How to maximize eligibility and enrollment through virtual technology

COVID-19 accelerated adoption of virtual technology in healthcare. In addition to telehealth visits, systems can now more easily build new business models virtually with solutions that best meet patients’ clinical needs and ensure reimbursement for provided services, helping protect an organization’s financial health. This comes at a time when payment is in flux with alternative reimbursement models, introducing economic unknowns.

During an Oct. 13 webinar, two executives from Savista - Laxmi Patel, chief strategy officer and Aimee Newson, senior director of revenue cycle solutions - shared solutions for navigating the current landscape and how virtual technology can improve a system’s finances.

1 The patient is now a major payer.

The patient is the third largest payer of healthcare costs. Patient medical liability is growing 20 percent each year largely because of increased out-ofpocket healthcare costs. That turns patients into consumers, and they have expectations about quality of services. More patients are researching before receiving elective services, combing through provider reviews available online. Additionally, Savista’s Consumer Impact Study showed that 79 percent of patients consider billing and payment experience when choosing a healthcare provider including opportunities to pay by phone and use online portals.

2 Healthcare revenue cycle departments face more challenges.

The transition from traditional fee-forservice to value-based models means healthcare providers are facing greater reimbursement and revenue risks. Newer models are more complex, which challenges healthcare revenue cycles. Furthermore, health systems often have thin profit margins, and administrative costs are expected to increase 100 percent to 300 percent in the next five years. With that, the ability to efficiently collect revenue has become more important.

3 Providers are being measured on patient experience.

COVID-19 ushered in a new era of telehealth visits, with payer adoption gaining traction, at least temporarily. Prior to the pandemic, telehealth was not readily scalable or widely adopted, largely due to restrictive state and federal regulations. Systems quickly implemented or grew telehealth programs at the start of the pandemic. Although telehealth usage is lower than its pandemic peak, with current visit volume at an estimated 15 percent, it’s still higher than pre-pandemic levels. As regulations and payment for telehealth expand going forward, mainstream use of telehealth should ensure that the patient’s overall experience is cohesive, which includes registration, appointment set-up, appointment communications, the waiting room, the visit and follow-up.

4 Utilize patient segmentation to better manage revenue cycle.

While patient segmentation and tailored experiences are popular in other industries, it’s newer to healthcare. Technology can help systems quickly assess and segment patients by clinical needs and revenue cycle issues, which is especially important in alternative payment models. By segmenting patients, financial liabilities can be addressed before it’s too late and becomes difficult for the health system to collect outstanding bills. Segment patients into four quadrants: high or low touch and high or low financial risk. High or low touch focuses on complexity of medical needs. High or low risk focuses on insurance status and propensity to pay.

5 Leveraging innovative services can revolutionize the patient experience.

Screening patients before their visit occurs enhances the patient experience while reducing uncompensated care and bad debt. It can be used for visits in emergency rooms, outpatient services and clinics. With a patient-centric screening process and supporting technology, a health system can assist patients with understanding their insurance and potential out-of-pocket costs.