Northwestern Medicine, an academic medical center serving the Chicago area, created and implemented a two-part improvement pilot in 2018. The pilot included discussing patients’ insurance benefits prior to the beginning of treatment in one intervention. It also included reaching out to patients who had outstanding balances to discuss the barriers to payment they were facing in the second intervention. In both interventions, patients were educated about common insurance terms, such as deductible and co-payment.
As a first step, the team reviewed bad debt trends and identified the highest opportunity areas. Oncology was identified as the third highest contributor to bad debt and the service line that had the greatest potential for improvement because the services with the highest cost are generally planned in advance.
In baseline cases within oncology from September 2017 through February 2018, the team found that 50% of the bad debt came from just 2% of patients who had balances over $10,000.
The team then performed retrospective chart review on 20 patients with the highest amount of bad debt to identify root causes and risk factors for accounts falling to bad debt. The variables explored were age, gender, treatment course, insurance type and network status. It was determined that the majority of the cost was from chemotherapy, and most of the patients were insured. Based on that analysis, the financial counseling and billing services interventions were developed.
The pilot, which included these two distinct interventions, was conducted between May and August 2018. Results are shown in the exhibit.
- Billing specialist pilot. For individuals with outstanding balances, a billing specialist contacted the patient to discuss barriers to payment. Patients were offered assistance such as drug replacement and co-pay assistance programs, financial assistance and payment plans. Billing specialists also provided education regarding common terms such as deductible, copayment, coinsurance, deposit, estimate, out-of-network and out-of-pocket maximum.
- Financial counseling pilot. In a parallel pilot, a proactive financial counseling intervention was conducted for all patients starting a new regimen of intravenous chemotherapy at one of Northwestern Medicine’s infusion centers. Financial counselors provided education regarding each patient’s insurance benefits as well as term definitions as provided in the other pilot. And those patients with a risk factor for bad debt (e.g., out of network, no prescription drug coverage) received more direct counseling to address their identified need.