Why Patient Engagement Is a Paradigm Shift for Revenue Cycle Management

For a business process focused on the hard measurables of operational efficiency, revenue cycle management (RCM) has not historically maintained a reputation for having a core focus on patient engagement.

But as the healthcare market evolves, there is an increasing understanding that putting patients’ goals at the center of every part of the business model has major impacts on outcomes—both for patients themselves and for the health systems they are a part of.

We recently conducted a study among providers to explore where they are in their patient journey and the importance of humanizing the RCM experience. The survey was with healthcare providers across the revenue cycle spectrum, leading to some incredible insights from patient-facing, financial, IT, executive, and digital champion staff. Here are some of the things we learned along the way.

Focusing on patients has come a long way

Healthcare’s legacy is that of a hierarchy, where physicians and providers have gained fame for administering arcane treatments to fortunate recipients (i.e., patients) from on high. The idea of “patient engagement” has historically been seen as little more than a strategy to get patients to act in a preferred way, with little value placed on their preferences, emotions, and needs. In the past, this has led to a systemically poor understanding of patients and their behaviors.

Much of this way of thinking was simply a sign of the times: non-healthcare corporations typically consisted of hierarchical, top-down business structures that dominated decision-making and strategy, often independent of the customers they served.

But recent decades have seen a paradigm shift—one which recognizes the consumer as having autonomy, self-knowledge, and an experiential perspective that ultimately drives the bottom line of the businesses they engage with.

Organizations began to realize the value of improving the customer experience while also discovering that a horizontal business structure could provide precious insight from departments all across the organization. These valuable lessons were, in many ways, adapted to accommodate health systems and a few things happened:

1. The focus on “patient engagement” turned into a focus on “patient success,” where the patients’ own perspectives on their experience and outcomes were no longer seen as a “nice-to-have.”
2. Patients began to be seen as healthcare consumers whose perspectives mattered in a competitive healthcare marketplace.
3. Revenue cycle management shifted from siloed decisions being made in the C-suite to a collaborative exercise with feedback loops across the organization and a focus on patients that unified everyone’s efforts.

One thing that was interesting to uncover was just how unified business units were in their understanding of the patient experience as the central goal in all of their strategizing and decision-making. However, the gap between aspiring to focus on patients to then practically executing on that vision was clearly seen as well.

Patient centricity still has a long way to go

There seems to be a general consensus that patients’ outcomes, experience, needs, and emotions should guide RCM since this, in turn, recursively improves critical elements of the revenue cycle itself. But it was interesting to uncover just how lagging tools, processes, and business infrastructure are in making that a reality.

Simply put, healthcare is complex and confusing. There’s a number of reasons for this, but the one who suffers most is the patient. We identified several key areas where organizations struggle to improve patient engagement:

1. Operational processes are often high touch, redundant, and lack automation, leading to errors, reduced efficiency, and lost reimbursement capture. On average, it takes healthcare organizations 20 healthcare workers to schedule, register, and financially clear each patient for their appointment.
2. Communications are fractured across the clinical/financial divide, all while using multiple technologies to deliver them. All of this furthers patient confusion and frustration. For 79% of organizations, clinical and financial patient communications are entirely separate.
3. Solutions designed to centralize the patient experience are few and far between. As a result, billing, coding, registration, scheduling, IT, eligibility, reporting, etc. often function in siloes with department-specific KPIs driving their performance, which may or may not be influenced by the patient experience. 79% of healthcare organizations manage clinical and financial patient communications via different technologies without a unified system.
4. Even when data on the patient experience is available, it isn’t leveraged effectively to improve operations or patient outcomes.

The road ahead for patient engagement

Despite the challenges, the battle toward patient engagement-enhanced RCM begins with awareness. However, the complexity inherent to revenue cycle improvement across an organization can be overwhelming; and having a siloed RCM journey can introduce inefficiencies, errors, and lack of transparency for both providers and patients.

As such, providers need a vendor who can help them consolidate all the steps across revenue cycle management to ensure patients have a seamless experience.

According to Change Healthcare’s recent study, the biggest patient complaint is having to input the same information multiple times. In addition, 39% of the respondents said it’s too difficult to understand bills and 38% said there are simply too many forms to fill out. Patients also struggle with surprise bills and other issues of price transparency.

These patient complaints are a direct result of the internal challenges RCM decision-makers face and navigating multiple vendors and systems. With the right tools, expertise, and partner on board, healthcare organizations can improve their collection and use of data, enable more effective communication, and automate workflows.

How Change Healthcare can help

At Change Healthcare, we’ve long been leaders in leveraging data to transform organizations’ approaches to RCM. We know how complex the RCM process can become with multiple in-house and outsourced teams, resources, unorganized systems, and processes. But we also know most healthcare organizations’ number one priority is fixing patient pain points and improving outcomes.

Our goal is to connect the dots between providers, patients, and payers through one platform and make sure operational, clinical, and financial journeys are working seamlessly together by sharing data, consolidating systems, and communicating across departments.

If your organization’s revenue cycle is in need of a paradigm shift, consider a renewed focus on a patient centric approach in all elements of your business to optimize revenue and elevate patient engagement.