Traditionally, when we referred to the patient experience, the focus was on the clinical encounter. Today, we know that the patient experience includes the entire patient journey — from scheduling an appointment to paying the bill. Therefore, providing a positive patient experience requires attention at every encounter along the way. With today’s staffing shortages, however, this can be challenging.
Outsourcing processes that have a direct impact on the patient experience can help. A great place to begin is with scheduling, eligibility and enrollment and, finally, prior authorization. The following guidelines will help hospitals know what to look for when choosing an outsourcing partner.
1) Patient-friendly scheduling
Scheduling patients is a highly manual, time-consuming process. In today’s stressful hospital environment, it can be easy for staff to become rote and rushed in their approach.
Yet, scheduling is often the first encounter the patient has with the hospital. It sets the stage for the entire encounter, which is why it’s so important that schedulers provide a friendly, unrushed experience. The best scheduling partners should be able demonstrate low call abandonment, high patient satisfaction rates and reduced no-show rates.
Following are four capabilities to look for in a scheduling partner.
- Understands your hospital systems. To establish a successful partnership, it’s imperative to choose a vendor whose scheduling team is fully trained in your specific electronic health record (EHR) system. The last thing your staff needs is to have to train the outsourcing team on how to use your system. They should be able to be up and running on Day One.
- Acts as an extension of your team. Make sure that the solution provider acts as an extension of your team so that scheduling is conducted in real time and aligns with existing workflows. They should be able to manage all aspects of scheduling, including cancellations and reminders as well as pre-registration. It’s also important to find a partner that is flexible and able to scale as volumes change.
- Offers multilingual scheduling. If there is a large bilingual population in your community, be sure to choose a partner with multilingual schedulers to streamline the process for all patients and reduce the chance of no-shows.
- Ensures rapid deployment. It would be wise to bypass any partner that suggests implementation and deployment would take more than 30 days to go live. Experienced partners should have this process down to a science so that it’s quick, easy and takes as few of the hospital’s IT resources as possible.
2) Streamlined prior authorizations
Issues with prior authorizations are a top reason why claims are denied. Just as with scheduling, managing prior authorizations can be a time-consuming, manual process. Yet, the impact goes even beyond denied claims. When issues do arise, it can result in patients having to wait to get the care they need, which can negatively impact outcomes and the patient experience.
Out of physicians surveyed, 91% say prior authorizations have a “somewhat” or “significant” impact on outcomes, 34% say a delayed prior authorization has led to a serious adverse event for one of their patients, 24% say it has led to hospitalization, and 18% say it has led to a life-threatening event or the need for intervention to prevent permanent damage. Outsourcing can help optimize the entire process.
Be sure to choose a partner with the following capabilities.
- Uses the right technology. One of the best ways to improve prior authorizations and reduce delays in care is by leveraging automation tools that streamline processes. Vendors that still rely on manual, error-prone workflows will produce substandard results that could actually increase delays in care and put patient lives in danger.
- Manages the entire process. If the partner you choose isn’t willing to manage the entire prior authorization process, tasks like tracking down additional information and following up with payers will fall back on your team. The best partners are those that are willing to take care of the entire process on your behalf.
- Provides a record of reduced denials. When looking for a partner to manage prior authorizations, look for those that can provide a record of their typical results, including reduced claim denials. When vendors are unable or unwilling to provide this information, it should serve as a red flag.
3) Optimized eligibility and enrollment
While the number of uninsured Americans is dropping, around 26 million are still without coverage.
Today, 40% of Americans — with or without coverage — have medical debt. Of those, 20% believe they may never be able to pay it off. When patients have trouble paying their medical bills, they’re more likely to put off care, which can impact outcomes. Verifying eligibility and financial assistance is critical in helping patients afford the care they need. Outsourcing this process to eligibility and enrollment experts is a fantastic way to do just that.
When choosing a partner, look for the following capabilities.
- Takes a holistic approach. A patient’s financial situation is connected to so much more than their bank account. Even for patients with coverage and without medical debt, rising inflation has significantly impacted their finances, making it harder for them to pay and for hospitals to collect. Choose a partner that goes beyond just verifying coverage and checking propensity to pay. They should also incorporate social determinants into the picture and work with community resources to help get patients the help they need.
- Acts as an advocate for your patients. When it comes time to pay for their services, patients often see providers as adversaries, just trying to get their money. That’s why it’s important to choose a partner that provides certified application counselors to not only identify financial assistance, but to help patients navigate the often-complex enrollment process. In cases when a patient’s assistance is denied, these counselors should provide representation on behalf of the patient to appeal the denial. Not only does this help hospitals get reimbursed, but it also positions them as advocates for their patients. And when patients know their provider will work with them to ensure they get the care they need, it can improve loyalty and the hospital’s reputation.
- Leverages technology. Today’s sophisticated software uses artificial intelligence to help identify financial resources more effectively than outdated manual processes. Look for a partner that employs such technology so that you and your patients achieve the greatest benefit in the financial experience.
By focusing on the entire patient experience and not just the clinical encounter, hospitals can improve patient loyalty and gain a competitive advantage.
But it’s important to realize that the patient experience begins even before patients walk through your door. With today’s current staffing limitations, however, ensuring a positive patient encounter at every step of the journey can be challenging. Outsourcing provides a great opportunity to help hospitals improve the patient experience, enhance outcomes and optimize their bottom line.