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In today’s healthcare industry, consumers expect—even demand—transparency and simplicity. Leaders have grown to understand that healthcare provided from within hospital walls accounts for only 20% of patient wellness—and they are
now considering the healthcare experience beyond hospitals.1
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. However, new technological strides can help track patient experience; by using predictive analytics, health systems will be able to precisely tailor their experience to suit the needs of specific patients.2
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 appeal 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.
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 Agency for Healthcare Research and Quality (AHRQ) reported that low health
literacy is associated with more emergency department visits and hospital readmissions, less preventive care and poor medication administration skills.3
Despite efforts to improve the clarity of information and meet expectations, the industry still has a long way to go.
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 100-289B4 per
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. Some
readmissions are unavoidable, but many are preventable when proper efforts are made. Evidence-based interventions to lower readmission rates include patient coaching, telehealth services and follow-up after discharge.5 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 is a huge source of administrative costs in the Healthcare system. It is often an emotionally-charged scenario and is 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.
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.
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?
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.
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