Long-term loyalty of patients to hospitals is impacted by surprise medical bills, according to one study on an obstacle to becoming more consumer-oriented.


March 5—Providers and health plans have found some success—and identified new challenges—in their efforts to better engage patients as consumers who are willing to choose care based on price and quality.

Engagement often is the first step—and a frequently challenging one—in the effort of healthcare providers to more closely involve patients in their care.

Among healthcare organizations that have developed innovative approaches to engaging patients is not-for-profit Sutter Health, which implemented a vendor-based patient portal that was used by 79 percent of patients seeking ambulatory care—contrary to the low engagement of many provider portals.

New research in Health Affairs credited the widespread adoption to various ways that the health system made clinicians accountable for enrollment, and identified its key benefit as enabling secure patient-clinician messaging. After finding that most users of the messaging function reduced their in-person visits, the health system eliminated user fees for the service.

In 2017, patients used the portal to exchange almost 16 million secure messages with clinicians, and more than 90 percent of patient-initiated messages were answered within one business day.

Meanwhile, Stanford Health Care, a not-for-profit multihospital health system, used its patient portal to systematically survey cancer patients for unaddressed symptoms. The surveys of 45,000 patients resulted in more than 6,000 referrals for psychotherapy, case management, nutrition, and other services, according to the researchers.

“We will see more patient engagement through these technologies,” Ming Tai-Seale, one of the study authors and a professor at the University of California San Diego, said at a Washington, D.C., briefing.

Another response to consumerism is to help patients make more-informed choices by increasing their access to clinical-quality information. Contrary to many previous findings, a separate survey-based study found the share of patients seeing information on physician quality increased substantially over the past decade—from 12 percent in 2008 to 26 percent in 2015.

The most-sought data were patients’ comments about physicians, and minorities sought and used quality information more frequently.

“Americans are substantially more aware of physician quality information than we would have predicted based on previous data,” said Lise Rybowski, a study author and president of The Severyn Group. “And for many people, patient comments are the only data they are seeing.”

Providers may benefit from more efforts to ensure such comments are useful and representative of a broad swath of their patients, Rybowski said.

Financial Considerations

Employers and insurers are experimenting with benefit designs that encourage patients to switch to lower-price providers. An evaluation of a rewards program that paid consumers for seeking elective procedures from lower-price providers found that the program cut spending by 2.1 percent, or $2.3 million, in the first year. The savings primarily arose from choices in magnetic resonance imaging and ultrasounds, and prices were reduced for covered surgical procedures.

“We have to be very cautious about expectations of savings, which were very modest in magnitude—but they were real,” said Ateev Mehrotra, a study author and associate professor at Harvard Medical School.

Despite the low overall savings, the small share of patients who did shop saved 78 percent on ultrasounds, 33 percent on mammograms, and 25 percent on MRIs, the study found.

A financial speedbump to making health care more consumer-oriented has emerged in the form of surprise medical bills, in which patients using in-network facilities are unknowingly treated by an out-of-network clinician and receive large bills.

Another new study found that half of new mothers who received a bill from an out-of-network clinician involved in their delivery at an in-network hospital switched to another hospital for their subsequent child.

Benjamin Chartock, one of the study’s authors and a PhD student at the University of Pennsylvania’s Wharton School, said the findings were important for hospital managers since childbirth is often the first experience with the healthcare system for expectant mothers and the experience can affect their long-term loyalty to a provider.

“So, we encouraged hospital managers to take advantage of the loyalty that is established and think of a surprise out-of-network medical bill as another attribute that they should care about,” Chartock said.

High-Deductible Challenge

The insurance product most associated with consumerism is the high-deductible health plan (HDHP), but another study released by Health Affairs this week concluded that enrollees do not engage in consumer behaviors such as price shopping. However, the researchers identified new strategies that employers, health plans, and health systems could explore to promote greater engagement in consumer behaviors among patients in HDHPs.

For example, health plans could develop programs to help HDHP enrollees learn to communicate effectively with providers about costs of services and to negotiate prices. These activities could produce the higher confidence that the researchers found to be associated with more-frequent engagement in consumerism.

Health systems could encourage patient-provider conversations about costs and promote price negotiation by making prices available to HDHP enrollees at the point of care. Approaches like that could not only reduce cost-related nonadherence for patients but also reduce bad debt for health systems, the authors concluded.

“They could also be training clinical staff to use these prices when making care plans—not just healthcare providers, but other parts of healthcare teams,” said Jeffrey Kullgren, one of the study’s authors and a research scientist with the Center for Clinical Management Research at the VA Ann Arbor Healthcare System.


Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Wednesday, March 06, 2019