity to deliver a more personalized experience. And of course, appointment reminders is just one example.

But being able to tune and adjust how and when and which channel we engage a patient with for things like appointment reminders in a more personalized way. We still have a lot of work to do to make sure that matches up with where patients want to be [00:08:00] engaged. So that's going to be a recurrent theme here as we dig into.

Where we think there's opportunities and, dig deeper into the conversation here as we jump right into how we view the front of the of the revenue cycle and the front of the entire patient experience when they're looking to, let's say seek care once they and we'll call that first bucket here in the tripod of patient acquisition.

patient financial clearance and payments, and we'll look at it in those three high level buckets. And in fact, that's going to be the manner through which we're going to be going deeper into the content here. And we'll break into each one of these and much more. detail in just a second.

But before, before we do that, let me give a high level overview of what we mean by each of these subjects. So acquisition, that means all of the kind of access and engagement that you provide to a patient to ensure that they're able to find and identify by your organization as a place with [00:09:00] which that they would like to seek the care that they need.

The middle bucket is going to be all of the activities associated with ensuring a patient is financially cleared for their visit prior to their visit, as much as possible. And then the third bucket is payments, meaning you're providing different channels and different ways and simplifying the way a patient can make a payment for their respon for the responsibility that they have for the care that they're seeking.

And in fact, you could probably put a wrapper around this entire thing for patient engagement and thinking through how we continue to stay engaged with the patient, make channels open for questions and comments and concerns that they may have prior to coming in for their visit as they go through this entire pre visit experience.

This is how we're gonna dig deeper into each section. I'm going to cover off on the net. I'm sorry. I'm going to hand it off to Morgan here. I apologize. I'm going to, I'm going to hand it off to Morgan here to cover the next section here for patient acquisition. Great, thanks. Can I think, important.

You think about it? We always talk about the lifetime value of a patient and their recommendations to family and friends. And so getting the entire process, right? It's so important we start with patient acquisition. Revenue cycle is critical, right? The 1st interaction that a patient has with your health care organization and then ultimately throughout the course of it to the last.

And we'll talk about how important that is towards the end of the presentation. But when we think about the few sources of inefficiency, there are 3 big ones. We want to cover 1. It's all about giving patients access to the care they're seeking. It is hard to find an appointment sometimes, let alone schedule it for many patients.

This is due to a number of different reasons. It could be provider availability. It could be the affordability of the service or just health system limitations and the actual scheduling process. The next inefficiency really comes in the form from a financial standpoint. Patients really just want to know how much it's going to cost them to get care and they are shopping and looking at different organizations to get that information.

The options that an organization has to verify insurance and provide that accurate estimate are so important to the process, but they can be limited. Or fragmented for organizations. We also know insurance coverage changes all the time. And so making sure that we are doing this at a timely manner can be a challenge as well.

And finally, there's often a disconnected experience for patients as it relates to online phone communication and all the in between 1 example of this is the quote unquote online scheduling when you think you're making an appointment. But in reality, you're just requesting an appointment. This just happened to me recently and then spent a whole week playing phone tag to just find out that the appointment that I wanted was no longer available.

It's frustrating to me. And I understand the system and why, and the limitations behind it. So we've been more [00:12:00] challenging for patients who really don't understand why it's so hard to obtain care. We really don't make it easy. And in some instances within the same healthcare system for patients from an acquisition standpoint.

All is not lost. There are a number of different ways to overcome this, starting with access and scheduling. The first is really optimize your EHR. It was a big investment for your organization. There are a number of ways to really make sure you're getting the most out of it. Decision trees, scheduling rules, maximizing the portal usage for patients.

But you also have to understand that there are going to be limitations and understand those and invest in Tools and support that is going to better the experience overall the 2nd, deploy digital self service tools. This is becoming a need to have no longer a. Nice to have. This is going to help your organization.

Reduce that reliance on F. T. E. S. It's the workforce is still challenged here, and so that will help with that problem. But also you're going to start engaging patients up front and supporting their own health care journey. When we think about the broader tie into population health, it really starts here.

Artificial intelligence automation. We are hearing about it a lot. We are talking about a lot. It is here today is going to share more about this. And we get into some of the emerging innovations, but really to provide that experience to your patients, you need to have these communication tools that can really personalize that and understand the human nuance that exists in that patients are looking for.

And then finally. You cannot lose sight of the providers and your physicians and how important that patient provider relationship is. We often talk about this as clearing the way for providers. How can you make sure the entire care team is working top of license to reduce provider burnout, increase their capacity to see patients and spend more time with those patients.

You're going to get a satisfier both for patients and providers.

If we move on to the insurance verification and pricing again, I think in every conversation I have, you probably hear this a lot sooner to denials. It is a top issue. It continues to be a main focus area and there are ways to avoid and to really focus on prevention and coverage. Discovery is 1 of those remove the manual process and potential for human error and leverage data and analytics to proactively identify that coverage up front.

It's going to have. Not only patient benefit, but huge benefits for your broader revenue cycle downstream as well. Provide your patients multiple ways to interact with you. It is not just a phone number for a single office anymore where we are seeing organizations build up centralized contact centers.

You can improve the process just by offering multiple communication channels. Again, you can solve that phone call, but you can. Talk through multiple services at once, chat functionality, text, meet your patients where they are, and it's going to help the entire process today. You mentioned that's on customer engagement.

This is really across the entire spectrum, but. A lot of patient dissatisfaction stems from repetitive requests and interactions in a format that is not what they are looking for. Again, how can we address these repetitive steps through patient verification, digital actions, synchronization, something that's going to support patients and your staff by reducing that.

Let me fill out the same form again and again. And then one of the biggest areas of opportunity that I see all the time is understanding the voice of your customer. What really do your patients want? That side that soon a showed was a good example of. Expectation and reality. So how do they want to interact with your health system?

I, for instance, want to text, not necessarily play phone tag when I'm trying to lead a webinar and getting calls from a health care provider. But my retired mother really wants to talk to somebody to ask her questions. And so making sure that you've got multiple options to offer patients. Again, it is becoming required, especially if you're in a competitive market.

And then when we think about how do you measure and evaluate the experience across patient acquisition, there are a handful of metrics here. What I will say is that cannot be done in a vacuum. All of these are critically important, but you have to be looking at more of your productivity metrics. Again, average speed to answer abandonment rate handle time, but also with more of the quality side. So the quality assurance of your agent performance scores, the percentage of calls resolved [00:17:00] all of that is critical. I had a client that their speed to answer time was phenomenal. Yet, when we started to pull back the curtain and look at metrics across the board, all of their agents knew.

That was their performance metrics. So they answered those calls pretty quickly, but they were not ultimately resolving the patient's requests when they looked at it. So again, performance of all of these for a holistic view is very important. Let's jump into financial clearance, which you know, there's a lot of inefficiencies, but also a lot of ways that we can be better supporting patients.

No question. Thanks, Morgan. And two quick comments from what you shared. I love the example of, incentives drive performance and actions. And depending on, what and how we coach and train our teams to measure their objectives and incentivize them. Morgan. Sometimes those we have to be thoughtful about what unintended consequences they may have and be really thoughtful about how we structure those.

So that was a great example of it's important to measure, but make sure we're measuring the right things and [00:18:00] incentivizing our teams in the right way to do what's right and what's best for patients in our organization. And the second thing that came to my mind as you were running through that and, talking about meeting our patients where.

Where they want to be met and the channels that they're interested in, and you can't help but look at what's happening in other industries and other experiences we have as consumers and not be frustrated with some of the experiences we have, as you described when trying to schedule an appointment.

And just how difficult and complex the entire process is. And, we feel like we're spending time in a way that is unproductive and then we have to restart the process again, if we started with the digital channel and then we have to go and call somebody in and your story resonated very much with me as I had a very similar experience when I've tried to schedule care through my digital channel and you get all the way to the end of the calendar.

And it's sorry, nothing available. Call the office and you have to start over. And I like when I take my phone and throw it across the room because I'm so frustrated. Absolutely. Yeah. And again, we [00:19:00] and we understand why, but Most patients don't. And so it's even more frustrating for them. Yeah. Yeah, exactly.

Yeah. I couldn't agree more. Let's talk about another area where there's lots of opportunities and that's financial clearance. And, I think when the first thing that comes to my mind, when I think of financial clearance and, the regulations and the policies that we try to check boxes with and providing, patient estimates on their out of pocket expenses, pre visit and build up.

Kind of the value of that and if there is any value at all in that, just given the lack of, I think, clarity and the lack of specificity and true kind of accuracy in what we receive in patient out of pocket estimates. And I think a lot of it is really goes back to the first step in the financial clearance process.

And Morgan, you touched on this is ensuring that we do have the right coverage plan and policy in place for that patient. Number one issue for patients when they're seeking care is making sure that the provider that they see that they're going to be seeking care from participates in their plan for those that are commercially insured, right?

So I think, financial clearance comes down to clearly two buckets for those that have insurance for those that don't. And we'll cover both of those as we dig into this a little bit. But across the board, In terms of getting patients financially cleared, they want to know that the care that they're going to seek is going to be covered by some insurance.

If they're not able to, get coverage through their, if they don't have insurance, then they're going to want to understand what their out of pocket responsibility is and what the organization is going to be able to do to help them to feel comfortable that they can get the care covered.

And then I think the last piece is, that when it comes time to actually pay their bill and the bill that they receive, the expectation is that is going to be accurate. And they're going to, there's, they're going to, there's trust built over time between the organization, the insurance company that the patient has, if they have coverage and the actual charges that the patient is going to be responsible for.

Let's jump into that. Let's unpack that a little bit. [00:21:00] Moving on to the next slide here of, what are some of the inefficiencies that we think are opportunities for improvement? Morgan, you touched on this a bit of proactive identification. through coverage discovery tools. I think there's even additional advancements that are happening through certain features within either vendors or within EHRs where certain life events can be used to alert a agent that is either scheduling or a digital solution that's providing scheduling to.

confirm that a patient's insurance has not changed. If we see change of addresses, if you change of employers, those are certainly triggers that usually will indicate or could potentially indicate a change in insurance. And another sort of fail safe to make sure we're getting accurate information up front to reduce back in denials.

For what coverage plan details we have in the system for a given patient. I talked about what we can do to help uninsured patients or [00:22:00] underinsured patients. And I think trying to support those patients as early in their care journey as possible is critical, not only from the patient perspective, but also from a provider perspective to try to get them into, for example state Medicaid plans as quickly as possible maybe educate them on ACA plans or other financial assistance programs that they may qualify for as early in the process as possible so that you have time to potentially get the patient enrolled prior to their visit first, especially for certain plans that don't have retroactive coverage.

So starting that process as early as possible is I think a critical point. And then we talked about this a couple of times of ensuring that we're routing patients and not a one size fits all approach, but rather customizing their workflow based off of their profile. Government coverage secondary tertiary coverage, commercially insured, self pay, uninsured, et cetera.

We want to make sure we're building robust workflows to route patients as efficiently through our process to use as [00:23:00] possible. and ensuring that we're tracking patients throughout their financial clearance journey and not having them fall through the cracks and run the risk of a patient showing up to the office without a clear plan of how they're going to be able to get their care covered and paid for either through payment plans or through a commercial or government plan.

The next step is, of course, one of our favorite activities from a pre visit perspective navigating prior authorization complexities from from our payers and, looking for ways to streamline that entire process I think is very critical. There's, stories of obviously failed attempts at completely automating this process.

There continues to be lots of changes happening very dynamically in this marketplace and some of the challenges and complexities that we're facing. As I'm speaking with you related to how clearinghouses are even changing their models for how authorization [00:24:00] inquiries are being educated and moving away from, let's call it free API calls to now monetizing API calls for every time we run an inquiry again, further making it complicated for automations to be put into place to drive efficiencies within authorization inquiries.

Okay. Determinations as well as submissions and follow up. So I think, one, one important step here is to leverage automations in a smart way where and when available, certainly that can and should be prioritized. However, it's important to have robust services and agents surrounding the automation, such that if an automation fails or doesn't work for a given payer plan, even clearinghouse, You have agents that are standing by equipped and ready to support those authorizations in an intelligently prioritized work queue and ensuring that those are all processed and submitted and appealed and all completed prior to a pin [00:25:00] coming to the office as efficiently and as quickly as possible.

Leverage automations where you can ensure your rep services and agents around it to ensure as comprehensive of approach as possible. As the industry continues to make changes, then this is an ever evolving landscape. Through from multiple lenses. Both from on automation payers, we've heard programs related to gold program.

So that's another opportunity for certain payers where you may be able to get preferential status through a historical performance analysis that shows that you were able to manage and process authorizations in an effective way, potentially reducing the overall burden that your particular provider or office has to go through when it comes to authorization. Stay up to date on that. Certainly keep track and see what opportunities you can certainly take advantage of to reduce the burden of authorizations within your practice. So evaluating your performance from a financial clearance standpoint, I think, Morgan and I talked about this and trying to reduce front end denials for sure.

That's a key focus. I think. latest numbers, somewhere between 30 to 40, 35 to 40 percent of denials can be prevented through changes or activities on the front end. So clearly an area to focus on to reduce overall back end denials. We want to look at overall reductions in bad debt total management metrics, looking at how we are managing those denials looking at whether we're able to reduce self pay dollars, increase Medicaid coverage for patients that could qualify for that.

So just overall looking at how we can best. Reduce denials, reduce bad debt and take advantage of the different coverage programs that our organization may have available such that we're maximizing the opportunities for our patients, delivering a streamlined experience for them and delivering as much transparency and support so that they can afford the care that they're seeking.

All right. I think with that, we're going to jump into the payment section. Morgan, I'm going to turn it back over to you. Yeah, thank you. I just have to say the authorization piece today and the automation. It is it's so interesting, but I your point about making sure that you have a. Backup plan, contingency plan, if you will.

It's working by exception, but you have to have individuals that are going to be there in case something a system goes down or something happens because it's such a critical piece to getting patients their care. So I, I appreciate that. I think there's a lot that can be done digitally and from a touchless standpoint, but you're never gonna fully reduce the need to have really skilled trained individuals supporting patients through the entire process.

Yeah, no, no question. Yeah. And that can't be it can't be downplay when you think about that. back end. So what, as they say, the last impression is the lasting impression. So again, we have the revenue cycle so critical throughout the entire patient journey. And at the end of the day, patient payments and your patients experience around billing and collections is going to have a big impact on how they view your organization.

We and that I loved that graphic from the kickoff on, that was probably even a nice way to put the complexity of the revenue cycle process and what happens behind the scenes. It takes a long time to work through the process for claims to be adjudicated even before that, to make sure that it's the right procedure that was scheduled and completed by the provider.

And so there are a lot of steps that happen. If you've got secondary coverage, then if there was a denial, so it takes time to get to the point where the patient's responsibility is going to come out at the end. And so any further errors there leads to frustration. Also, just again, the lack of patient [00:29:00] centricity.

So do we have different payment methods for individuals to reduce delays and then. It's expensive. At the end of the day, we'll talk through some of the different payment options and incentives for patients. But again, it is difficult for patients to understand and then manage those large medical.

Bills the entire process just plays such a huge role in how the health care system or how patients view your health care system. Really making sure we figure out a way to address these inefficiencies is going to be critical.

So when we think about this from a kind of billing patient collections, I often ask myself the same questions in a that you did. Is there something that we can learn or adopt from other industries? You're never going to go. Buy a TV. And then at the end, when it arrives, they say, Oh, I'm sorry. I told you it would be 500.

And it's actually 700 there. There are so many things that we can learn. And how can we infuse some of that into health care? And so I always say it starts with education. It is again complex, confusing, challenging. It's also not the only thing that a patient is worried about or family is worried about, but it is so critical.

How do we make sure that we are spending and investing the time to educate patients on their insurance benefits and coverage? So many times they don't really understand the insurance that they. purchased from their employer. And so how do we make sure that we can distill our understanding to them? I constantly find myself educating friends and family.

I'm sure you do as well, Sune. So again, how do we provide that service for patients? The accuracy of estimates through that process, it starts up front. Through making sure you've got the right coverage to them through the financial clearance process. But as things change, [00:31:00] how are we making sure we've got an accurate bill on the back end workflows again, working by exception.

How are we really minimizing any errors that ultimately make it to a patient that's going to cause frustration and then similar to what I mentioned in patient acquisition, we have to make it. more simple for patients. So how can we find user friendly methods to deliver consistent statements? And ideally, if you got a hospital and physician, a single bill to patients, not always the case, but there has been a lot of legislation around.

Getting the right information accurately to patients. So they understand this. So again, let's make it convenient user friendly. For any patient, whether they're going to see it, read it, how can we help that? Because that will clearly lead into how they pay their bill.

There's a couple of solutions or recommendations here. I often ask myself when I think about the collection workflow again, what can we get out of another industry? Can we make this more like the Amazon experience? So when you're paying for something number one, we have to make sure it's safe and secure, obviously, because it is financial information.

But when you think about accessible storage solutions for credit cards, HSAs, FSAs, to streamline that process, make it easier for a patient to go via text or into your portal to pay can we link those cards as well? Just like in any other shopping experience I have, it's going to make it a whole lot easier again, done safely and securely.

And then it is a expectation for all other services that we buy. That you're going to know the cost of it, and you're ultimately going to get a receipt when you do pay. How can we deliver this from a, in a text based manner? I had again, another experience went to pay my bill, got nothing. I did not know if it went through.

What do I need to do? How to check? Go in and check my credit card statement again. A challenge and makes me think next time. Do I want to get my care there and have that experience? Or maybe I'll just delay paying because it was such an inconvenience at the time. Neither of those you want to see from your patient.

So again, how can we meet them where they're at throughout this entire process?

When we think about payment plans and affordability, really 2 big things, transparency and ease. Again, proactive, accurate communication when there are changes. It is healthcare. It's dynamic. There are things that are going to happen between coverage changes benefits being exhausted procedure changes really be up front and communicative with patients.

The transparency that is going to be the best option here. It's okay when something changes, but again, communicate that. And then the bottom two, really, how are we helping patients eliminate that financial stress? There are a number of different ways. We're seeing organizations approach that. 1 is around early payment incentives.

Again, I think you mentioned it. Disincentivizing the right actions that you want to see. Internally with our agents and our staff, but also with patients. So again, how can you incentivize them around paying promptly timely financial transactions? And then again, preemptive payment plan. How are we building within our system approved payment plans that patients can enter into again?

It's building autonomy and giving patients the ability to. Be involved in their health care journey and alleviate and manage some of the stress and the payments that need to come. There are a number of different metrics to evaluate this at the end of the day. A few of these are [00:35:00] here aging a bill. Again, just trending outstanding balances, bad debt reduction.

How are we doing in enrolling patients and payment plans? And how are they enrolling? Is it a discussion with our customer service center? Or is it something that a patient is enrolling themselves online? There's a number of kind of other ways to also think about this number of systems have patient payment scores.

I've got another organization that implemented more of a pulse survey. Just like when you're on the phone, let's say with Verizon and they ask you at the end, rate your satisfaction. So there's a number of ways to gather feedback qualitatively and understand the quality and then also looking at this to see the impact that you're having in the work that you're doing, but there's also some new things that are out there and coming.

And today I'm gonna let you talk a little bit about some of the emerging innovations that you're seeing and that you're helping to implement. Yeah, absolutely. And Morgan, I couldn't as we think about what are some of the emerging innovations and cool new features and functions that we're keeping an eye on and working on as well.

I can't help but think what you said about, the incentives driving the behavior. And, even to the earlier point of how satisfied patients are 72 percent more likely to pay their bills, that trust is probably the most important ingredient in being able to. Successfully collect your patients out of pocket costs and trust.

As we all know, just takes time to build. And I think one of the other investment areas that I get questions about is, how much should we invest in educating our patients on, what their plan details are, especially given how complicated it is. Is how much time it takes. I think having an omni channel approach to even patient education on, what the terms mean.

I think even, patients understanding what a copay is versus a co insurance. I 100 percent agree. Like that, even just the basics will help a lot of patients to feel more comfortable, at least even when they're on the. [00:37:00] phone going through the financial clearance and payment process, right?

Like just those basic things, which may not take more than a minute, can have drastic improvements in trust and even collection of patients out of pockets. Sorry. Go ahead, Morgan. No, 100 percent agree with you. And then you can measure that too. Again, it's not just how quickly do you get the patient off the phone if they're calling about payment, but spending the time to educate them.

And then that results in a patient that pays their bill and continuously pays their bill. You can track that. And again, it's far above and beyond the benefits, I think, when you see it over time. Yeah, no question. And hard, hard to build, easy to destroy but reaps huge benefits in building that trust.

And to your point, you can track it, you can look at patient retention, you can look at, the trust scores, the pulse surveys that you were mentioning. And I think that's a very important way to continue to improve in those areas too, right? That's how you can highlight insights and obtain insights on.

You know where you can be putting more energy, more focus more change processes in place to try to drive a higher level of performance in those areas and. 11 kind of technology automation that we're keeping a close eye on and also working on as well. From a, capability standpoint is conversational AI.

We've heard so much about a I. M. L. And looking at ways in which we can, let's say, safely and efficiently deploy a I. When we think of our centralized contact center services. We think there's meaningful value and significant opportunity for deploying conversational AI in partnership with our live agents and partnership with digital self scheduling and mobile outreach and engagement with patients in a comprehensive front RC and, this is also this also can be deployed in a measured calculated kind of iterative approach where you can start with very basic use cases like, patient identity verification.

Looking at, confirming that the patient is who they say they are validating their information, via demographics and addresses and phone numbers, etcetera. Matching up the number with which they're calling from with their number within the EHR system and saying, Oh, Sune, I see you have an appointment coming up on October 31st.

Are you calling in regards to that appointment? And then you say yes, and then you get connected to a live agent and now the live agent doesn't have to spend as much time. Going through some of the basics of what the caller intent is and the patient verification process making your costs for the contact center go down drastically.

So I think that's a really exciting area and the use cases within conversational AI are going to continue to grow all the way to the point where we can see there being clinical use cases for refill reminders for [00:40:00] Financial clearance capabilities where if you're under underinsured patient and you want to complete a Medicaid screening in partnership with a conversational AI to support some of your questions, the multi language support of conversational AI is very powerful and very easy to deploy as you see in the visual there.

And then even from an access standpoint, being able to complete the entire scheduling process through the conversational AI is something that is also not too far away and on the horizon and available in the marketplace soon. This is certainly 1 of the areas that we're really excited about and think is going to add a lot of value both to patients as well as providers.

I'm very Morgan. I think I'm going to bring this home. Yeah I'm so excited today. I think not just personally, but. When you see what is coming, it's really gonna transform the industry. I think. Yeah, and we have to write like we're behind other industries. We see it through mobile phones.

We see it when we do airlines, consumer experiences [00:41:00] are adopting these technologies in a very efficient, effective way. And there's no question. We have to get there soon and quick. Yeah. Agreed. We do. All right let's close it out with a couple of. Focus again. If you bring it all together on how do you reimagine what your patient experience?

Could look like and let's start with navigating some of the common challenges. This obviously isn't easy and it's not you snap your fingers and it's done or everyone would be doing it. We wouldn't be talking about it, but there are some common pitfalls. We've got a few of these here. They're all just as important as the next, but let me address a couple of these that constantly come up in conversations.

I'm having with clients and providers. The 1st is implementing changes with provider buy in. I spoke a little bit about the hand in hand relationship with the provider and patient your providers or physicians. They're going to be hearing. The challenges, the complaints from patients directly when they're receiving care.

Both of these parties are such important constituents and we need to be listening to both and be moving forward together. Patients providers want to spend more time. With patients want to spend more time with their providers. There's a number of things that we can be doing to help enable that.

And so again, making sure you've got that provider champion providers at the table. Do that from the start. The 2nd kind of ties with what you just mentioned around implementing and technology. So you've got to understand what your patients want. You've got to understand how that. Mary's with your own internal infrastructure tool limitations and design the strategy and how to leverage a I with that in mind.

Don't just see a shiny object and think that's what's going to happen. It's really gotta be focused and you've got to have a strategy. And how am I going to improve the patient experience through? HR or additional technology and tools. And so thinking about what does that end goal in mind is going to be critical there.

And then lastly, just the whole digital presence and brand visibility. So you have to make sure that you differentiate that. And I will use this example that a colleague always says is. Let's take organizations that are on epic in a single. City or market. All the porters are going to look the same minus your logo on there.

So how are you going to make your organization different from maybe not the look and feel, but then what you have to offer your patient. So again, the omni channels, the understanding and meeting their preference, meeting their expectations with the preferences you give them if they ask for something electronically, are we giving it to them electronically and so really just accentuating that when you think about brand visibility and making your, And differentiating what you have to offer in the market.

And then we'll close out with a couple of kind of ways to reimagine that experience. And you shared some statistics. early on. And I think there's a few more that are just really important here. So one, again, 69 percent of Americans considering switching to another provider that offers a better experience.

79 percent want to use technology managing their health care experience. And then again, 81 percent believe scheduling appointments online would make the whole process easier. We have to listen to what is out there. And so when we think about the Financial experience. There's really three main areas. So one every organization strives to have top quality, top clinical quality, and they focus on prescani scores and the like to make sure that they're providing that for their patients.

How do we mirror that? How do we make sure that the financial experience from acquisition, financial clearance to billing and patient payments is  the They're gonna patients think about this when they make their choices about where to go get care. If you assume quality is going to be the same across each organization, the 2nd, really focusing on that financial piece.

Like I said, we know that this is a huge influence on patient loyalty. I mentioned the lifetime value of a patient early on. But again, how can you. Really focus in on that, that one experience and drive that because you're going to grow by having that patient, especially if they are perhaps a younger patient, generally generationally stay with your health care system, tell their friends, family and the like.

And then, lastly, again, I just mentioned it. No one is doing this top. Or what are we talking about it? And so it continues to be such an important focus. It was just with a group of health care providers last week. And, they're really still focused on minimizing dissatisfaction right now with the patient experience instead of  deploying strategies that are going to truly be.

Move this from transactional to relationship based in a consistent and differentiated way. And so there's a lot of room to just think transformationally and shift from just trying to stop the problem. To really being differentiated and be that first mover from an experience standpoint. So I think all of the items today we talked about today.

All are really important understanding your organization where you have opportunity and there's a lot of ways to solve that. But I will pause here and I think we've got some time for Q and a here. All right. Thank you both for that excellent presentation. As noted, this now brings us to the Q& A segment of the program, so we would like to invite you to ask live questions of our speakers.

As a reminder, to submit a question, click on the Q& A widget at the bottom of your console player. Again, it may be open already and appear on the left side of your screen. And please note that your questions will remain anonymous and will not be viewable by other [00:47:00] audience members. First question is directed to you, Sunay, from something you mentioned during the program.

It said you mentioned clearinghouses now charging for a type of call that used to be free. Could you please repeat that? This individual didn't quite catch it during the program. Yeah, sure. This is a yeah, this is a digital API call that we make through clearinghouses for some of our automations for checking the status of a prior authorization that we submitted.

What we're finding is that certain clearinghouses are now implementing a per transaction fee per each call that we make through the automated bot. And so that adds an additional layer of cost and complexity to navigating the automation, and it's essentially a barrier that impacts our ability to use the bots.

Really, again, talking about the importance of having a. A flexible multi pronged approach to automations and ensuring we're wrapping services around automation because the landscape within healthcare continues to change. And having a robust plan in place to support automations, in fact, even provide oversight of automations given, especially in certain sensitive areas where we know the impact of an error within an automation or an A.I. tool can have significant consequences you want to wrap around and have a complimentary service available. And that's that's similar best practices that we're encouraging folks to follow when it comes to authorizations as well. So that was what I was referring to just how the automation is being impacted by certain obstacles that are being put in place by clearing houses.

Great. Thank you for going through that again. And next question I'll throw out to the both of you. For an ambulatory primary care practice with multiple locations, is it more effective to have scheduling conducted by each site or by a centralized call center?

Go ahead, Morgan. Do you want to take it over? Oh, I am happy to. Go for it. There is, there's no silver bullet. I think there are a lot of considerations to. Take in mind when you make this decision, I think for sure. Can you probably gain the most economies of scale and efficiency? If you've got a single contact center that can schedule for multiple locations.

Absolutely, but it's not easy to just make that transition. There's a number of things to think about again, technology in place provider templates and scheduling logic and rules. Standardization at minimum, we would say is going to be best practice across if you do have multiple sites doing it. But I know I would say if many organizations are moving towards that centralized call center, just for all of the numerous benefits you could get.

But what are you seeing soon? I yeah, similar Morgan. I think, of course the standard, each organization has their own kind of unique nuance. However, as one trend we see is continuing to be true, there's consolidation organizations are getting larger. I think having centralized contact center functions, especially if you're part of a large integrated system that has both, acute care as well as ambulatory care.

Getting that all of that centralized scheduling implemented is not a small feat, but I think the investments from what I've seen are end up being worth it in the long run. And it lays a good foundation to continue to scale, whether it be organically or inorganically through acquisitions, because now God, at least a core technology in place that then allows you to plug additional systems and health systems in place.

But I Morgan, to your point, there's no question there's a significant amount of effort involved to get it going to get all the data, consolidated, centralized the appointments, the visit types, the scripts, the workflow. Flows, the call flows no small feat, but it's like one of those things where once you make that investment the dividends and the returns play out for years to come.

Absolutely. If you do it right. I have, years ago you saw people say, all right we'll put everyone in a single building, but they still only individually scheduled for certain sites. Then you're not really getting the benefits of what you want. So I think all of those. mentioned are going to be critical again.

Let's do it right and get the output we want for the investment we're making. Yeah. And depending on what the existing even infrastructure is, if you've got If you're not on a cloud based telephony platform, and to your point, you've got, server rooms and, wires and rooms and hardware all over the place that you need to manage and, moving over to a cloud based telephony platform also reduces your maintenance costs and, like I mentioned, sets you up to scale in the future as well.

So each case is unique. There's complexities and nuances based on. What your current state is, but I,  from, I think what I'm seeing, I think what you're seeing as well, Morgan, is we're seeing that the trend is to centralize more and more. Thank you both for that insight. Our next question, again, I'll throw it out to the both of you.

Can you share any successful case studies or examples of healthcare organizations that have enhanced their patient financial processes?

Yeah, I can talk about I can talk about this one. For sure. There's again, going back to trying to standardize as much as possible. But, knowing that each. organizations, demographic and unique patient populations have different impacts on the financial success of an organization.

We had a customer that is in a in an urban, highly urban area. 25 percent of their population is on Medicaid. And, being able to screen [00:53:00] Green and support patients as early in the process as possible had a significant financial impact on reducing the organization's bad debt and that program ended up helping that particular organization quite a bit both in terms of improving patient satisfaction.

And retention because of the patients knowing that, they are going to be supported through an enrollment process to get coverage in a process that, otherwise would have been somewhat complicated. But then also from a reduct from a provider standpoint in a reduction of bad debt because now instead of that particular service or care being provided and it being uncompensated or written off now through available state programs the organization was able to, recoup the costs and be able to get insurance Coverage payment or Medicaid government coverage payment for the care that they were delivering and having a significant improvement in the financial performance of that organization as well.

So that's 1 example that comes to mind when that's a great 1 question like that. Yeah. Yeah, I've got a, I got 2, maybe 1, an organization midwest again, another urban area. They conducted their own. Patient survey to understand again, not just nationally, but what was happening in their area because it is a highly competitive market.

What could they be doing from a financial standpoint to really address patient complaints and concerns proactively? And so 1 of the things that came out of it is they started leveraging. Their patient payment scores to understand the behavior of their patients. So not just willingness, but actual behavior to pay.

And so it was really unique for those individuals that, always paid their bills. They just wanted to make sure they saw the claim at the end of the day and make sure it was accurate. They didn't hound them up front for point of service. They still may be asked consistently but they had that note in the system and then they let the patient pay and they tracked it and saw.

No reduction whatsoever in patient payments in actuality, based on increase. Because again, we were meeting patient preference with what they were looking for, especially those that were loyal to the system. And then another 1, is there some really unique, I would say, technology out there when you think about the back end customer service that just can measure, tone.

Sentiment, how your agents are having conversations again to really understand. Are they interacting with patients speed up slow down? Are they explaining things? And so I've had some organizations that are really implementing some cool stuff on the back end. Yeah, I can examples. Thank you.

Oh, yeah. Sorry, Brian. I guess we're coming up on time. Yeah. All right, Brian. I'll go ahead. Sorry about that. No, we've got about 90 seconds if you want to have the last word here very quickly. Yeah, I was just going to double down on what morgan was saying related to caller sentiment analysis And I know that's a key feature that we're also hearing from our customer base good feedback on where you know, very similar where while an agent is on the phone with a patient there's like red, yellow, green that comes up through the analysis of the speech that is happening, the volume of the patient's responses.

And then providing some real time coaching or interventions and warnings on the screen for the agent while they're talking with the patient to serve as that guide to perhaps change the subject or to use some filler words to break the tension or to apologize or things like that.

And it's been, we've received some good initial feedback on that. It's a relative. Yeah. Fantastic. Exactly. It's so much faster to do real time than the, how are you listening to call after call after the fact. So I think, again, immediate intervention is really, again, reimagined experience, if you will, for that segment.

Perfect. Two excellent examples again to wrap up the program. So that is unfortunately all the time we have for today. Again, I want to thank our speakers once again for an excellent presentation and our sponsor Optum for making this program possible. Finally, a thank you to you and our audience for participating today.

We hope you'll join us in the future for another health leaders webinar. And this concludes today's program.