To patients, the financial experience isn’t separate from the clinical one. Here’s how to leave them with a good lasting impression.

Jason Wolf: Even the things that you might not think are directly touching a patient or family member every day actually influence the way they experience your healthcare organization and therefore impact things like the way they will choose you in the future.

Erika Grotto: Transforming the human experience in healthcare, today on HFMA’s Voices in Healthcare Finance podcast.

Hello, and welcome to the podcast. I’m your host, Erika Grotto, and I’m excited today to bring you the second of our two speakers from HFMA’s upcoming revenue cycle conference. Jason Wolf is the president and CEO of The Beryl Institute, and he’ll be speaking at the conference about the patient financial experience. That’s one of my favorite topics, and if you know HFMA’s president and CEO Joe Fifer, it’s certainly one of his as well. We recently invited Jason to speak with Joe about the continued importance of keeping the patient front and center.

Joe Fifer: My guest today is a longtime champion for better patient experience. Jason Wolf is the president and CEO of The Beryl Institute and the founder and president of The Patient Experience Institute and a public speaker at HFMA’s upcoming Revenue Cycle Conference, where he’s going to be talking about this very issue, transforming the human experience in healthcare. At least a significant part of that, hopefully, will be from a revenue cycle perspective. I’d also add that we work closely with The Beryl Institute. They issued a really good whitepaper recently on patient financial experience. We were able to contribute to that, which we were just thrilled to do. It just fits into everything that we’ve been talking about for such a long time. The paper was about the role of the revenue cycle in elevating the healthcare experience. So with all that, welcome to the podcast, Jason.

Wolf: I so appreciate being here with you, Joe, and I’m excited to have our conversation today.

Fifer: Good deal. Well, let’s just jump right into it. As I alluded to in my intro, we at HFMA have been talking about patient financial experience for a really long time. And in a time of price transparency and the No Surprises Act, this idea is starting to take center stage, although we could debate about whether it’s in the right direction or not. But what do you think are the most important things for healthcare organizations to know right now in this area?

Wolf: I appreciate the question, and I think you’re right. I think this is still an area that folks are prioritizing and trying to figure out how to weave all the disparate parts of healthcare together. I think for a long time we’ve operationalized healthcare from the inside out, just trying to make the chaos work for ourselves. I think we’ve seen a significant shift, catalyzed by the pandemic to look at this as an integrated strategy from the outside in. And that really frames this idea that experience happens in our healthcare organizations no matter what we do. There’s an experience that our patients, their family members, their care partners that are with them are having in every encounter along their care journey. And so, you know, I think it’s important first that we acknowledge that experience is happening. This is not just something on the side or something that we just measure via surveys. It’s the reality of everyday encounters from consumers in healthcare. And the fact is that if we come from that lens, they’re not distinguishing between all the pieces and parts. The patient financial experience is not a separate bucket that they see as distinct from everything else that they’ve experienced on their journey. And so I think it’s really important that organizations really think about the fact that these patients, families and their care partners are not distinguishing these as separate buckets or assessing them distinguished from one another. But in fact, the patient financial experience then is an integral part of the overall experience people have, and if we don’t consider it part of that integrated experience, then we have a chance to really miss what we’re providing in the totality of outcomes we aspire to in healthcare. Because I think as we even talked about in the paper you alluded to, it’s often the first encounter for many folks in a healthcare experience journey. And often it’s the last impression, and I would even change that to say it’s the lasting impression—

Fifer: I was just gonna say lasting.

Wolf: –people have of an organization. You know, it is part of their experience, and I think it’s important that we don’t see it as just an operational function that we create efficiency or drive revenue or capture dollars, but the way that people from the outside in look at it is, it’s part of their journey, it impacts their lives. It is how they reflect on and think about the healthcare organization overall that they just had an encounter with. It’s important to begin to have that lens, I think, as we move forward.

Fifer: Gosh, there’s two phrases that you used that I want to follow up on. I mean, one, we talked about making the chaos work. I’m from Michigan. I’m not a car guy, but I’m from Michigan, so I like to use that car analogy, but, you know, when you buy a car, it’s a really complex piece of machinery, and yet, you know, the whole process is boiled down to something that I can understand as a consumer. I may not use all the features and the capabilities of my car, but it does what I want it to do, and yet there’s so much science that goes into the formation of that car. And so I think again, we have to adopt this attitude of making the chaos work. So–

Wolf: Yes.

Fifer: Kudos to you on that one. The other one is so true. The experience happens.

Wolf: Yes.

Fifer: It’s not just happening because we’re measuring it. It happens, so we can either participate in it and measure it and understand it and really feel what it’s like to be a consumer, or just leave it out there for whatever happens, and that’s a really powerful concept by itself. So thank you for doing that. It does lead me into another question though. I’m curious—and I’ve written about this and I won’t tell you what my bias is—but I’m curious maybe a current state of, what are you seeing in the C-suite? Do you see the C-suite in health systems focusing on patient financial experience? We have a long history of clinical experience and lots of focus there, and we want to have good clinical outcomes, and we want the patient to feel good in the clinical settings. But are you seeing it on the revenue cycle side as well?

Wolf: Yeah, it’s interesting. I think we have long, like you, espoused for it. I think it’s reflected in the models that have come out of HFMA for awhile around that integrated consumer encounter. But I still have yet to see it in significant amounts, if that’s a fair way to put it. I think there are sort of more visionary or integrated C-suites that realize all the component parts are around the integrated experience that we were talking about in the previous question. But I do still think, you know, we’re trying to survive a lot these days in healthcare, so I think we have to acknowledge that. We’re trying to manage the integrated parts. We are operating our financials off of just making what we can and trying to figure out how that works, and I think sometimes we forget that things like revenue capture is an outcome measure of how we engage the people that we care for. And so I think there’s a shift that still needs to happen in the C-suite conversation, an integrated lens around how all those folks are part of the conversation. I know if you sat around a C-suite meeting right now, and you look at the chief nurse and say, “Well, you’re clinical, and you touch our patients, so you’re responsible for how they feel. And you, CFO or folks that run our revenue cycle, just get the numbers right, manage our budget, and capture dollars.” And I think that that distinction actually causes greater problems for us organizationally and experientially overall. So I do think there is an opportunity, and would concur with you–I know you haven’t shared your bias, but I’m gonna guess that you’re thinking like me, it’s probably not happening as much as it should or could. I think we have an opportunity to encourage that discussion around the role that every part of the operations of a healthcare organization play in driving experience and helping people realize that even the things that you might not think are directly touching a patient or family member every day actually influence the way they experience your healthcare organization and therefore impact things like the way they will choose you in the future, the loyalty that they have for you as a healthcare institution, the way they talk about you at the Walmart or the soccer game with their kids and how someone else chooses you down the road as a place for care. There are huge ripple effects, and that integrated lens I think is so critical. So it is an opportunity, I will say, to your question, that we still have to address.

Fifer: I don’t have hard data, so I think —

Wolf: Neither do I.

Fifer: I think the tide might be shifting a little bit, but my gut feel is that it’s not talked about enough.

Wolf: Yeah.

Fifer: And honestly I don’t understand it, because that has such a profound impact on what consumers think to get to the point that you make so well. So that’s, you know, that’s my answer to it, and again, I’ve been pretty open about it, and so I think we share the same sentiment. Maybe shifting a little bit, there are a lot of knowledge gaps for patients about all aspects of healthcare, and again, it’s that car analogy, what’s going on under the hood. But especially financially, people just don’t know how healthcare finance works. They don’t know how their health plan works. They don’t know how they fit into this. How much of providing a great patient experience is in education of the patients?

Wolf: I think the answer is simply, a lot.

Fifer: Yeah.

Wolf: I’ll age myself and geographically place myself, with you being in Michigan. I grew up in New York, and there was a commercial and a place. It was called Syms. The guy’s name was Sy Syms, and he ran, basically, it was the first warehouse-y clothing store. It was all suits. He got all the suits, like the really nice suits on sale. He put them out there, and his whole slogan was, “An educated consumer is my best customer.” Because he knew that when people came in knowing what they wanted, they actually were able to get what they wanted from that experience, and it was actually better for everyone. And I think we forget that in healthcare, that our educated consumers are our best customers because we can better care for them, that they can be partners in our care process, which I think is essential to experience. They’re not just transactional recipients or unknowing participants in an actual financial process. So I think there was a great interview as part of the paper we did, I think it was with Tiffany Huston from Door County, who built a huge education process within their own endeavors where they were actually helping explain people’s bills. And they became so well known for caring for helping explain the process, understanding bills, educating consumers on that process, that people were showing up with shoe boxes of stuff from other healthcare institutions that weren’t their own to get education. So what that infers to me is that there’s a thirst for it, because it is cumbersome and overwhelming and hard to understand. Two, when people understand, they can be better participants in their overall care, and through that, actually feel like you care about them. Providing education for information is one thing, but providing education to say, “We see you as a partner in your care journey, of which we believe the financial aspects of ensuring you can get care easily and in accessible way is part of that,” is something that I think most consumers, most patients and family members would be like, “Thank you so much, because this is the most stressful part. I’m actually more stressed about the financial piece than the fact that I know I have to go to surgery tomorrow.” And we make that the hardest part to deal with sometimes. So I can just say, coming full circle to your question, an extensive amount is needed. I think we can do a better job of educating, and it’s not a complicated process. It should not be a cumbersome process, and I think the time and energy that we invest in doing that would actually save us time down the road in terms of how we engage patients and families and even how we see the outcomes we want, like capturing dollars, like ensuring better financial returns, like lessening times of collections. All of those things would result. And so I think we have to do a better job with that too.

Fifer: Yeah. Well, common sense would say that if they understand it, there’s a much higher likelihood that they’ll actually pay what they owe than if they don’t. And I think that there’s plenty of studies out there to show that. But the other part of your story reminds me of–gosh, just goes way back when we were first putting together our patient financial communications best practices report. We had people from insurance, we had some provider groups, we had a couple other industry people, but we had a couple people there from consumer groups representing the consumers. And so—gosh, this goes back like eight or nine years. A big part of our patient financial communications best practices, as you well know, is having clear and concise discussion early on, and then in the document we talked about what settings are appropriate. And before we formed those suggestions, the industry people were the ones that were hesitant to have these conversations early. Oh, the patients are too worried about their healthcare, they don’t want to talk money. And you know who was banging on the table were the consumer groups saying, “You have to have these conversations up front.” And I can remember that conversation like it was yesterday. Nancy Davenport-Ennis was her name, and I haven’t seen her since, but she was just so adamant about, you have to have these conversations early for all the reasons that you’ve articulated so well for so many years.

Wolf: Well, imagine that’s hanging over your head. You want people to come to healthcare to, you know, either get better with our treatments or at least live the rest of the lives that they have with dignity and respect. And if you have that hanging over your head the whole time, there is actually stuff in your way of being able to do those things. And so if we are up front, open, education—provide the education needed and help put that at ease or resolve it, or at least put it in a box and know it can go over here until later. They can do the healthcare journey, the actual delivery of care, in a much more effective way. And I would dare say—I don’t know if we have the evidence on this either—but I think you’d actually see better outcomes because people would be able to focus on healing. They would adhere to their care plans and engage with their doctors and physicians versus whirring in some portion of their brain around, How am I going to pay for all this, or what does this even mean for me? So I think it is a significant step in how we refocus and repurpose the way engage patients, families, care partners in their overall care journey.

Fifer: That would be a really interesting study—

Wolf: Yeah.

Fifer: –to see if you could isolate the variables to see how the financial experience impacts our outcomes. But even if you didn’t buy into that, just back to your original point, it’s the lasting impression of the health system, and to me, that’s a pretty compelling argument.

Wolf: Yeah.

Fifer: A last question for you that kind of brings…you mentioned earlier that, gosh, we’ve all got so many things that we’re working on, and there’s a survival strategy. And it is a stressful time in healthcare. I’m glad I’m not a hospital CFO anymore. And we’re facing workforce shortages and burnout throughout the whole industry. Do you have any thoughts on how we could best support our people so they can, in turn, provide our patients, our consumers, with a good, positive financial experience?

Wolf: Yeah. I mean, I think it comes back to something you said, and it came up in the paper as well. I mean, you know, one of the three main points we talked about was making the complex simple and accessible. So I think the first point, or the tip of the spear on this one, is trying to make things simple. We have built—again, back to our first part of the conversation—systems and processes to manage the chaos for ourselves in delivering care, not necessarily from the lens of the users, and the users are not only, from a human experience lens, patients and families, they’re also our healthcare workforce. We have to care for our healthcare workforce as much as we care for those patients and families and caregivers, or we can’t deliver care effectively in the first place, so that’s the wedge that we kind of have to work through. So when we think about making process simple and making the way we have to manage our financial practices in a way that are easier or access practices in a way that are easier so we’re not doing multiple entries, and we’re not managing questions over and over again. Those are the kinds of things, designing systems and processes that make it simple for people not just at the end user standpoint but even in the entry point, that people have to run the mechanisms. So process for process sake is still a problem, I think, in healthcare, I’m sure you remember from the days you and I both kind of walking around the inside of hospitals. We create another process to manage the problem, and it ended up doing was creating more layers of work. And I think that this opportunity to create a simple, efficient process for not just our patients, their care partners, their family members, but for the folks that have to run that process every day, addresses this very issue. And so to lessen that work burden, to think about how we can make things more efficient for what it means, how we capture information, how we share information, we really need to think about that now more than ever. And really kind of boil down our work to the essence of what’s really important. And I think we’ve all been there now. This pandemic has elevated for all of us the things that are really important. We should be taking that lesson and putting it into the actual way we operationalize healthcare to focus and do what’s really important and realize a lot of the other stuff that we’ve done has probably just gotten in the way of delivering what we really want to deliver.

Fifer: Yeah, you know what term is going through my head as I listen to your answer is honestly, is “common sense.” If we could—

Wolf: Yeah. Crazy, huh?

Fifer: If we could just—because every rule, you know, there’s deviations from that rule, and then you create another rule to fix that, and yet if we step back and I often encourage our members to do an honest walk through of their revenue cycle process. I mean, not send somebody out and come back with a report, but as a CFO even to walk through, understand, listen to conversations with a common sense filter, my guess is we’d end up with a better patient financial experience at the end of the day.

Wolf: And I think to that point what’s really important is that you listen to it from both sides of the conversation. You should not just be looking at it from the lens of our patients and families—you know, from the consumer lens. We have to. I mean, clearly that’s critical there. But I mean, we also have to look at the folks who have to operationalize it every day because you might be asking them to do things that like, we scratch our head and go, “Why do we do that again? Why do we have a system that makes you enter it at check-in and you’re re-entering it after paperwork comes in…” Looking at it from both processes around what the work burden is on people, especially with the fact that people are feeling overwhelmed and kind of burdened by things today, we have a huge opportunity to lighten the load, I think.

Fifer: It reminds me of one last story I just thought of that I hadn’t thought of in a number of years. This goes back to my time at Spectrum Health. We were pretty focused on the experience, and we were offering out-of-pocket cost estimates. This was like, 12, 13 years ago, way before we had the technology to do it. But we developed the process and we had scripting and all that. And I remember standing in front of our patient access people, and I was just feeling really proud of myself and boy, we were rolling this out. And I swear, this lady raises her hand in the back of the room and she says—this is a true story—she says, “Joe, you don’t know what you’re talking about.” I went, “Woah. What do you mean?” She went on to say that the script that we had put together for them to use was heavy on legalese and it was too long and it wasn’t gonna work. And rather than get defensive, I said, “Alright, let’s go,” and I went to her work station, and she showed me the process. There were two of them then that were teaming up on me. And it was such a learning experience because they were the front-line folks. They were the ones that were having these conversations and said, here’s what we need to talk about. So we took this long legalese, and I didn’t ask our legal folks. I said, “We’re gonna shorten it up, and here’s what we’re gonna talk about.” And we just did it that way. And it worked. So it was a beautiful learning experience for me, got me off my high horse and got me real with people that are really knowing what was going on.

Wolf: I love it. I mean, that’s the essence of human experience that we’re talking about. We have to have a conversation with both those who receive our care every day and those who deliver it.

Fifer: Absolutely.

Wolf: If we aren’t caring for both in that equation, then we actually aren’t going to achieve the outcomes we’re ultimately striving for. That’s a great story and I love that story. I might have to borrow that.

Fifer: You’re free to do it. You can humble me the whole time.

Wolf: I will.

Fifer: This is a dangerous thing because Jason and I could talk about experience forever. You’ve been so gracious with your time. I would encourage folks to come to Revenue Cycle Conference. You’ll get Jason in spades and hear a lot more about this, because it’s so important for us to do. But thank you for sharing your time with me today.

Wolf: Totally a pleasure. I’m really honored and humbled to be with you. Thanks so much.

Grotto: Voices in Healthcare Finance is produced by the Healthcare Financial Management Association and written and hosted by me, Erika Grotto. Sound editing is by Linda Chandler. Brad Dennison is our director of content strategy. Our president and CEO is Joe Fifer. There’s still time to sign up for our Revenue Cycle Conference. You’ll get to hear from Jason Wolf, from Joe DeLoss, who was on our podcast a few weeks ago. And if you stick around for the closing general session—and I think you should—we have a great panel discussion titled A Cost Effective Revenue Cycle, which I’m thrilled to be moderating. You can register for the conference by going to hfma.org and clicking on Events. And if you have a great idea for a future episode or you want to get in touch with our team, you can email us at [email protected].