Price Transparency to Digital Billing, Unlocking Financial Experience

March 23, 2021 - Carilion Clinic has had all of its pricing information on its public website since January 1, 2021, the day HHS implemented a new hospital price transparency rule.

Compliance with the new rule—including the controversial disclosure of payer-specific negotiated rates—took the Virginia-based health system several months to get right, Don Halliwill, executive vice president and chief financial officer, recently told RevCycleIntelligence.

“You work on the different aspects of the requirements and you have to test it and then, you find little things that need to be tweaked. So then, you test it again,” Halliwill explained. “Just by, [the rule’s] nature it takes a lot of time and a lot of people involved, from the clinical areas, revenue cycle, contracting to our IT folks and our folks on the media side who helped us with the website.”

Carilion’s efforts to comply with the price transparency rule are not uncommon. HHS itself estimated 150 hours of work would be needed to fully comply with the rule’s requirements in the first year, which industry groups have criticized as being too onerous.

But compliance was more than meeting the rule’s requirements to Carilion; price transparency has been a staple in the system’s efforts to improve patient engagement and experience, even on the financial side of healthcare.

READ MORE: 3 Key Steps for Hospital Price Transparency Compliance

For example, patients at Carilion Clinic had already been able to look up and obtain cost estimates through the system’s patient portal MyChart before HHS implemented the price transparency rule this year.

“We had been focused on price transparency and helping to enable patients with information about the financial responsibilities they might have for years,” Halliwill explained.

Patient engagement is a top priority for leaders and staff at Carilion, Halliwill continued, whether it be through the more traditional notion of clinical data sharing with patients or on the financial side, with estimating patient financial responsibility prior to service.

The latter is also one facet of the health system’s larger attempt to create a “digital front door” for patients—a term that has become increasingly popular in healthcare meaning a strategy for engaging patients at every major touchpoint in their healthcare journey.

In addition to price transparency and cost estimates, Carilion has also tailored patient navigation through the financial points of the journey to specific patient needs. So if a patient would rather call in to receive a price estimate, the health system has staff to respond. Alternatively, the system also has a chat function for those patients preferring text-based exchanges.

READ MORE: Yale New Haven Health Streamlines Patient Billing Experience

Many healthcare organizations have recently been focusing on creating this digital front door to enhance the patient’s—and consequently, provider’s—financial experience. But with improvements like price transparency now in place, Carilion is now shifting to what happens once patients enter the front door and are ready to come out of the other side.

“We've moved to what we like to refer to as the digital back door,” Halliwill said. “Once a patient has made a decision about their care, they've received their care, and they're now dealing with the backend of the process with their financial responsibility, how do we enable that and engage patients at that point in the relationship to try to make it easier on them?”

Creating a digital back door

The latter part of a healthcare journey is not usually the patient’s favorite, and understandably so. Patients do not typically enjoy paying for healthcare, especially in the age of high-deductible health plans and record-high patient financial responsibility.

But healthcare organizations need to take some responsibility for the “bad rap” billing and collections usually gets, according to Halliwill.

“We’ve had a lot of opportunities to improve in a lot of different ways and let's face it, the financial part of healthcare many times can be the most stressful and frustrating part,” Halliwill said.

READ MORE: Patient Financial Experience the New Focus for Revenue Cycle Tech

Manual backend processes do little to resolve patient concerns about billing and collections. In fact, surveys show that patients prefer more automated and self-service options when it comes to paying their medical bills.

Some of those same surveys also found that patients are less likely to pay providers in full if they have a bad billing and collections experience. Some patients would even switch providers in order to get a more digital backend experience from a healthcare organization.

Leaders at Carilion are conscious of evolving patient needs with respect to the latter part of a patient’s healthcare journey. The health system recently implemented Carilion Bill Pay in conjunction with VisitPay to enable patients to pay medical bills online and sign up for payment plans to better manage rising financial responsibility.

“It really brings us into the digital age the way most patients are used to with banking or shopping or those types of things where you can do a lot of it independently, through an app or through online resources,” Halliwill stated. “But it's not your only option.”

Like with the front door, patients also have the option to connect with a staff representative about their financial responsibility or even text the health system on the way out.

“We recognize that while it may be acceptable for some consumer environments to not have anybody to speak with, we’ve all had an experience before where you really wanted to talk to someone and either couldn’t find the phone number or you called the phone number and it's an hour wait to speak with someone,” Halliwill explained. “Unlike those services, healthcare billing needs that personal human touch, so we continue to make those more traditional resources available as well.”

The full range of billing and collection options for patients has led to early improvements for the system, at least in terms of positive reviews.

“We're actually getting social media posts now praising the billing and collections process that we have in place,” Halliwill commented. “And we used to laugh about those kinds of things. We'd say, ‘Yeah, just imagine a day where we had people out on Facebook saying what a good job we did.’ We chuckled about it but it’s happening now. So we know it’s working.”

The health system is also connecting with its patients outside of social media a lot more through patient surveys that ask specifically about the revenue cycle.

“What we, and others, have missed historically is asking patients, in different ways and more frequently, what we can do differently,” Halliwill explained. “Did you like Carilion Bill Pay? What did you not like about Carilion Bill Pay? So it's not just rate us on a scale of one to five but really what works, what doesn't work, and when something doesn't work, is there a way for us to fix that?”

Sometimes a bad patient financial experience simply comes from the complex billing and collections process, Halliwill conceded, but other times, there are tools health systems can put in place to meet patient needs, like texting services for those who would rather pay on their phones.

“Make sure you’re really thinking about things from the patient’s point of view,” Halliwill said. “And the best way to do that is to ask them.”

Still, backend capabilities aren’t the silver bullet for patient engagement, just as the front door isn’t, the health system executive stated.

“It's a journey, it's hard work, and it's constant,” Halliwill concluded. “I know a lot of attention is on price transparency regulation right now. There's so much other work for us to do whether it's the digital front door, whether it's with our physicians and other clinicians during the care experience, or the digital back door, if you will, with the patient's financial responsibility.”

“It should be seen as a continuum. So just doing one thing is part of that continuum, it's really the sum of the parts that make the whole, that really should be what we're all focused on and asking questions about day in and day out.”