Lathrop, KevinDiscussing payment with patients can be difficult. For that and other reasons, providers generally like to keep patient treatment and patient financials separate. But a frank discussion of payment alongside patient care actually can improve the relationship between providers and patients. By working to build these relationships through open, honest communication about pricing prior to treatment, providers can help patients better understand today’s complex healthcare environment.

Customer Service Built on Data

The process of making treatment cost transparent is greatly simplified for providers if they can make effective use of data. Some data are easy to access; some are not. But reliable data are needed to build an accurate patient cost estimate.

It’s virtually impossible to provide accurate prices in real time without using digital technology to integrate data and manage the many different pricing variables and delivery channels. Providers that want to stay ahead of patient requests for detailed cost and quality analysis must develop a digital strategy to combine contract management systems, cost estimators, and comparative pricing tools with analytics for large datasets. They also require algorithms and rules engines to automate estimation calculations and the delivery of the results to patient navigators and customer-service employees. Just as important, the strategy must meet existing and emerging regulatory compliance requirements.

The systems and tools required to execute the digital strategy will give providers the following capabilities to create a consumer-friendly online experience:

  • Patient access to a cost-estimation tool that can calculate patient responsibility and allow consumers to access other useful features such as plan information and appointment scheduling
  • Transparent pricing on elective or noncritical procedures for cost-conscious consumers who are more likely to comparison shop
  • Streamlined estimates with payer-specific bundling of episodes of care

Another key step in an effective patient payment initiative is determining how patients want to pay. Healthcare consumers are accustomed to online or device-based payment options for a variety of services and products. The easier it is for patients to pay, the more likely they are to do so.

Crystal Clear Information

To succeed in an increasingly price-driven industry, providers must make a strategic commitment to achieving transparency in how they deliver information to patients. Analytics and business intelligence can identify priority areas for pricing transparency, which may include specific types of services with a lot of local competition.

A total-cost-of-care analysis and other exercises also are effective means for determining where and even why a provider is less efficient than its competitor in delivering specific services , with the result that its process are higher. Such information can become the impetus for process improvement, cost reduction, and innovation.

Providers that can provide quick, clear answers when a consumer asks, “How much?” will be in the best position to thrive in a market-driven health ecosystem. But developing this capability requires much thought and deliberate action. By having a clear rationale for pricing, as well as internal and external processes and tools for sharing and explaining the data, providers can present a compelling story to consumers who are increasingly empowered to consider multiple providers when deciding where they will go for their care. 


Kevin Lathrop is president of TriZetto Providers Solutions, a Cognizant Company, Earth City, Mo. 

Publication Date: Thursday, February 22, 2018