connance presents "customer satisfaction and self-pay: the hidden opportunity"
DESCRIPTION
These slides focus on a recent study proving the link between patient satisfaction, billing experiences and clinical satisfaction and how it affects self-pay collections. We know that patient loyalty is influenced by how patients are treated during the billing process, post-care. Viewers of these slides will learn the details of this recent study, including: • 23% of hospital patients who received bills for services expressed discontent with the billing process • Among these patients who were dissatisfied with their hospital billing experience, only 63% of them were satisfied with the clinical treatment they received. By comparison, among patients who were satisfied with the billing experience, 93% were satisfied with their clinical treatment • Among uninsured patients, 76% thought the amount they owed the hospital was incorrect; while 55% of patients with responsibility after insurance said they were uncertain that the amount owed was correct Billing issues appear to directly impact customer satisfaction with the hospital and affect a patient’s willingness to refer the hospital to a friend – a measure proven to be connected to customer loyalty and correlated to customer lifecycle profitability. There is a major opportunity to improve the total patient experience by improving the billing process. With the rapid growth in lives covered by high deductible health plans and health savings accounts, the short term cash at risk and long term customer loyalty issues suggested by this research are only going to increase. Providers should to start now to build their organizational competencies to ultimately increase self-pay collections.TRANSCRIPT
Intelligence for the Business Office
Customer Satisfaction and Self-Pay:The Hidden Opportunity
April 2011
Proprietary and Confidential ©2011 Connance, Inc.
Customer Satisfaction and Self-Pay: The Hidden Opportunity
The following information is not intended as legal advice and may not be used as legal advice. Legal advice must be tailored to the specific facts and circumstances of each case or inquiry. Every effort has been made to assure that the information contained in this presentation is up-to-date as of the date of publication. It is not intended to be a full and exhaustive explanation of the law in any area, nor should it be used to replace the advice of your own legal counsel.
Proprietary and Confidential ©2011 Connance, Inc.
Presenter
Steve Levin is Chief Executive Officer of Connance.Steve has worked extensively with leading healthcare providers, health insurers, and revenue cycle services companies and is a frequent speaker at industry events and author of industry articles. He is a graduate of Dartmouth College and Harvard Business School.
Proprietary and Confidential ©2011 Connance, Inc.
Customer Satisfaction Increasingly A Concern
Outsiders Now Tracking Healthcare Satisfaction and
Experience
Consumer Groups and Government Watching
Quality and Choice
Satisfaction and Loyalty Link to Engagement, Critical for Outcomes and Utilization
Management
Proprietary and Confidential ©2011 Connance, Inc.
Customer Satisfaction…and Dissatisfaction
• Customers who rate satisfaction “5” are six times more likely to buy again
• Twice as many people are told about a bad experience as a good one
• 1-5% of customers will escalate their complaint to a local manager or headquarters— 50-75% will complain to the front-line personnel
• It takes 10 good experience to make up for a bad one
….and so on
Proprietary and Confidential ©2011 Connance, Inc.
Healthcare is Different
Proprietary and Confidential ©2011 Connance, Inc.
Connance Customer Satisfaction Survey
• Hospital experience within last year
• Insurance coverage at time
• Understanding of the hospital bill
• Satisfaction with billing process
• Use of and usefulness of billing question support
• Satisfaction with clinical experience
• Likelihood to recommend hospital
• Likelihood to recommend physician
• Executed Nov. 2010
• 500 respondents
— 13.5% uninsured
— 86.5% insured
• 47 different states
Proprietary and Confidential ©2011 Connance, Inc.
Customer Satisfaction with the Billing Process
All Patients (n=500)
Very Satisfied (5)
More than Satisfied
Satisfied (3)
Less than Satisfied
Dissatisfied (1)
Connance Consumer Survey, Nov 2010; n=500
20% rank “5” and 23% rank 3 or less
Proprietary and Confidential ©2011 Connance, Inc.
Customer Satisfaction with the Billing Process
Satisfaction With Billing Process
Connance Consumer Survey, Nov 2010; n=500
Billing Process is significantly less satisfying than clinical process
Satisfaction with Clinicians
Very Satisfied (5)
More than Satisfied
Satisfied (3)
Less than Satisfied
Dissatisfied (1)
Proprietary and Confidential ©2011 Connance, Inc.
Customer Satisfaction with the Billing Process
Balance After Insurance (n=433)
Very Satisfied (5)
More than Satisfied
Satisfied (3)
Less than Satisfied
Dissatisfied (1)
Uninsured (n=67)
Connance Consumer Survey, Nov 2010; n=500
The issue is similar among uninsured and insured with BAI
• BAI: 22% rank “5” and 60% are 3 or less
• 81% of uninsured are 3 or less
Proprietary and Confidential ©2011 Connance, Inc.
Customer Expectation of Receiving A Bill
Customers expect to have to pay something for service
Balance After Insurance (n=433)
Expected to Pay
Did Not Expect to Pay
Did Not Have To Pay
Uninsured (n=67)
Connance Consumer Survey, Nov 2010; n=500
Proprietary and Confidential ©2011 Connance, Inc.
Customer Satisfaction with Bill
Very Certain AccurateYes, Correct
Think Correct
Not Certain CorrectVery Certain Not CorrectDon't Know -80%
-60%
-40%
-20%
0%
20%
40%
60%
Cell Phone
Credit Card
Utility Bill
Hospital More Understandable
Hospital Less Understandable
Connance Consumer Survey, Nov 2010; n=500
Only 25% are very certain bills are accurate
• Hospital bills less understandable than other bills
Proprietary and Confidential ©2011 Connance, Inc.
Hospital Satisfaction Connected
0%
20%
40%
60%
80%
100%
Very Satisfied with Billing (5)
No Opinion on Billing (3,4)
Negative Opinion on Billing (1,2)
Less than Satisfied with Hospital (1,2)
Middling on Hospital (3,4)
Very Satisfied with Hospital (5)
Billing satisfaction appears directly tied to hospital satisfaction
Connance Consumer Survey, Nov 2010; n=500
Satisfaction of Billing and Satisfaction with Hospital
Proprietary and Confidential ©2011 Connance, Inc.
Overall Recommendation Pattern
-20%
-10%
0%
10%
20%
30%
40%
50%
Clinician Hospital
Recommend
Negative OpinionGo Elsewhere
For every 3 customers who would recommend the hospital, 1 would not (e.g. 3:1). By contrast, it is 5:1 for clinicians
Connance Consumer Survey, Nov 2010; n=500
Would You Recommend To A Friend?
Proprietary and Confidential ©2011 Connance, Inc.
Billing Experience and Hospital Recommendation
Connance Consumer Survey, Nov 2010; n=500
-60%
-40%
-20%
0%
20%
40%
60%
80%
100%
Clinician Hospital
Of Those Dissatisfied with Billing (1,2)
-60%
-40%
-20%
0%
20%
40%
60%
80%
100%
Clinician Hospital
Of Those Fully Satisfied with Billing (5)
When billing is unsatisfying, recommendation level falls precipitously for both hospital and clinical
Recommend
Negative Opinion
Go Elsewhere
Proprietary and Confidential ©2011 Connance, Inc.
High Cost Low Value Situation
• More letters, postage cost• More inbound calls• More accounts to bad debt• Higher vendor fees• More compliance risks• More customers with “attitude”• More first-time patients / fewer
repeat users
• Disappointing patient-to-prospect referral
• Strains with physicians• Motivation for follow-up
elsewhere• Cash later• Lower yield rates
Proprietary and Confidential ©2011 Connance, Inc.
Turning the Cycle Positive
To deliver a more satisfying billing process …
1. Patients are not all healthcare billing experts
2. Deliver billing support that meets the unique needs of the patient, e.g. segment and focus
3. Root out process breakdowns, ensure basic process integrity
4. Close the loop between business office and clinical events
Proprietary and Confidential ©2011 Connance, Inc.
1. Patients Not Healthcare Experts
• Language
— What’s an EOB?
• Communications
— How visually attractive are you bills?
— Can someone not in healthcare understand them?
— How many different bills will a patient receive for a single visit?
Proprietary and Confidential ©2011 Connance, Inc.
2. Billing Process Segmentation
• Consumers have different familiarity and attitudes toward healthcare and healthcare bills
— Experienced vs. New
— Proactive vs. Reactive
• A few predictable payment patterns
• Approach should balance needs of consumer and hospital
Proprietary and Confidential ©2011 Connance, Inc.
Patient Repayment Behavior
Reluctant Payor
Self-Directed
Low High
2. Billing Process Segmentation
Segment-Tailored Messages
Segmentation Grid
• Segmentation makes sure that each process feels different to the patient, consistent with their needs and hospital interest
− What activity, when, with what message
− Deliver 20-30% more cash for same budgets
Segment Four
Day Activity
0-10 LTR – A2
10-20
20-30 Reminder Msg
30-40
40-50 LTR – A4
50-60
60-70 PT Dialer
70-80 LTR – A7
Segment-Tailored Process
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3. Process Integrity
Eligibility
Collection Agency
Biz. Office
• Multiple handoffs over many weeks, months… or years
— Single guarantor with bills in different locations
• Breakdowns, confusion common and accepted
— 13% of inventory with vendors has reconciliation issue with hospital
Hospital Billing Pinball Machine
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3. Process Integrity
• Data flowing both ways— Account-level — Financial and activity
• Integrity in information across vendors— Common definitions— Retained— Reconciled
• Accessible— Reporting functions— Analysis platform
• Exception-driven— Rule driven— Push up breakdowns, concerns — Uncovers gaps
Collection Agencies
Small Balance MC Follow-Up
Early Out Agencies
Eligibility Agents
Proprietary and Confidential ©2011 Connance
Business Office
Deliver more consistent patient experience end-to-end, resulting in more cash while improving process integrity
Database of Placed Inventory
ReportingBusiness Rules
Proprietary and Confidential ©2011 Connance, Inc.
4. Closing the Loop
• “Relationship” not “encounters”— Business office is “pre-registration” to a
next visit— Satisfaction somehow connected to
perception of institutional quality— More consumer choices and involvement
every day
• Priority has to be to connect “back” to “front”— Payment patterns (cash value, business
office support requirements, etc.)— Clinical context (recurring, patient vs.
guarantor, etc.)
• Continuum of opportunities— E.g. Free parking on next visit— E.g. “loyalty” program— E.g. Integrated clinically-based collection
processes…. and many others
Proprietary and Confidential ©2011 Connance
Patient 1
Clinical Need /
Schedule
Treatment
Coding / Billing
Commercial Collection
Self-Pay Collection
Healthy Living
Patient 2
Proprietary and Confidential ©2011 Connance, Inc.
Summary Lessons From Customer Satisfaction Data
• Opportunity area to improve satisfaction in the business office process
• Dissatisfaction has system wide implications beyond simply disappointing patients…
— Raising operating costs
— Reducing cash
— Impacting hospital reputation and “recommend-ability”
• Immediate actions that can be executed on today
— Remembering they are consumers not healthcare experts
— Incorporating segmented communications: address their different needs
— Improving process integrity: avoid breakdowns
• Consumer centric business processes change the dynamic
— Certainly improve immediate cash equation and related processes and team of the hospital
— Leading practice “closes the loop” and to impact new business
