Building a Healthcare Revenue Cycle for Patients

healthcare revenue cycle management leader Avadyne Health

Several weeks after my father died from prostate cancer, I was sitting at my dining room table facing stacks of his medical bills and insurance documents. Even after 20+ years of specializing in healthcare revenue cycle as a management consultant and as a senior executive in revenue cycle outsourcing companies, I found the morass of paperwork daunting.

All of us in healthcare talk about how confusing it is for patients to navigate their medical billing and insurance, but in that moment, it really hit home for me.

The process is broken, and I decided to do something about it. After all my time working in the healthcare revenue cycle, I began working on the revenue cycle—to make it better; to encourage providers to create an empowering patient financial experience.

That’s a major reason why, in 2017, I accepted the position of CEO for Avadyne, a leading revenue cycle management (RCM) firm that specializes in patient early out / self-pay and debt collection. It’s also why I wrote the recently released book, Rev Up!: Bold and Disruptive Strategies to Rev Up! Your Revenue Cycle Hero’s Journey.

Revenue cycle at a crossroads

I believe we are at a turning point in healthcare and healthcare revenue cycle. Patients are shouldering a greater share of their medical expenses, thus accounting for a growing portion of provider revenue and margin. At the same time, consumers are being treated to exceptional customer experiences, every time, from customer experience (CX) leaders such as Apple and Amazon.

Consumers aren’t going to indefinitely put up with the disconnect between the best-in-class experiences they receive from other industries and the type of patient financial experience they currently receive, especially as healthcare consumes more of their family budget.

But it still isn’t getting the necessary attention:  While patient experience (PX) is a growing focus for many providers, the primary focus is almost always on clinical care, not patient financial interactions. Yet the billing and payment experience is an integral part of the patient journey from the first step to the last, making it memorable and consequential.

Four guiding principles for outstanding financial PX

Healthcare providers and their RCM partners have to measure up against the top CX companies if they are to retain loyalty and protect revenue. Doing so requires adopting a framework that makes catering to patients’ needs and expectations the overriding focus. Four key principles:

  1. Treat patients as individuals. Taking individual preferences into account is key, especially when it comes to how patients receive their bills and their options for payment. Use technology, including customer communications management and electronic bill presentment and payment solutions, to connect with patients on their preferred devices and channels, including texting, email, mail, self-service portals, click-to-chat solutions and call centers.
  2. Adopt a concierge model for customer service. Given the complexity of patient financial discussions in a high-deductible world, there is a real need for assisted service. Technology can help here, too. For example, speech analytics can help patient financial services representatives adjust their approach in real time (for example, by being mindful of speaking patterns that detract from the patient experience) and provide the right information at the right time. Additionally, technology that assesses the types of encounters that most frequently are cause for frustration enables revenue cycle leaders to focus attention on top pain points quickly for an improved experience.

Recently, Avadyne added the option of a payment plan to statements for balances that exceed a defined threshold, rather than waiting to make the offer when a patient calls the contact center because they can’t pay or missed a payment. Our payment portal also enables patients to self-enroll into more flexible payment arrangements.

  1. Look for ways to use new technologies to deliver a better patient financial experience.

I’m a huge fan of superhero comics, so I saw the potential for improving the revenue cycle by adapting the tech used in the first augmented reality comic book, Masters of the Sun. Recently, Avadyne developed the first augmented reality app for healthcare revenue cycle, an avatar we call “Eve.” When patients use this app on their smartphone, Eve appears as a 3D character who walks to the section of the billing statement where the patient taps on his or her phone and explains the detail to the patient in easy-to-understand terms. This app will soon be rolled out at a 30-hospital system.

  1. Measure patient financial experience. You know the saying: What gets measured gets done. HCAHPS and other patient satisfaction surveys generally do not include questions around patient financial interactions. When hospitals do attempt to quantify the patient financial experience, they typically target just a few metrics, such as accounts sent to collections—metrics that do not really address satisfaction. What’s needed is the ability to gather data around every touchpoint in the patient financial journey and how these experiences impact the overall PX. At Avadyne, we’ve created a patient financial experience scorecard with eight metrics that helps providers more accurately gauge the quality of the patient financial experience they provide. With this information in hand, providers gain actionable intelligence for patient-focused improvement.

Improving the healthcare revenue cycle offers a tremendous opportunity to drive patient satisfaction and loyalty at lower cost—and ultimately, boost revenue. None of this is pie-in-the-sky; neither is it rocket science. It requires investment and a commitment to modern financial care, just as hospitals invest in modern clinical care.

About the Author

Jayson Yardley is CEO of Avadyne Health, one of the 10 largest U.S. revenue cycle management firms in the country specializing in patient liability resolution. In his role, he provides strategic direction and management oversight and drives impactful relationships to change the paradigm of the patient financial experience. Prior to joining Avadyne Health, Jayson held executive positions with Conifer Health Solutions, Navigant Cymetrix, Navigant Consulting, Capgemini and Ernst & Young, LLC.

Jayson holds a Master of Business Administration from California State Polytechnic University-Pomona and earned a bachelor of science in Political Science from the University of California, Los Angeles. He’s an active member of the Healthcare Financial Management Association (HFMA).

Jayson Yardley
Avadyne CEO