In this Business Profile, Shawn Yates, director of healthcare product management at Ontario Systems, discusses the growing challenge of managing self-pay accounts and provides insight on how providers can successfully collect patient payments.

Shawn YatesTell me a little bit about your organization.

Ontario Systems offers solutions for revenue cycle management, including insurance follow up, denials prevention, and self-pay management. Our single-platform solutions streamline, automate, and build workflows, integrating key tools to help providers better manage their revenue cycle. By making processes more efficient, we help organizations reduce costs and ultimately increase revenue.

What are some of the biggest challenges you see affecting healthcare organizations?

An obvious one is patient payment, which is becoming a growing portion of hospital and health system revenue. The challenge is that many of the newly insured—as a result of the Affordable Care Act—have high-deductible health plans with deductibles of $1,500 or more. For someone earning $50,000 a year or less, this is a hard—if not impossible—obligation to meet.

Historically, hospitals and health systems have not been especially good at collecting money from patients—this process is relatively new for them—and there are some nuances involved. For example, it matters how you contact patients or figure out who is more likely to pay. Plus, now more than ever, patient satisfaction has to be a consideration, with every part of the revenue cycle supporting a positive experience.

How do your solutions help address these needs?

We focus on helping provider organizations collect as much of what they are owed as possible, allowing them to maintain financial viability and achieve their strategic goals. Regarding self-pay collections, to be most efficient and effective, you have to prioritize patients’ abilities to pay.

Basically, there are three types of patients: patients who can afford to pay; patients who struggle to make payments but can meet their responsibilities eventually; and patients who are eligible for financial assistance or charity care. Each group should be approached differently. For example, those who can afford to pay don’t want to be contacted immediately after the outpatient visit or inpatient stay. You shouldn’t call right away, but give them time to make the payment on their own. On the other hand, with your ability to collect hardly anything from those who require charity or financial assistance, you should carve this portion of your patient population out to financial counselors. The middle group, those who struggle to pay, might need structured, long-term payment plans. Those are the patients you want to focus on and get in touch with sooner rather than later.

The contact method also matters. Organizations must prioritize which patients to call first and how those contacts should occur, such as via a statement, messaging, automated phone call, live discussion, and so on.

Ontario Systems’ integrated revenue cycle solutions categorize and prioritize the patient’s ability to pay and identify the best contact approach. Although you could use several vendors to achieve this level of functionality, our solutions combine these functions in one platform with standardized messaging and scripting.

What are some key considerations for healthcare leaders when choosing this type of product or service? Are there certain product/service features that people should know about?

Flexibility is important. Some providers choose to outsource financial assistance processes and self-pay collections while others do everything in-house, or have a hybrid model. Our solutions can fit any of these scenarios, maximizing each function no matter where it occurs.

Compliance is another key component. With the Consumer Financial Protection Bureau (CFPB) about to release regulations on first party collection functions, having a solution that is already well-versed in these areas is critical.

What should healthcare leaders be looking for when choosing among vendors?

You want to make sure that a vendor can provide good strategic advice. Providers struggle to understand how to best collect self-pay dollars; however, CFOs don’t have to make these decisions alone. We help our customers understand the best strategies to use given their unique characteristics and needs. Our strategy consultants meet with a provider, review its operations, and determine the best model that works within the environment.

The second consideration is whether the vendor can deliver actionable information. Anybody can come up with a strategy, but if they can’t make it meaningful for you, the client, then it’s going to be hard to see the ROI. We don’t just provide advice, our solutions can build complex workflows that route patient accounts to the appropriate tier based on the ability to pay and then categorizes them according to the best contact approach, such as automated calling versus live calling. Provider information systems are accustomed to working the big dollar accounts first, which is useful in insurance collections but not good for self-pay follow-up. Our tools focus on putting the patient in the right category, helping drive patient satisfaction while improving collections.

As healthcare organizations implement your solutions, what advice would you offer so they can best set themselves up for success?

Organizations should appreciate the flexibility of our solutions and start out small when using them. It’s kind of like using an iPad for the first time. Because this was something new, people did very basic and simple things with the technology. Then, as they learned the functionality, they started to do a lot more cool and unique things. If a person has had a tablet for two or three years, he or she is probably fully leveraging the technology in ways that he or she never even imagined. That’s how providers should approach any new technology solution. Our managed services group along with our product consultants can help providers throughout the learning continuum. We work with providers to determine where they are at in terms of patient collection sophistication and build a plan to move them forward. Essentially, organizations should start with small steps and move to bigger initiatives. Having a company with experts on how to use the product for this purpose is critical to being successful and producing a strong ROI.

Are there any educational materials you would like to share to help healthcare providers in these efforts?

We have an Infohub section on our website that includes several presentations, webinars, and ebooks, including “Tackling the Growing Self-Pay Revenue Problem,” that offers guidance for providers. The ebook can be found here.

HFMA is the nation’s leading membership organization for more than 40,000 healthcare financial management professionals. Business Profiles are funded through advertising with leading solution providers. Learn more.

Ontario SystemsContent for this Business Profile is supplied by Ontario Systems. This published piece is provided for advertisement purposes. HFMA does not endorse the published material or warrant or guarantee its accuracy. The statements and opinions of those profiled are those of the individual and not those of HFMA. References to commercial manufacturers, vendors, products, or services that appear do not constitute endorsement by HFMA.

Publication Date: Thursday, September 01, 2016