PROCESS, PROPENSITY AND PAYMENT
HOW TO EFFECTIVELY MANAGE YOUR HDHP’S
Joe McMurray
Vice President of Patient Experience
AGENDA
• Market changes: the transformation to consumer health
• Impact and percentages of High Deductible Plans
• The new model of healthcare
• Collection strategies for the new patient consumer
• Patient propensities and responsibilities
• Effective follow-up campaigns and the movement to mobile
TRANSFORMATION TO
CONSUMER HEALTH
H O W T H E MA R K E T I S C H A N G I N G
TRANSFORMATION TO CONSUMER HEALTH
PHYSICIAN
CARRIER
TRANSFORMATION TO CONSUMER HEALTH
PHYSICIAN
PATIENT
HIGH-DEDUCTIBLE PLANS
46%
360% INCREASE
10%
Source: Kaiser Family Foundation
HIGH-DEDUCTIBLE PLANS
Source: Kaiser Family Foundation
CONTRACTING WITH CARRIERS
$1,200
$1200
$1094
$1,000
INSURANCE DEDUCTIBLE
$800
PATIENT RESPONSIBILITY
BAD DEBT
$600
$400
$250
$200
2003
Source: Kaiser Family Foundation
2009
2015
NEW MODEL OF HEALTHCARE - BUSINESS TO CONSUMER
ESTATEMENTS
TEXTING
SNAILMAIL
E-CHECK
IVR
OUTBOUND
CALLS
PATIENT
PORTAL
MOBILE
CONSUMERS
WEBSITE
INSTANT
MESSAGING
NEW MODEL OF HEALTHCARE - BUSINESS TO CONSUMER
Patient Personas
PROPENSITY FOR FRICTION
INBOUND/OUTBOUND
PHONE CALLS
CONTRACTED
VARIANCE
RE-FILED CLAIMS
BAD ADDRESS
RFI
DENIALS
PROPENSITY FOR FRICTION
PATIENT PERSONA
FRICTION %
Propensity to Pay
History to Complain
CARRIER PERSONA
FRICTION %
•
•
•
Electronic
Denial %
% of Allowed
PHYSICIAN PERSONA
FRICTION %
History / Patterns
• Denials % Documentation
• Specialty
• CPT Codes Used
• ICD – 10 History/ Patterns
PROBABILITY
OF FRICTION
PATH TO ELIMINATE
FRICTION
PATIENT RESPONSIBILITY
Up Front Estimation
$
$
$
$
PAYER
PATIENT
Payment as Percentage
of Allowed (Remainder is
Patient Responsibility)
Trended Responsibility as
Percentage of Allowed
PROPENSITY TO PAY
WILLINGNESS TO
PAY
(MEDICAL BILLS)
ABILITY TO PAY
PRIOR MEDICAL BILL
PAYMENT HISTORY
PRIOR CHARGES
IN COLLECTION
DIAGNOSED FOR
RECENT
PROCEDURES
HIGH DEDUCTIBLE
PLAN
PROPENSITY TO PAY
PROPENSITY TO PAY
PROPENSITY TO PAY
FRICTION
DASHBOARD
THE MOVEMENT TO MOBILE
T E X T ME S S A G I N G
GUARANTOR
RESPONSE
DAY (GRD) 1
GRD 15
GRD 30
GRD 45
GRD 60
GRD 75
GRD 90
Stronger
Reminder
TEXT #1
TEXT #2
With Statement
Friendly Reminder
BILL
STATEMENT
COLLECTION
WRITE-OFF
Unless no paper
statement and no
payment
TEXT #3
REMINDER
FINAL PRE
FINAL PRE
PHONE CALL
COLLECT CALL
COLLECT CALL
COLLECTION
WRITE-OFF
STATEMENT
COLLECTION
WRITE-OFF
ROLL TO COLLECTION
ROLL TO GUARANTOR
TEXTING CAMPAIGN
TEXTING CAMPAIGN
PRACTICE
NAME
LINK TO PATIENT
ACCOUNT AND
STATEMENT
SECURITY
QUESTION FOR
VALIDATION
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