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Using design thinking principles to improve patient billing
Remember medical bills of the past? The not-quite-black font generated on a dot matrix printer certainly wasn’t sexy, but it got the job done—at least it did a few decades ago when patient payments accounted for just a tiny slice of providers’ revenues, and patient experience was a very different concept.
Today’s providers, however, are more reliant on patient payments. As out-of-pocket expenses have soared, patient payments now account for greater chunks of the revenue cycle. Providers need to recover every dollar possible to sustain healthy bottom lines. Lackluster and hard-to-read statements just don’t cut it anymore. In fact, research shows that patients don’t want separate bills from multiple parties for one episode of care. They want one, easy-to-read statement that provides a breakdown of each cost.
But providers can’t afford to overhaul their statements and billing strategies arbitrarily. There’s too much at stake. Patients not only need to understand their bills, they need to trust what those bills say regarding how much they owe before they’ll take action.
Instead of trial-and-error, providers should use methodical statement design approaches such as design thinking, which can help identify how to successfully engage patients in the billing process.
Stop Guessing, Get the Data
For many years, marketing folks have used interviews, focus groups, surveys, and other strategies to test and develop products or gauge consumer interest and satisfaction. Healthcare organizations often apply the same tactics as they develop patient statements. The problem with these strategies is that what consumerssay they like doesn’t always correlate with how they act.
For example, one design team devised an innovative way to draw attention to the amount owed on a patient statement. Based on feedback, the team placed the dollar amount in a red circle. The team and provider leadership thought it was a terrific and bold design choice, but they soon found patients had other ideas. Testing revealed that most had an adverse, sometimes visceral, reaction to “how in your face” the cost appeared. Findings suggested patients felt the provider was trying too hard to collect money which could have a negative impact on the brand perception, loyalty, and customer experience.
This example illustrates why making such decisions without first gathering data to support them can be costly. Not just from a design and development perspective, but from a revenue perspective and patient experience, as well.
Providers will better serve their patients and themselves during and following a statement redesign by applying the five design thinking stages: empathize, define, ideate, prototype, and test. Providers not only gather information directly from patients during this process, they brainstorm ideas using behavioral economics and psychology. The next step is assessing patients’ actual behaviors and using this data to design bills that engage patients more successfully.
Design Thinking at Work
The Center for Health Experience Design launched “ A Bill You Can Understand” Design and Innovation Challenge last year to spur statement improvements and help patients better understand their medical bills. Change Healthcare, which was awarded an honorable mention for easiest bill to understand, followed design thinking principles throughout the challenge.
Among the intriguing facts learned during the empathize stage of development was that 49 percent of patients didn’t believe their bills were accurate, 23 percent didn’t understand the terminology/language on them, and an alarming 56 percent were so frustrated by their bills, they wouldn’t seek further care from the providers who sent the bills.
The goal of a good statement is the exact opposite of these reactions. It should trigger patients to confidently make a payment to the provider. To do this, providers should ensure their bills accomplish the following goals.
Identify key information. Patients typically look for basic information first, such as service details and date, how much they owe, and how much their insurance covered. If this information is difficult to find or to understand, they may delay payments. It may even prevent them from taking action.
Guide the patient through the statement. Patients want to progress through their statements in the same way they read books. Statement designs should logically walk through patients’ experiences using easy-to-understand language: I saw this doctor. I had this done. This is what I owe. Those who aren’t able to easily progress through their bills might throw them back onto their mail piles and revisit them days—or weeks—later when they have more time to call providers with questions.
Are trustworthy. Service level details and other information such as provider names and amounts owed need to be accurate in order for patients to trust their statements. When approximate amounts due don’t accurately reflect what patients owe, it feeds skepticism. But providers are in tough positions when it comes to timing and billing. If they send statements too early, insurance payments might not be reflected. On the flip side, providers who wait to send out statements can inflate their accounts receivables. Providers need to strike a middle ground by sending bills as soon as they accurately can and by clearly explaining all of the details.
Apply innovation appropriately. Fully 81 percent of patients that participated in the challenge still preferred paper statements. With this thought in mind, consider using icons, different colors, and other graphic elements to represent information and help patients easily progress through their statements. But don’t use visual elements for the sake of using visual elements. They need to serve specific purposes and achieve specific benefits.
No Perfect Bill Exists
We know a single bill won’t address the needs of all consumers. Let’s start with a good design that addresses patients’ needs. Then optimize and personalize designs through time by continuously applying design thinking principles to test, learn, and update bills to address consumers’ ever-changing design preferences and communication styles.
Bryce Bruner is director, product innovation, Change Healthcare.
