HFMA has developed a model for healthcare organizations to determine their level of consumer-centric service and identify areas for improvement.
“The expectations of the business part of healthcare have increased for consumers,” said Todd Nelson, HFMA’s director of partner relationships and chief partnership executive. “Folks have always expected high-quality patient care and excellent clinical care, but today’s consumers are demanding more.”
To help providers respond to consumer demands, HFMA created a Consumerism Maturity Model, a mechanism that allows healthcare organizations to score themselves in key areas relating to consumerism. The model is the culmination of 18 months of work by a task force of industry leaders. It brings together the various resources HFMA has published around patient-friendly financial communications, price transparency, medical debt resolution and more.
Maureen Clancy, senior vice president, operations at Privia Health in Arlington, Virginia, who served on the task force, said the group’s goal was to provide guidance to organizations looking to improve the patient experience.
“I think it is high time that physicians and health systems listen and learn from the patients. Let’s understand what the patients are telling us,” she said.
Calculating consumerism readiness
The first step in following the Consumerism Maturity Model, which is available at hfma.org to HFMA members and non-members, is to determine an organization’s Consumerism Maturity Index Score (CMIS) by filling out the CMIS worksheet and transferring the worksheet data into the calculator on HFMA’s website. Scoring is segmented into three sections that are crucial to consumer-friendly practices:
- Consumer interaction channels
- Quality and accuracy
- Consumer experience
Within each section are several specific areas in which healthcare organizations must score themselves. Some examples include ease of scheduling appointments or wayfinding upon arrival at the hospital, availability of medical records and consumer-feedback methods. Based on the guidance provided in the model, an organization assigns itself a score between 1 and 5, with 5 being the top rating.
The final section on the worksheet asks for hard numbers based on five of the 29 HFMA MAP Keys, industry standard metrics that help a healthcare organization measure revenue cycle performance. These metrics were included to ensure organizations focus their consumerism efforts on strategies that maintain or improve overall performance, Nelson said. HCAHPS scores also are represented in that section.
The CMIS assessment is comprehensive but based on information those conducting it will have on hand, Nelson said. Those who have scored themselves were pleasantly surprised that the process took only 15 to 20 minutes to complete, he said.
‘An aspirational model’
The initial assessment is meant to provide a starting point and some areas of focus for improvement, Nelson said. In fact, many of the organizations that took the assessment during testing of the model did not score as high as they had anticipated, underscoring the need for both the model and a performance-improvement focus.
“This is an aspirational model,” Nelson said. “The expectation is not that anyone will be at the highest level, but instead continue to refine their process to improve.”
Many of the elements necessary to score in the top “consumer-centric” level are not common in the industry today. For example, price transparency is a critical focus area of the model, but many healthcare organizations have been slow to develop meaningful strategies in that area. For an organization to be truly consumer ready in that area, patients would be able to get an accurate price estimate based on their health plan via phone, patient portal or mobile app.
As a patient-centric organization, Privia always has worked to be ahead of the curve on consumerism, Clancy said. As a result, her organization ended up in the “emerging” category, which is the second-highest category. The third and fourth categories are “initiating” and “undeveloped,” respectively.
“We always have ways to improve,” she said. “This assessment allows us to prioritize and benchmark.”
Once an organization’s areas for improvement are identified, the Consumerism Maturity Model will point to resources that will help in those areas. For example, if an organization scores low in one of the MAP Key areas, winners of HFMA’s MAP Award for excellence in revenue cycle performance could provide insight. HFMA also has a host of consumerism-related resources that could be helpful as healthcare leaders work to improve their patient-friendly practices.
Although the model clearly states the elements necessary to becoming consumer-centric, there is some room for interpretation, Clancy said. For example, the score around what patients can expect when they arrive for service includes a wayfinding element, which is critical in a large health system but not an issue in a physician’s office. There are also some areas where an organization might meet four out of five criteria to gain a specific score and choose to score themselves at the higher level.
Recommendations also are not prescriptive, Clancy said. She recommends that organizations take a hard look at where they fell short and ask, “Do we need this exact thing, or is there another way to achieve this goal?”
A continued consumerism focus
Nelson recommends organizations retake the assessment periodically at whatever interval makes sense when considering the specific challenges being addressed.
“Some of these specific metrics will take several months to move the needle on,” he said.
Although it’s unlikely an organization will score at the top level after the first assessment, Nelson said doing so is achievable. However, even organizations that get to that top level must keep a consumerism focus as the industry evolves.