Patient Engagement is Not the Same as Patient Experience

Providers of healthcare in America, from sole-practitioners to multi-location hospital networks, are justifiably proud of the quality of care they deliver. Still, as seemingly every hospital launches a patient engagement initiative, the gap that separates the clinical side of healthcare from the business side gets wider.

At its heart, patient engagement involves getting patients and consumers more deeply and actively involved in their healthcare. Offering information about a malady or how to deal with it has always made sense. Leveraging broadly available technology platforms, like tablets, to make such content available makes even more sense, as long as it is easy to use.

A core principle of patient engagement is that a better engaged patient will have a better overall experience, resulting in the served person feeling better about the institution. That may sound good in theory, but it is far from the case within healthcare.

While healthcare organizations have made significant advances in clinical care and environmental aspects of customer service, the billing and payment experience has not received much attention. It should, because customer perceptions of healthcare bills are often not good. Bills seem to be riddled with items never ordered and a cost that was unanticipated.

This is part of the disconnect that afflicts patient engagement within healthcare. Trustees, CEOs, CFOs and medical chiefs see an ever-increasing use of state-of-the-art technology as the cure for poor patient engagement scores.

While attending an industry conference recently, I spent time with the CEO of a major pediatric medical center in Texas. When our conversation got around to patient engagement, this seasoned hospital executive offered the view that clinically focused patient engagement will miss the mark if it doesn’t include cost expectation, and a good billing and collection process.

Quite literally, I’ve been there. My daughter had two patient experiences over the last year. The first involved a fall on her ankle while playing soccer. The second was a wrist issue. In both instances the hospital did a great job taking care of her. But after treatment, whatever goodwill I felt was erased because the bill was incomprehensible.

The bill showed four different amounts due. I looked at our Explanation of Benefits (EOB) to find any matches to the four amounts shown on the bill. One, labeled “Past Due,” did show up on the EOB. I sent in a payment, assuming the other numbers on the bill were wrong. When another bill for the same services showed up the next month, I was asked by my wife why I hadn’t paid it.

After spending an hour on the phone with a billing person from our hospital, I learned that my payment did arrive but it was posted to the oldest balance; not reflected on my latest bill. After another hour on the phone, we got it worked out.

America’s 21st century medical capability is hamstrung by the continuing use of paper-based billing and balance management methods that harken back to the 1980s. It’s a dichotomy that just should not exist in today’s digitally driven world. Look at a hospital’s business office; with its piles of paper statements sent monthly and manually prepared reconciliation once payments are sent back—it just makes no sense.

The findings of the 2015 Deloitte Survey of U.S. Healthcare Consumers strongly indicates healthcare better apply some, if not the same, level of attention to deployment of technology for the business side as it does to the clinical side.

The expansion of High Deductible Health Plans (HDHPs) across the country has forced patients to become more involved in the cost aspects of their healthcare. After all, health insurers are paying providers 50 percent of the cost, down from 85 percent. And, obviously, the remainder is the patient’s obligation.

So when a patient gets a bill, it will get far more scrutiny than it did just a few years ago. If it comes as paper and it doesn’t add up, so to speak, it will get put aside or hospital billing departments will get calls like mine.

Research into consumer behavior and the payment of healthcare bills has found that consumers typically must receive more than three statements before they make a payment. For this to work better, clarity is essential. Asking a patient to align paper statement charges with an EOB, which is event-based, is insulting, especially when technology exists to accomplish that automatically.

Healthcare continues to be one of the few businesses where the majority of customers have no idea what they’ll pay until after the fact. Interestingly, Deloitte found about 40 percent of those surveyed are utterly comfortable asking about costs.

Overall, those surveyed who looked online for cost information grew by 45 percent from 2013 to 2015. Not surprisingly, cost information was of greatest interest among the survey’s millennials; almost 30 percent sought pricing data. Those handling patient consent and their colleagues in the business office should be able to access costs with just a couple of mouse clicks. Ultimately, patients ought to be able to estimate the cost for treatment from their smartphones.

Reflective of healthcare keying on the clinical is something Deloitte calls “the fitbit phenomenon.” The survey respondents saw technology within the healthcare environment as being more about monitoring and managing health than bill paying. If we think about how patient engagement tends to center around the patient being more involved in his or her health regimen, then the participants in the Deloitte research are seeing clearly. There’s a technology gap between the clinical side and the business side.

The real impediment to progress here is executive management commitment. Healthcare administrators must recognize the value of technology that enables automated cost estimating, paperless billing and reconciliation down to the line item, as well as other systems and methods to make patient engagement or the patient experience more positive. The other benefit is the cost to bill will go down, so these dollars can be used toward continued clinical advancements. Hopefully patients go back to complaining about “hospital food” and not “hospital bills.”