In today’s healthcare industry, consumers expect—even demand—transparency and simplicity. A 2012 survey on healthcare1 revealed that “30% of respondents wanted their patient… experience to be the same as any other customer experience they have—such as shopping, hotel and travel.”
There is ample published material suggesting that improving the patient experience directly impacts a business’ ability to retain and grow market share. This certainly provides justification to invest in experience improvements, but those impacts can be difficult to quantify. A 2016 article from McKinsey2 indicates that many “experience improvement” initiatives fail, simply because the owner of the program can’t prove the value of the improved experience to their business. The authors noted that “at a recent roundtable, fewer than half of the customer-experience leaders present could say what ten points of net promoter score would be worth to their businesses.”
Improve patient experience. Reduce costs. Win-win.
Often, the things that drive poor patient experience also drive costs for providers, payers, employers and patients. Eliminating noise and waste allows organizations to self-fund their improvement initiatives and increases the likelihood they will succeed. One of the best ways you can ensure a successful transformation is to ensure you understand what impacts costs and experience in detail.
Many causes of costly contact volume, claims appeals and adjustments, complaint investigations and outstanding medical debts can be minimized through better education for patients and the people who serve them along their journey.
Education and Communication
When it comes to patient education and communication, simplicity is King. Healthcare and insurance are complicated topics for the majority of U.S. consumers to grasp. The Washington Post reported on a CDC study3 from 2007 that found 36% (more than 90 million) of U.S. adults had only basic or below-basic skills for dealing with health material. In other words, patients with that level of health literacy would only be able to understand discharge instructions written at a fifth grade level or lower.
While there have been initiatives across the industry to simplify health communications since then, the number of insured patients has also grown significantly. A 2015 CDC survey4 indicated that for the first time in 50 years, the number of uninsured dropped below 10%, which has flooded the entire system with new users.
Despite efforts to improve the clarity of information and meet expectations, the industry still has a long way to go. According to a 2013 survey, two-thirds of consumers say it is important for insurers to provide easy-to-understand information on their policies—yet only 27% say they were satisfied with their insurers’ efforts to do so.
Confusion Increases Contact
When patients have trouble understanding, or are misinformed about their care and coverage, they reach out for help—sometimes multiple times and to multiple places. Millions of administrative labor dollars are wasted each year by providers, payers and benefits administrators alike, trying to rectify the confusion. Patients are often passed back and forth between these groups, increasing the effort they have to expend to get resolution, all the while diminishing their opinion of the overall experience. Additionally, poorly informed patients are at greater risk for poor medication compliance, a problem that costs the U.S. economy an estimated $283B5 per year.
In our business, we see the downstream impacts of poor communication first-hand. We handle thousands of contacts a year with patients, providers and insurance companies all trying to navigate a very complex system. Let’s look at a few examples from around the industry of how education and communication impacts cost and experience.
Re-admissions represent a huge challenge; they are dangerous and costly to patients, providers and insurance companies. Customers who misunderstand their discharge instructions are at greater risk for complications, poor outcomes and re-admissions. A study conducted by the University of California’s School of Pharmacy showed that placing an outbound call to patients after receiving hospital care to ensure they understood discharge instructions helped proactively address problems or questions related to medications in 19% of patients. In addition, this call helped to uncover new medical problems or concerns that could be addressed by the medical team in 15% of patients. The group receiving calls had a 10% 30-day re-admission rate (compared to 24% with no phone calls), and reported higher patient satisfaction rates. Overall, the proactive approach was able to prevent further, more expensive touch points and interactions down the line, and provided better care outcomes for the patients involved.
Claims Processing and Collection Multiplies Administrative Drag
Claims processing and revenue collection are a huge source of administrative costs in the Healthcare system. They are often emotionally-charged scenarios and are highly likely to result in repeat contacts, escalations, complaints and appeals. An Alorica review6 of contact patterns and satisfaction rates related to claims calls showed a claim unresolved after 85 days produces three times more contacts to the insurance company compared to claims closed in 28 days or less—and the more contacts involved to resolve it, the less likely it is to produce a satisfied customer.
We also know that claims involving disputes and errors drive longer processing times and more contacts. A Kaiser Family Foundation survey7 on surprise medical costs found that “among insured, non-elderly adults struggling with medical bill problems, charges from out-of-network medical bills were a contributing factor one-third of the time. Further, nearly seven in 10 individuals with unaffordable out-of-network medical bills did not know the healthcare provider was not in their plan’s network at the time they received care.”
More often than not, these surprises happen with emergency care, where we find issues related to the customer-facing tools to select in- and out-of-network providers. Many times, the hospital where the patient was seen is in-network, but the doctor/radiologist/anesthesiologist is not. The average user, particularly if new to the system, does not understand the nuances that can impact total out-of-pocket costs.
Simple Ways to Improve the Patient Experience
What do these examples teach about how to attack the problem? What are your lines of defense against costly problems impacting your patients and your business? Quite frankly, how do we make things better?
- Know your drivers of volume and noise, and what impact they have on your cost model.
- Have a systematic process to collect, dissect and understand root causes of each driver, so they can be addressed before they negatively impact cost and experience.
- Use clear, easy-to-access, easy-to-understand and omnichannel communications to educate patients proactively about what impacts they can expect with regards to care outcomes and costs.
- Prepare anyone who interacts with your patients to explain and educate in clear, simple terms, and with empathy and communication appropriate to the patient and the situation.
Improving the lives of the people we serve should be reason enough to look at the patient experience and determine if there are ways to improve upon it. But if that’s not enough, consider the financial impact: given the need to drive value back to your business and your partners, you really can’t afford to not make the experience better.