Connecting Payers, Providers, and Tech for a Better Patient Financial Experience

The patient financial journey can be lengthy and confusing for consumers following a healthcare encounter, making it a critical area of improvement for providers and their revenue cycle management teams.

Streamlining the patient financial experience requires support from not only providers but also payers. Data sharing between stakeholders can help improve the process and reduce consumer grievances.

A Pittsburgh-based payer and provider combo comprised of Highmark Health and Allegheny Health Network has started on this journey with the help of a technology platform from Cedar.

“The guiding principle in this process has been to reduce the pain points and frustrations that consumers and patients have,” James Rohrbaugh, chief financial officer at Allegheny Health Network, told RevCycleIntelligence.

“What’s unique about the work we’re doing here is that in the case of Highmark and Allegheny Health Network, Allegheny Health Network is part of Highmark, so we have both a provider and a payer. [That] provided us a unique opportunity to address the challenges that consumers and our patients find with that.”

The organizations have partnered with Cedar to deploy a new technology involving both providers and payers in the patient billing process.

With the new digital approach, Allegheny patients with Highmark insurance will have access to several pieces of information in one space following a healthcare encounter, Seth Cohen, president of Cedar, shared.

Typically, patients receive their explanation of benefits (EOB), deductible information, and health funding account information in different places. With the new solution, all of these pieces will appear on a patient’s medical bill, allowing them to see the complete breakdown of what they owe in one spot.

The idea of involving payers in provider revenue cycle management is relatively new.

“Oftentimes insurance companies and providers are at odds with one another,” Rohrbaugh said. “What this project has done is put us in a position to show the value of bringing those two organizations and those partnerships together.”

The technology aspect was the missing piece for Allegheny to streamline the patient financial experience.

“These are issues we’ve been grappling with in healthcare for a long time, and many of these issues are technologies that are being utilized in other industries. We just haven’t packaged it up in a way to address the consumer issues, the consumer space, and the provider and payer space,” Rohrbaugh explained.

By leveraging the technology, Allegheny hopes to improve consumer interactions, as dealing with the financial aspect of healthcare can be incredibly burdensome after a healthcare encounter.

The platform is only the beginning of what technology can do to bring payers and providers together for the sake of consumers.

“What we identified is there’s a lot that needs to be done to bring a payer and provider more aligned in benefit of the consumer. And what we’ve done is identify where to start,” Cohen pointed out.

Allegheny Health Network is building cost estimation tools and Highmark has cost transparency tools in the works to comply with the various price transparency regulations and help consumers access affordable care.

“In general, what we’re excited about is there’s a number of opportunities, and in particular not just waiting until after the patient has left the building to provide them [with] a better experience, but how do we set expectations ahead of that visit? How do we make sure we’re onboarding that patient where there’s clarity and certainty and consistency in the experience they’re having before they’re walking in the building?” Cohen said.

Going forward, Rohrbaugh hopes that future strategies will help make consumer interactions simpler and more engaging while producing results in everybody’s best interest.

“As I think about the things we’ve done to improve access, really enabling experience around those is a big opportunity. It’s great to get something quickly, but then to the extent that we can make the intake process, gathering information, scheduling, all of that, even simpler, we all win,” he mentioned.

Healthcare providers working to fix their fragmented patient financial experience processes should be mindful of the technology opportunities available and not shy away from new strategies.

“Many of the challenges we have, we’ve had for many, many years. So, it takes a different approach and a different set of tools than maybe we’ve been approaching them [with] in the past,” Rohrbaugh noted.

In addition, providers must realize that patient billing is not just a revenue cycle problem.

“The idea that revenue cycle should be the only solution, the only stakeholder responsible for figuring this out, misses the fact the patient is interacting with way more than what the revenue cycle team is producing,” Cohen asserted.

All stakeholders, including providers, payers, and the revenue cycle team, must be involved in the process and engage in data sharing.

“There are so many different touchpoints to the patient, and if we’re really going to take a patient-centered view to this, we need to start with that and make sure we’re thinking about all those different interactions,” Cohen concluded.