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Answering the Call for Financial Transparency: Executive Summary

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Like it or not, healthcare is a business. And like any business, to survive and hopefully thrive, you must adapt to the market. Even though most healthcare facilities are non-profits 1, they still seek high operating margins that focus on maximizing revenue and reducing costs.  

Traditionally, a health care provider’s ability to maximize payor revenues determined its financial success. Data transparency centered on a payor’s needs, not a patient’s.   For many insured patients, bills were treated as “informational only” since the cost passed between a healthcare provider and payor and left the patient out of the transactions. 

But things have changed.  The patient continues to become an important part of the payor mix for many healthcare providers’ revenue cycles. 35% of physician revenue is attributed to consumers2.  With this change in revenue composition, comes a need for providers to put patients at the center of their payment platform strategies.

More and more providers are investing in technology that will transform the patient experience, especially when it comes to the payment process. Hospital electronic health record (EHR) systems serve as the foundation for this technology.

As of 2015, 84%3 of hospitals adopted some sort of EHR system; this represented a 9-fold increase since 2008. No doubt, this number is even higher now. And with EHR systems in place, healthcare providers are looking to optimize interoperability to provide better care while improving the patient experience and maximizing their ROI.

The importance of interoperability continues to grow across healthcare. Not only is interoperability important to the continuity of care, but it plays a role in the overall patient experience.  When done right, it puts patients’ medical and financial information in their hands so they can make informed decisions about their care.  

Over the next five years, CIOs plan to make big investments in optimizing their EHR and interoperability4. When we interviewed providers and asked if they’d consider upgrading their current technology or switching to a new EHR, they told us that they’d weigh the cost of the investment, both financial and opportunity, with the ROI they hope to gain.

Respondents told us that although some EHRs have their own patient portals or other patient engagement/payment functionality, providers still invest a tremendous amount of time to get multiple bolt-on technologies to work together.

“It takes a lot of my mental energy and time to make sure all of these things work well together.  I need to have the confidence in whom I’m working with to make all of these elements work well.”  Practice Administrator, Neurology, 12 providers

An intriguing solution is a unified patient platform that acts as a one-stop shop from a patient perspective, yet interacts seamlessly with existing EHRs.

Over 80% of providers think a unified solution is valuable or extremely valuable5

“It’s a genius thought to integrate front-end and back-end. We struggle horribly with the giant chasm in between what happens on the front-end and what we get on the back-end… It saves everyone time and money to get the information correct the first time.  It makes the patient experience better, and we get paid more quickly.”  Revenue Cycle Director, Ortho Practice, ~80 providers

Even though most providers see the value in a unified patient solution, they’re hesitant to make the switch unless there’s a compelling ROI and ability to integrate seamlessly with their EHR systems.

When considering a unified patient platform, providers need to identify a solution that integrates with their current EHR while driving significant ROI and improving the patient experience.  

This is easier said than done. The pressure to meet government regulations, payor rules, and patient expectations make this a significant challenge. But, with the right approach, it’s possible.


Endnotes

1.  Health Forum, LLC, an affiliate of the American Hospital Association. “Hospitals by Ownership Type.” KFF, 2020, https://www.kff.org/other/state-indicator/hospitals-by-ownership/?dataView=0&currentTimeframe=0&sortModel=%7B%22colId%22:%22For-Profit%22,%22sort%22:%22desc%22%7D. Accessed 29 March 2022.

2. 2019 MGMA Annual Conference

3.  Henry, MPH, JaWanna, et al. “Data Brief 35: Adoption of Electronic Health Record Systems among US Non-Federal Acute Care Hospitals: 2008-2015.” Office of the National Coordinator for Health Information Technology, May 2016, https://www.healthit.gov/sites/default/files/briefs/2015_hospital_adoption_db_v17.pdf. Accessed 29 March 2022.

4.  Dyrda, Laura. “The big 2021 tech investments for 5 health system CIOs.” Becker’s Hospital Review, 7 January 2021, https://www.beckershospitalreview.com/healthcare-information-technology/the-big-2021-tech-investments-for-5-health-system-cios.html. Accessed 29 March 2022.

5.  Eliciting Insights. “Provider Market Outreach Research.” Combination of 20 in-depth qualitative interviews with 10 physician providers and 10 hospital providers along with survey of 200 hospital and physician group revenue cycle leaders with oversight. Understanding provider needs and opportunities in patient engagement and payments, November 2021.