Hospitals and health systems must adapt their practices using an innovator’s mindset to keep up with the change sweeping the industry, according to a presentation this week at HFMA’s Annual Conference.
“Innovation, at this point in our industry’s landscape, is pretty critical,” said Praveen Mekala, enterprise division chair with Mayo Clinic, referring to the problems that have hampered traditional providers over the past several years.
“Prior to the pandemic, I think everyone was noodling about how inflation’s probably going to challenge us, we’re going to probably have a staffing shortage in 10 to 15 years,” he added. “Fast-forward about four years, [and] it’s all here, and it’s here with a vengeance.”
In the context of consumer sentiment and media attention, “We’re being challenged on those elements that we would traditionally tap into to quickly turn our financial statements around,” Mekala said. “Quickly [turning] around cash point-of-service collections, managing that receivable in a much more efficient fashion, managing throughput in a much more efficient fashion.
“All those tactics that everybody probably tries to deploy, or invest in, are tactics that may not be recognized as valuable in the face of our consumers right now. And that’s a challenge that requires us to really think about things in a different way.”
Mekala and colleagues Michael Khan, director of Mayo Clinic’s Financial Counseling Contact Center, and Phil Lord, senior director of revenue cycle, said traits of successful innovators include:
- Connecting things even when they are unrelated
- Bringing an inquisitive and sometimes provocative mindset
- Being observant of the world around them
- Seeking sounding boards and alternative opinions
- Experimenting without a fear of failure
Applying an innovator’s mindset to the revenue cycle
Mayo Clinic focuses on innovation in areas that can deliver value in both patient satisfaction and financial performance.
“One of the fundamental things we’ve observed is that challenge of the revenue cycle — patients not really being clear on navigating that financial journey,” Mekala said. “And we’ve worked on some steps to try to address that.”
A key step is integrating patient estimates into preservice processes. The program improves patient financial accountability, the health system’s financial counseling services, and the efficiency of collections.
Real-time, automated estimates are synchronized to a patient’s insurance coverage and specific health plan, allowing for denial risks to be identified farther in advance.
In addition, Kahn said, “By providing good-faith estimates, we’re able to have tangible discussions for current and subsequent care. We’re able to plan that out as best we can. And that can also lead to our financial counselors exploring funding [options]. That could be Medicaid, it could be foundation grants or free drug programs.”
After a service, billing processes become more like a continuation of a conversation than a source of surprise or alarm for the patient.
Beyond the immediate advantages of price transparency, benefits-design data harvested from a robust estimation program offers key operational insights.
“We’ve slowly started trying to work with some of our practices in using some of this information to actually inform access,” Mekala said. “Ensuring that physicians aren’t leaving wait space in ORs, [that] our oncologists are able to continue courses of therapy from a longitudinal standpoint. It has a lot of great applications from that lens.”
Innovating to find actionable insights
Other pertinent innovations at Mayo Clinic include use of natural language processing tools to identify trends in patient communications. These insights inform decisions about low-value activities that could be eliminated via automation.
“You don’t necessarily need some fancy third-party program to bolt on to really do that,” Lord said. “Just trying to really understand your patients and then taking this valuable feedback and deploying it.”
He added, “This data is pulling together almost what we would call a focus group. Instead of interviewing hundreds of patients, we’re able to get a lot of this information and really have an opportunity to turn it into feedback that we can ultimately find applications for.”
Mayo Clinic has used the insights to identify shorter-duration phone calls that can be phased out in favor of chatbots or a self-service portal for queries about bills, medical records or the status of prior authorizations. That, in turn, can allow staff to be redeployed.
“Just trying to find those low-value opportunities [where] you can leverage technology, you can build scripting, you can work through deploying a systematic approach with your staff interacting with the patients,” Lord said.
Next-level patient-centric innovations include understanding the health system’s price competitiveness relative to similar institutions, how and when patients want to be contacted (e.g., text messaging, phone calls), and how and where patients prefer to engage with the health system for care delivery.
Coming up, Mayo Clinic is looking to integrate with its practices and clinics to proactively push relevant information to patients. That’s an especially meaningful effort amid the ongoing Medicaid eligibility redeterminations.
“We’ve started to take that approach of dispersing communications to patients so they have that opportunity to make that connection [with their state program],” Lord said.
Not as daunting as it seems
Keys to the success of innovative initiatives include maintaining a patient-centric outlook and taking the right approach.
“Don’t be afraid to break that fourth wall,” Kahn said. “If you have questions for your customers or patients, ask them. And start with where you’re at. If where you’re at is an Excel spreadsheet, start there. Document it, look for trends, go from there and your capabilities will build up.”