Using Technology to Rebuild Trust in Healthcare

“Providing patients and consumers with solid information on the cost and quality of their healthcare options can literally make the difference between life or death; and play a decisive role in whether a family or employer can afford healthcare.”

While revenue cycle management (RCM) staff collectively have an appreciation for how their work impacts healthcare beyond solely the revenue cycle, this quote from former U.S. congressman Timothy Murphy makes unambiguously explicit one of the many ways RCM staff can have an unmistakably positive effect on the quality of the patient journey.

As with most positive effects in this context, it beings with trust. Trust, or in many cases, the lack thereof, can affect the quality of care a patient receives as well as the patient’s overall satisfaction and adherence to their treatment. Each step in the healthcare lifecycle is an opportunity to strengthen that trust, and it continues from the initial interaction until the final bill payment. 

For RCM organizations, the payment process, and the way in which it is handled, represents a critical step in the patient journey and a key opportunity to help build that trust.

Trust in healthcare today

Directionally, trust in the healthcare system broadly has fallen, particularly in the wake of the COVID-19 pandemic. This mistrust permeates the clinical side as well as the back office. To be sure, there is no one reason why the healthcare system has suffered this erosion of trust. For some, it is as simple as being unhappy with the way they were treated by a healthcare provider or staff member. For others, it was receiving an unexpected medical bill well after receiving treatment. Layered on top of this, the digitization of the healthcare industry, coupled with stories about data breaches, don’t help the matter.

This is why, according to 71% of respondents in a recent survey, rebuilding trust is a critical task facing healthcare sector companies. After all, if there is mistrust within any element of patient journey, it stands to reason that this mistrust will extend to the broader journey as a whole – be it clinical, financial, or anything in between.

One way for organizations to rebuild trust and confidence in the healthcare ecosystem is to break through the information barrier and create greater transparency into what is otherwise seen as a convoluted, even confusing system. Having, or not having, the right information has a major impact on what a patient does, even going so far as to keep them from walking through the door.

According to a 2022 survey, more than 50% of respondents revealed that their confidence in whether or not their insurance would cover the cost of treatments had a direct influence on them making an appointment. Another 10% of respondents said that knowing their payment options or what third-party financing is available to help cover costs also plays an important role in their healthcare decision-making.

In other words, patients need information. And they are counting on you to provide it.

Using technology to rebuild trust

With few exceptions, RCM organizations generally have all of the data necessary to meet this need within their systems – with the key word being “systems.” For too many, this data doesn’t reside in a centralized, or even single, location. Staff often must access multiple systems to gather information, even on the same patient. If organizations desire to unravel this web, they must be able to depend upon a unified system that not only provides critical data (ideally at the touch of a button), but also puts employees in a position to provide the “human touch” needed at crucial points throughout the patient journey. 

This data can be used to help put patients in charge of their financial decisions. Details about their current coverage, as well as information about what additional coverage is available, enable patients to make informed decisions about obtaining services. And, for patients without coverage, RCM staff can share details about available coverage options, either before the patient is seen or after service has been provided.

Additionally, these unified systems contain data that can shed light on a patient’s capacity to pay, as well as potentially outlining various payment plans to help meet a patient’s financial needs. Sharing this data provides patients with the confidence to obtain treatment, fill prescriptions, and remain a proactive, engaged participant when it comes to their care and when it comes to fulfilling financial obligations.

With regards to these financial obligations, many RCM organizations are beginning to adopt software solutions that feature an integrated payment platform as a means of removing friction and barriers from that component of the patient journey. Doing so provides patients with easy and convenient digital payment options that they are accustomed to seeing more broadly as consumers, which in turn, helps patients feel more comfortable throughout the entire process.

Further, RCM organizations can also use the data in these systems to craft personalized communication strategies that not only align with the patient’s preferences, but also carry the greatest probability of successful outcomes. Be it text messaging, email, or phone calls, staff can connect with patients on their preferred channel, improving the likelihood of payment and, more importantly, the overall patient experience.   

Finally, such tools can take some of the monotonous, manual work away from staff, allowing them to concentrate on the human aspects of their job, including the important conversations with patients about their treatment, as well as insurance and payment options – all necessary to rebuild trust.

Trust can also be improved in the event that the patient’s insurance claim is denied, particularly if RCM organizations use robotic process automation (RPA) to manage the claim denial process in a more expedient manner, alleviating patient stress in the process. RPA is a technology that allows anyone today to configure computer software, or a “robot,” to emulate and integrate the actions of a human interacting within digital systems to execute a business process. As such, RPA can search data sets faster than humans, helping resolve patient issues in a more timely manner. In addition, RPA follows predefined instructions and logic without being influenced by human emotions, preferences, or prejudices.

As mentioned previously, having data supporting insurance coverage plays a critical role in the patient’s decision to seek treatment. But when a patient does get treatment and the insurance provider denies the claim, patients can be stuck with a large bill that they often can’t pay. 

Insurance providers are using automation to validate claims against policy terms and conditions. If the submitted claim doesn’t meet certain criteria, it is often automatically denied. The staggering volume and velocity of such denials inevitably means that RCM organizations must use technology, such as RPA, to resolve these issues. 

Among many other use cases, specific to denials or otherwise, RPA can be configured to:

• Scour various systems to find incorrect and missing demographic, insurance, or other data points, and automatically update the account. 
• Conduct automated eligibility checks through various systems to search for coverage options. 
• Gather all necessary material as directed by the insurance company, such as medical records, pre-authorization details, clinical notes, and more, then create a PDF of the required documentation and submit it to the insurer.
• Remove the manual efforts associated with adjustment posting by logging into the system of record, then creating an adjustment transaction. 

This automation makes it easier for staff to handle the denials process, but also helps patients who can see and feel that the organization is doing everything possible to help alleviate financial hardships.

A positive future

Hospitals and healthcare organizations will no doubt continue to face obstacles – including workforce shortages, tightening budgets, and a growing number of patients, all of which place undue pressure on the patient experience. Technology can help healthcare organizations, including RCM departments, overcome many of these issues and, in turn, provide patients with the experience they expect. As these positive experiences accumulate, a rebuilding of trust in their healthcare journey and the healthcare system is certain to follow close behind.