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In today’s consumer-focused healthcare system, patients hold the upper hand. For providers, this new dynamic means financial success often hinges on whether patient expectations are being met — and those may have little to do with traditional measures like clinical outcomes and bedside manner.

So what determines whether a patient walks away happy? A positive revenue cycle experience. According to a 2014 Connance Consumer Impact Study, 95 percent of patients who had a good billing experience “would return to the same hospital for a future elective service,” while less than 60 percent who did not have a good experience would return[1]. Satisfied patients also are more likely to pay their bills: 74 percent of patients who had a positive billing experience paid their balances, while only one-third of non-paying patients did not.[2]

The revenue cycle experience also disproportionally affects a patient’s perception of the quality of care they received. And it’s easy to see why: A final bill is typically the last point of contact with a patient. Get it wrong, and that’s all they’ll remember. Getting it right, however, requires a deep understanding of how the payer landscape is changing and what types of information patients need to make informed decisions.

The new patient-consumer

For most patients, gone are the days of low out-of-pocket costs for healthcare — and that’s not by accident. In an attempt to bend the cost curve of healthcare expenditures in the United States, which reached a record 18 percent of GDP in 2009, authors of the Affordable Care Act (ACA) shifted more expenses to patients, based on the assumption they would be more cautious when spending their own money.[3]

The most prominent example of this cost-sharing strategy is how health insurance plans on the ACA federal exchanges are categorized: platinum-level ACA plans require patients to pay, on average, 10 percent of all out-of-pocket costs (deductibles, co-pays

and co-insurance), while gold-level plans require 20 percent, silver-level plans require 30 percent and bronze-level plans require 40 percent.[4]

Cost-sharing also is increasingly evident today in employer-based health insurance products. According to a 2017 study by The Henry J. Kaiser Family Foundation, “among covered workers with a general annual deductible, the average deductible amount for single coverage is $1,505, similar to the average deductible last year ($1,478).”[5]

Transparency and clarity

With increased out-of-pocket costs, patients need clear, accurate and timely information about where they stand in the lifecycle of their insurance, so they can make the best decisions for themselves and their families. Specifically, patients want to know about:

  • Eligibility: After patients are diagnosed, one of the first questions they typically ask is, “Will my insurance cover this?” Being able to access this information in real-time allows providers to better set and manage expectations.
  • Price: Once patients know what their insurance covers, they typically want to know what their exact financial responsibility will be. Providing clear, definitive expectations around their financial responsibility builds credibility and trust with patients.
  • Timing: Patients also want to know when their payments are due, and whether “Final Bill” really means the final bill.

Proactively providing detailed information regarding eligibility, copays and deductibles to patients can eliminate sticker shock at the point of service and increase satisfaction scores. Remember, healthcare encounters are often stressful for patients. And under these circumstances, making decisions based on unclear and incomplete information can make a stressful situation worse.

Interested in learning how Alveo can help you improve transparency and clarity? Let’s talk. We provide clients with tailored business solutions that simplify workflow, minimize operating costs, and maximize reimbursements. Our services include patient eligibility verification, claims processing, remittance advice, patient statements, patient payment portal, customized reporting and analytics, and a unique electronic prior authorization solution set. We process more than $1 billion claims each month with a 98 percent annual client retention rate. And through our connections with more than 4,000 payers, we possess a 96 percent clean claim rate.

1, “2014 Connance Consumer Impact Study Shows Link Between Business Office, Patient Payment Behaviors and Patient Satisfaction”
2 Ibid.
3 McKinsey & Co., “Accounting for the cost of U.S. health care,” 2011
4, “Your Insurance Choices in a Marketplace: FAQ,” 2017
5 The Henry J. Kaiser Family Foundation, “2017 Employer Health Benefits Survey”