Increasing Patient Financial Engagement with a Revenue Cycle Management Overhaul

Atrium Health asked a bold question: How would the revenue cycle look if it was 100 percent driven by patient experience in the financial department?

Two years ago, Atrium Health faced a challenge common to organizations converting to a new revenue cycle management (RCM) system: How to present a seamless patient financial experience while managing multiple systems.

Atrium Health—a large, integrated delivery network in the southeast, with 900 care locations and more than 12 million patient interactions per year—had long offered two types of payment options for patients:

• An internal payment program for accounts that would be paid within six months
• A zero-interest or low-interest financing option for extended payment plans (more than six months), operated in partnership with a vendor

But during its RCM system installation, a time when disruption to technology and process is simply part of the process, Atrium Health saw an opportunity. Most systems possess patient financial information in disparate systems because of how health systems organically grow, which is complex and limits patient financial services representatives’ abilities to engage patients in discussions around total cost of care, billing questions, or payment options.

That’s when Atrium Health asked a bold question: How would the revenue cycle look if it was 100 percent driven by patient experience in the financial department? The answer caused the team to re-evaluate its entire financial strategy and restructure its financial flow—all in the middle of its RCM system installation—to ensure that patient satisfaction and staff morale were the absolute priorities.

How Atrium Did It

The first step was realizing that it is impossible to innovate in a vacuum, so seeking outside advice would be important. The health system already had decided it preferred to keep its existing financial services relationships, but this level of customization was an unusual request. All the partners would need to work together, all the systems would need to seamlessly lock together and fit within the new RCM system’s workflow—all while consolidating, analyzing, and releasing data across multiple providers and software.

This unusual challenge and focus on patient financial engagement ultimately led to a “locking of arms” of a business process outsourcing partner, a patient financing partner, and a patient billing services partner. These three companies—each with diverse backgrounds and expertise—paired with Atrium to become the new team to put the plan into action.

Steps to Building the RCM

Key action steps to reinventing the RCM included the following:

Integrating patient financial information. Atrium Health’s first task was to consolidate benefits verification, billing functions, payment plan processes, and even patient billing services, giving staff streamlined access to the data needed while supporting a cohesive, highly patient-centric experience.

Leaders from the organizations came together to design ways to effectively integrate patient financial information across Atrium Health’s legacy systems and provide ease in access not only for customer service representatives, but also for patients. They also reassessed its payment plan offerings and sought to eliminate the challenges associated with establishing these plans while providing greater flexibility and continuity for patients.

Modifying patient financial policies. Formerly, customer service representatives not only were tasked with pairing patients with the right payment plans when circumstances prevented them from paying their bills in full at the time of services, but also with calculating the interest associated with plans over six months based on the total due after insurance had paid its portion. The internal payment plan was cumbersome to administer, and the health system’s leaders were concerned the use of both an internal and external plan caused confusion for patients.

So, it took a step back to evaluate its payment plans considering the health system’s goal: to ensure balances due were paid as quickly as possible. The health system needed a structure that would encourage patients to pay their bills in full within three months or enter payment plans as quickly as possible.

Ultimately, the health system determined that an internal payment program no longer met its needs. Instead, the health system worked with its payment financing partner to offer payment plans for all patients in need of flexible payment options. This effort minimized confusion while providing the payment financing partner with the ability to consolidate bills across all of its providers, where needed, for enhanced patient convenience.

In addition, Atrium Health’s financial assistance program offers supplemental assistance for low-income patients whose care has not been covered in full through government funding. Atrium Health incorporates several financial assistance measures to help this high-needs population cover the costs of care.

Putting self-service tools in the hands of patients. In collaboration with its patient billing services partner, Atrium Health supercharged its patient portal to provide the ability not only to view patient balances online—no matter which system they originated in—but also establish payment plans on their own. It also established options for communicating electronically with patients regarding balances due via notifications sent by e-mail. These communications can be sent via the patient portal or the RCM system, facilitating contact that appeals to patients’ personal preferences, including mobile accessibility.

These changes resulted in the following improvements:

• Customer calls are answered an average of two minutes sooner, a 67 percent drop in customer wait time.
• Electronic statement opt-ins jumped from zero to 16,000 patients.
• Nearly 30,000 new patient-payment-plan accounts have been established from January 2018 to September 2018—a 52 percent increase.

Atrium Health Patient Payment Plan Utilization

All around, patients are more actively engaged in managing their payments—and more satisfied with their care experience.

Key Takeaways

Our experience points to three lessons learned on how to thrive during an RCM system installation in a multisystem environment.

Don’t resign yourself to financial engagement challenges during RCM system installs. RCM systems offer strong potential to drive increased efficiencies, productivity, and revenue once installations are complete, but there are pain points with any installation—especially when it comes to integrating data from legacy systems. Partner with outside sources to identify potential issues that may have negative impact on revenue during installation processes and catalyze the rapid improvements needed to overcome these challenges.

Use employees as ambassadors for patient payment plans. At Atrium Health, employees who have received care and need flexible payment options now enter the same payment plans as patients, rather than having the amounts deducted from their paychecks a little at a time. To date, 6,000 employees are on payment plans, and many share their experiences with patients who have questions about this program.

Innovate with patients in mind. The last encounters many patients have with their providers are patient billing and collections experiences. If those experiences are fraught with challenges, it will color patients’ impressions of providers. Look for ways to bolster patient satisfaction during billing and collections, such as by supporting real-time access to patient payment information, self-service options for account management and payment, and HIPAA-compliant digital communications around account status.

A Complete Package

Although RCM implementation is a challenge on to itself, it may be a good time to look at a health system’s patient financial experience and add various patient-friendly payment options. Atrium Health accomplished this through an integrated effort with its partners and internal staff to boost patient engagement and staff morale.

Steve Burr is senior vice president, patient financial services, Atrium Health, and a member of HFMA’s North Carolina Chapter, Charlotte, N.C.

Mark Spinner is CEO of AccessOne, Charlotte, N.C.