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On-Demand: Optimizing Patient Revenue

May 8, 2019

This webinar will explain the issues facing revenue cycle and patient responsibility along with new technologies (EA-Collect) that help alleviate those issues.


Moderator: We are pleased to welcome you to today's webcast. In order to qualify for your CPE Certificate, you will need to remain logged on for at least 50 minutes. Respond to three out of the four polling questions. We would appreciate if you would complete the evaluation survey following the event. A link to the survey will be emailed to you automatically within the hour following the Webinar. You may submit questions and we will try to address them during the program.

Moderator: However, if time does not permit us to answer posed question during the webcast, it will be answered offline after the event. The presentation is available for download through the handout box on your GoToWebinar platform. For those who meet the criteria, you'll receive a CPE Certificate from within 14 business days of confirmed course attendance. Today's speakers are Katie Babcock, Director AR Exchange, Timothy Gordon Manager EisnerAmper. I will now turn it over to Tim.
Tim Gorton: Thank you Lexi and good afternoon everyone. My name is Tim Gorton. As Lexi had just mentioned, I'm a Consulting Manager with EisnerAmper's Healthcare Services Group and I want to thank you all for joining us today. A little bit about who I am and then I'll hand it over to Katie. My background is in Health System Operations, including front end revenue cycle management, which is also known as some of you may be aware of it today its Healthcare terms, patient access. Additionally, I'm a fellow with the American College of Healthcare Executives. I'm also the immediate past President of the Local ECG Chapter in New York called Healthcare Leaders of New York.

In short, I've dedicated my whole life to Healthcare leadership, including an eye on patient access issues specific to Revenue Cycle Management. That's a little bit about me. I want to hand it off to my colleague and Co Presenter, Katie Babcock, who will let you know a little bit about herself and her background, Katie.
Katie Babcock: Hi everyone. Thank you again for attending today. As Tim said, my name is Katie Babcock. I am the Director of Project Management and Client Relations at AR Exchange, which is a technology partner of EisnerAmper. I previously worked on the medical informatics team at Blue Cross. I'm a Sender Management for the South Carolina Hospital Association.

Before coming to AR Exchange about three years ago. I primarily work on the operations side here, so I get to work with different clients from small and rural critical access hospitals, two physician groups and ambulance companies and multimillion dollar health systems. I've had the opportunity to learn about this patient plans imperative from a lot of different points of view. I'm going to hand it back to Tim to set some goals to the presentation in today's discussion and we'll go ahead and get started.
Tim Gorton: Yeah, so everybody should see that we're now on the goal slide and now that you know a little bit about us, we want to also welcome an opportunity to connect with you both either on this Webinar through questions and answers and please feel free to submit them as we go along. We also would welcome a short call with you at your schedules' convenience. On the call this afternoon, I know that we have a mix of folks from hospitals, in addition to hospitals and they're a small to midsize health provider entities as well as our colleagues who are at for-profit entities companies. Again happy to have you all join us. Speaking about the goals of today's Webinar in our discussion, let's first talk about why we do what we do.

At the heart of why we do what we do is because of patients, patients are at the center. We have many stakeholders that we collaborate with every day who we work with but patients are our true cause. In my own words and even though that might sound a little cliché, we also know this to be true, that patients are at the center because we also have been patients before too.

Patients today, they are and are given an aware of different choices for their health needs compared to even five or 10 years ago. Not only just the internet but also tele-health and mobile Apps that can track, they trend, they predict health. There are options on there for healthcare decision making, it's endless. With all of that given where we are today in the healthcare world, patients are active participants in their health decision-making, given the wealth of information that they have that's available to them and for them.

The opportunities for healthcare services and how patients should be treated as individuals first is paramount to health and to healthy business decision making. It's on really the patient as the individual to be healthy. I'd also add that it's on the healthcare organization, the healthcare entity to also maintain its health. A somewhat separate topic from what I just mentioned, patients are also known and we even are aware of this, that the system can be broken.

I think I know why all of us are in the business that we're in. We want to solve problems, find opportunities for patients and for our businesses. As an example, patients have insurance woes. Some of us may have even had them, patients have them for themselves, for their families, whether the patients have insurance, whether they're partially insured or even if they have no insurance at all.

Given all of the individual and business health needs and call to action as providers and leaders, we need to positively respond to patients both as individuals and as we'll hear in a bit more in a few minutes responding to patients as payers. That brings up when you hear patients as payers, it's mixing two different things, but I'm sure more financial responsibility falls at the hands of patients more than ever before and Katie will review that in detail in a few more minutes.

I wanted to pose to the group of few questions to think about and these are hypothetical. What do we need to do and also add to that, why are you on this call? My answer is that I'll just put out to everyone is we need to ensure that our health systems are fiscally viable. One area we'll look at and the purpose partially for this call is to focus on Revenue Cycle Management. That piece of the pie there related to patient collections, so we need to ensure a quality of patient financial care experience.

What does that bring to? That brings to us to another question, how do we do that? It's through systems that are both responsive to patient needs and systems that are responsive to the financial stability of healthcare entities. These systems working together need to support patient care as a part of the ongoing Healthcare transformation that's happening in our industry. That transformation also includes taking to account patients, who may not be able to pay their bills. By brief being responsive to patients' financial conditions, we can reduce their financial anxieties by designing the systems that are both flexible to help the health entities bottom line as well as the patients.

If I could guess recap this in a way, the patient is at the center, we need to keep in mind the financial responsibilities of patients and the financial responsibility and stability of our health entities. That's the goals of where we want to go in this afternoon's discussion. I want to remind you that there is the question box, so don't forget to send them in as we move along. With that, we have a first polling question, I'll hand it over to Lexi who will facilitate that question.
Moderator: We have now reached polling question one. Do you have a command of why patients are not paying their medical bills? A yes, B no, C not applicable. Please remember in order to qualify for your CPE Certificate, you must remain logged on for at least 50 minutes and respond to three out of the four polling questions. We'll give everyone a few more seconds to respond. We are now closing the poll and sharing the results.
Tim Gorton: As we see in the first poll, do you have a command of why patients are not paying their medical bills? It's somewhat split some people do, some people don't. I think we can help answer some of that and look into that further as we move forward. Now I'll hand it over to Katie, who will talk a little bit more about taking a step back, the state of the state and where we are today, Katie.
Katie Babcock: All right, thanks Tim and we can go ahead. Yeah, I'll click into the next slide there. Thank you for the introduction and for setting some goals for today's talk. We know patient centric is the way the market is moving and we know that we have to say start to understand how to improve our patient collection. This isn't a brand new issue. It's been on the radar for years. We need to first understand why now, why is this something providers should be focused on and what is the state of the market that's currently causing this?

We know patient responsibility is increasing due to high deductible health plans, more patients taking financial responsibility for their healthcare through the exchanges, through Obama Care. We also know the trend is predicted to continue. What we don't know is how to deal with it. Providers are traditionally built for dealing with Insurance Companies with Medicare and Medicaid.

They're not necessarily built for dealing with the economics diversity that patients threat presents financially. Providers are working across the borders to try to figure out a way to cost effectively work with patients on an individual level. We diagnose people clinically and then we treat them individually. We don't apply the same strategies to every person who walks in the ER with chest pains. We take their vital signs, understand the medical history, and even the context they're coming into the ER with. The trauma or a heart attack but we do not do this financially.

Most providers will have a solid way to diagnose patients on such an individual level to their financial situation that would result in more patients paying their bills and becoming financially healthy. Figuring out how to do this is crucial to running a viable health system and being mindful of the patient experience in a healthcare market, it is turning more so being more focused on patient centricity.

We are working to understand patients behaviorally and economically to understand what they can afford. Why they pay their medical bills when they do? How soon in the process do they pay them? Anecdotally, through talking to your patients and to your family and friends, we know that patients have a much harder time with paying medical bills compared to consumer bills. It feels less urgent to pay a medical bill than to pay a mortgage or a credit card payment and because of how we consume healthcare, that also affects how we pay it. We actually want to go to the ER, no one wants to spend thousands of dollars on medical bills.

Completely different than getting to spend thousands of dollars on a new car or a new house. Because we struggle with the relationship between the costs and the quality of what we're paying for, we have a hard time understanding if it's a fair amount for the services rendered and so therefore the patients are even less likely to pay these bills. At the same time, providers are struggling to understand why patients are not paying and they're losing revenues that are vital to keeping the doors open at their health systems and physician practices.

It's a high level overview of the core business problems with the most important of those being the trend of costs you think to patients. The patient AR was about 5% of net charges in 2000 and now it's close to 35%. As I said before, that's only expected to increase, provide as an adequate to deal with the associated challenges that are coming with working with patients instead of through contracted companies, Insurance Companies, Medicare, Medicaid, et cetera.

I want us to draw your attention to the graphic on the right hand side of this screen. We had an HFMA Article featured about a study with over 750,000 patients. We will talk a little bit more about later. Where we looked at how does the thousands of patients financial interactions, and this graphic is a few of the stats that we found. 91% of uninsured out-of-pocket expenses are going unpaid.

It's about 56% of insurance out-of-pocket expenses are going unpaid. Patients are not paying that's the point of it and when they do, it's a super small amount. It's an average of $18 for an uninsured patient, which is crazy. We know that patients can afford a little more than that, even the 50 or a $100. When you multiply that by the amount of patients that are coming in your doors, it's out of small amount of money for providers. 40% of Americans are unable to run under an unexpected expense of $400 without having to sell something or without having to borrow money.

The average out-of-pocket expense for an emergency room visit is obviously, as you all know, much higher than $400. So many patients are in financial hardships due to these medical bills and are unable to pay them. If these patients who are in greater financial needs now than ever before can be moved from non-paying to paying, they're going to represent a vital revenue resource for health systems. Health systems have to figure out how to work with these patients and truly understand their payment behaviors and how to work with them compassionately and individually at the same way that we do on a clinical basis.

Unless we can go to the next slide, we talked about the economic and political state as the macro factor factors that have led us to this patient finance imperative. As we said before this has been an ongoing issue. We're still trying to get our arms around. One of the main issues in understanding and maintaining a financially healthy patient revenue streams, is working off of a shared analytical platform with all of your vendors. In both physician practices and hospitals there's no analytic foundation for all the vendors to work on, even though they're all trying to help providers provide patients financial care that will direct and inform their interactions with these patients.

Many times these hospitals are employing a ton of different vendors. There are various spot solutions to try to help them get at this problem of patients, finance or patient responsibility. These different solutions work separately on different parts of the revenue cycle. From registration to charity care to getting patients discovering their insurance or signed out for insurance to segmenting to early out into bad day.

Sometimes these solutions are overlapping, sometimes we're pulling the same data twice. They're taking credit for finding certain gaps in the process. These solutions alone aren't bad, but they're not great at working together. As they're all working out of a different playbook. In the end they end up costing clients more money and providing a disoriented experience for the patient and then ultimately are not solving the core business problems as you see patient payments continue to decrease and patients taking on more financial responsibility.

There are a lot of solutions as I said before that do some of all of this, of all parts of the revenue cycle and they're good at their respective parts. There are insurance companies who are good at or insurance discovery companies who are good at finding coverage. There are companies who will work in your emergency room to help with Medicaid discovery and enrollment. There are industry benchmarks who are basing it on historical performance or national benchmarks through HFMA that are not markets specific. There's companies like Experian or TransUnion who are giving you scores and doing basic segmentation.

The question is, is it granular or not? Is it detailed enough, do we know these vendors are performing as well at our facilities and our practices as they potentially could be? How do we truly measure how well they're doing? How well they could be doing and do we have the data to understand this and is the data that we have easily accessible and actionable? We think the most important part of building a patient financial care system is an integrated systems approach bringing all of this together. Effective patient revenue optimization will include incorporating all of these things throughout the revenue cycle. So from registration all the way through patient revenue collection with all the vendors working off the same analytical foundation. More importantly, being held accountable to standardize objectively measured benchmarks.

Everybody who is working as a vendor of a hospital or within a hospital, it's all on the same team, right? We all have to work together, we are out of the same playbook in order to truly be able to solve this problem, we've got to start measuring the performance of all of these vendors and of ourselves differently. We have to measure not to historical performance, but to true potential. If our liquidation rate this year was 27%, next year is 30%. Sounds good but the 3% increase to your bottom line. Is that good? Is that bad? Do we know where it should be? What are our vendors telling us about the performance? Again we have to measure this performance based on results, not on efforts, so now the number of calls are on payments but on patients who are paying.

Which makes sense, you wouldn't want the quality of your clinical care to be based on effort on the amount of test run per patient, but on which of those tests found the issue, which of those tests we're actually diagnostic for that specific patient. What works for them, their history, their specific vital signs, what actually allowed them to get better. It's the same on the financial side of it. We can't base performance on effort, but on what we're doing that actually gets patients to participate and to pay their medical bills in a compassionate and economically understanding way.

We have to understand, like I said before, that patients are people and so they're not going to fit into one bucket or six buckets. It's much more detailed and granular than that. For example, not all patients are good candidates but it should be in payment plans. Not all patients should make it to collections.

Are all patients who are pure self pay should be given an immediate 40% discount? They have to be treated as individuals. We have to have treatment strategies that are as diverse as they are. Now that I think we've captured the overall problems and some of the root causes of the under performance, we're going to do another poll and then I'm going to have Tim walk us through what a potential future state solution might look like to help us understand what does it look like to institute a true patient financial care system. We're going to show you some technology that could help you do so and discuss a few of those aspects, so we can go ahead, Lexi I'll hand it over to you if you want to do the second polling question.
Moderator: We have now reached polling question number two, where in the revenue cycle process are your significant patient collection challenges? A front end, B back end, C both, D N/A. Please remember in order to qualify for your CPE Certificate, you must remain logged on for at least 50 minutes and respond to three out of the four polling questions. We'll give everyone a few more seconds to respond. Okay. Well, we are now closing the poll and sharing the results.
Tim Gorton: The results came in and we're in the revenue cycle process so your significant patient collection challenges. Most of the people said, both, falling behind that was back ends and then last was front ends. I think if there are challenges both on front end and backend, that's where there's different solutions out there. There's different things that can be done to help solve some of the challenges and there are opportunities. Thank you Lexi. I also wanted to mention not to forget if there's any questions that come up, please send them in during the presentation. We can speak to them, there also will be time at the end to submit questions. We want to focus the conversation now from the challenges that are out there that we see as patients, as providers, as the leaders to more solutions.

I spoke earlier about our health systems being tailored to the needs of patients and it's quite specifically their financial needs as a part of our discussion this afternoon. As we know, financial is just one aspect. The aspect that health systems needs to be aligned with patients and again patients as individuals and their needs. I want to focus in on one aspect of data-driven patient centric systems and specifically in approach to patient collections.

Having said that, our Healthcare ecosystem it's challenging. There are needs for the system that the system should not be provider driven any more, but they should be patient driven. Before the patient walks into the door, they the patients and we as healthcare providers and leaders need to be aware of their financial condition. As an example, as providers, we should know the list of patients for example, that we would see in a day and know what they can owe and know what they should owe based on to their patient balance.

A system like EA Collect we would segment patients into 48 distinct propensity to pay categories where we're able to determine high, medium and low propensity to pay and how we can design our systems to balance a patient's responsibility to pay and their ability to pay. Responsibility and ability, first responsibility. A patient's responsibility to pay is seen as a requirement in our industry.

Now the requirement in the healthcare industry that, that could be a scary word. Then how do we change the focus of the conversation from responsibility to pay, to ability to pay. Patient's ability to pay is more of the ethical and the moral call to action that we have. In a few minutes, Katie will review it in a bit more with focus on the ability to pay. This is a shifted focus for us as Healthcare leaders to keep a keen eye on again, that responsibility to pay versus the ability to pay.

I wanted to make mention that through our work with clients and as Katie had pointed out earlier, they range from large academic health systems to small community hospitals as well as provider groups. We have seen a mind shift to ability to pay and we have seen on average a return on investment of about 2,000%. Now this is a consistent average amongst all of those different entities. I've mentioned even with different net revenue variables that are a part of each of them distinctly. To sum up, I think our goals are simple, data guidance systems that involve responsibility and ability of patient collections is key, with an eye on a patient's ability to pay, keeping in mind though the responsibility of healthcare entities and their responsibility and accountability to collect.

Then moving along to the next slide this is part of the call to action. How have re how have we realize the potential of improving the bottom line while keeping patients, like I said earlier at the center of healthcare decision making.

I think we do that through uniquely designed patient financial care system. We approach this from a systems perspective. How can we move the needle from patient responsibility to patient ability to pay while also being aware of the populations we serve and their needs as well as the needs of our organizations. I think that there are multiple client pay results. If I could just focus on one on the list in the middle of this slide.

Number three, improving performance and reducing costs. This'll be a key focus for Katie in a few minutes. But first I wanted to review in line with improving performance and reducing costs. I wanted to review each of the six applications that we have in the system EA collects. Katie and I will have a back and forth. I'll go over what the application is and I'll hand it off to Katie to provide us with a concrete example of how that's used.

The first step location and it states there, identity verification and management. What does this application do? This application verifies and enriches patient identities by collaborating and enhancing data with well-established, highly regulated external consumer database. What does this then translate to? It translates into real time identity verification. We're able to address standardized protocols that improved the quality of algorithms and their accuracy.

There's embedded logic to reduce false positives and safeguard accuracy. There's also multiple dataset collaboration and one of the results on average, we've seen about 55% give or take, enhance patient identity and contact data. Katie, do you want to share an example on identity verification and management?
Katie Babcock: Sure. We usually identify between 45 and 60%, which is our data enhancement rate. A client we had last week we did an assessment for, we had an enhanced rate of almost, I think it was 88%. Those are data we're able to enhance through verified for us as a cleaning and scrubbing it, which is really the foundation for anything else that you would do or any other application is to have clean and accurate data so that you're dealing with obviously the correct patients that 88% rate was after other vendors had cleaned the data and it could include mismatched names.

Perhaps we found the new address you can incorporate into your return mail process. We could have found additional phone numbers for contacting the patient. That's kind of the first step and the foundation to the rest of it is to have solid, clean data.
Tim Gorton: Great. Thanks Katie. The second application in the solution is insurance discovery and verification. This application includes insurance discovery verification algorithms that combine innovative technology with human intelligence to explore coverage options and sources for patients who present to us as self-pay. What have we seen with results, there's been real time verification and discovery. Average is twice the number of queries per pay or for each account when compared to our other friends or colleagues.

This application also employs direct connections to pay our data infrastructures to find more active coverage. The application applies advanced search algorithms for more than 2,000 payer and clearinghouse databases. And additionally, the application identifies active coverage for upwards of about 5% of pure self-pay balances, which next to about one and a half to 2% in insurance cash recovery and that's on average. Katie, what concrete example can you give us around this application?
Katie Babcock: Sure. The next phase obviously after having clean data is to find these patients who have insurance back your highest liquidation rate. For a medical center in New York so far a year to date, so just in 2019, the medical center has collected a little over 600,000 in incremental insurance collections through our discovery process and their physician group has collected a little bit over 300,000 in incremental insurance collections that we were able to find on patients that they're sending across as pure self-pay and we're able to discover and verify the insurance on those accounts.
Tim Gorton: Great, thanks Katie. Now moving onto the third application, that's charity care and adaptive financial assistance. Katie will speak to the term adaptive financial assistance coming up on the next slides. But what this application does is it calculates the applicable charity classification with the complimentary capability of custom tailored options for patients based on an array of financial assistance parameters and what they can afford. In short, what I spoke to earlier that responsibility versus ability to pay.

What are the results of this application? What have we seen in real-time charity care on financial assistance, policy determinations, mathematical alignment of patient affordability limits with the maximum revenue expectations of caregivers, individualized payment plan, options for patients as required? This includes advanced adaptive and customized financial assistance logic. Also, the application identifies the accounts that meet the criteria for charity care and financial assistance policies, which allow for automatic routing into specialized workflows. Katie, what example can you give us around this application?
Katie Babcock: Sure. We're going to talk a little bit more about adaptive financial assistance and those individualized payment plans in a minute. But as far as identifying accounts that presumptively meet charity care policy can be extremely important, especially for smaller hospitals to hold on dish funds or federal funds to help them to be successful. We've identified, for example, for one hospital of ours, it's in the South about 2.8 million in balance for accounts that for example they meet their charity care policy which will help to make sure they're meeting the state minimums and will also help to make sure they're correctly qualifying patients instead of putting them through a full bad debt spending cycle, et cetera, so to presumptively identify earlier in the process at least patients who will for their community charity care.
Tim Gorton: Great. Before I go into the next three applications, just one final reminder that if you have any questions, feel free to submit them. The fourth application in the suite is patient financial care. What I spoke to earlier about those 48 categories of segmentation, high propensity to pay, medium propensity to pay and lower propensity to pay. In short, this application intelligently groups patients based on their payment characteristics, their behaviors and the goal is applying more personalized financial care strategies to the patient, work flows to the system and messages to different segments.

What have we seen in the results? Real-time stratification sub-grouping of patients based on their payment attitudes and their behaviors. The application provides multidimensional visibility, it's a patient's unique economic capacities and how to best engage them financially. Then again, the app also extends beyond conventional segmentation and allows for that personalized patient centered care. Katie, can you provide an example around this patient financial care application?
Katie Babcock: Yeah. The patient financial care application is really what we were talking about earlier, which is finding a way to as Tim said, treat patients as individuals and to group them into granular segments that respond that are differently to certain treatment strategies. There are a couple of examples of how you might use this segmentation to optimally drive workflows at your organization. I think there is one for are both high quality segments usually the lower balance and newer accounts.

They'll pay usually just a little bit of effort. These are the patients that you're going to want to call, email, leaving a voicemail can usually trigger patients in these segments to go ahead, find online, call back and make a payment. And just by focusing on these patients, which represents significant amount of payments coming into hospitals, we can increase liquidation rates and use the resources that we have a little bit more effectively.

The second example I wanted to give is segment seven. Patients in this segment specifically usually have a higher income but also a higher balance. This is probably going to be your young professional patients who have a high deductible health plan. They might have a higher salary but if they have to go to the emergency room they probably will not be able to immediately cover their entire out-of-pocket expense. But that doesn't make them a really good candidate for a payment plan, right? because they're going to hopefully honor that payment plan and have the ability to pay it month over month. It's like Tim said, putting patients into these highly normalized micro segments is helpful in understanding how to treat them more like individual and less as one kind of blanket solution.
Tim Gorton: Great. I'll move on to the fifth application as a part of the suite and this is business intelligence. That's the dashboard, as some of us are aware of this application could advanced productivity, operational financial data visualizations and we'll see that in a little bit. Katie will be showing us that and that just helps us monitor performance metrics in real time. This application blends data from multiple sources into one single view on one single page.

It builds a dashboard from hundreds of chart and graph templates. You're then able to dive further into the data with drill downs and interactive intelligence. You can customize it and make it much more dynamic. Do ad hoc key performance indicator analysis all in real time. And you can also send alerts when any of the metrics, the KPIs needs some sort of attention by other leaders who you may be working with. Katie provide an example around business intelligence.
Katie Babcock: Sure, it's like Tim said, this is just the way to monitor day to day and in real time your patient AR situation. I think that you can see that the value of being able to see how patients are coming in, in different segments, high, mid or low buckets, but also in things like the accounts and specific departments who are finding missed insurance day over day.

Understanding if we're missing more insurance than we had been previously, is that in the ER, is it mostly Medicaid patients? Are we missing certain commercial plans and use that data to be actionable in solving problems in the registration or throughout revenue cycle if we can spot the solutions early and figure it out to be able to have that data accessible and actionable, then we can go ahead and fix some of those problems. Having that business intelligence that you can log into daily to see where you're at and set the ground for the day is extremely important.
Tim Gorton: Great. Thanks Katie, and just one more or less, but not least, the sixth application optimize workflows. So this application automatically devises optimal performance pathways that balances resources and mitigates revenue drift and financial risk. We see results that have included accelerated performance, enriched patient financial experience that's actionable and improved confidence, enhanced productivity and interpretive analytical support.

Finally, Katie, what concrete example can you provide around this application?
Katie Babcock: Right. This is the same that we had talked about building off of the patient financial care. So, part of it is understanding, I said, where your potential is in your market and then how do you get there and those are the optimal workflows to be designed. So, one of our clients in the Northeast is using our workflow design and operational direction. They've generated over $1 million in incremental patient payments, or incremental cash just in 2019 so far by implementing our workflows. And that's not including obviously the gains that they're seeing from insurance discovery or identity verification, but specifically just by implementing workflows for a specific segments of patients as we have discussed is causing that incremental cash in the patient payments side.
Tim Gorton: Great. Thank you Katie. We'll move on now to what I spoke about and I'll hand it off to Katie to speak a little bit about the, and we'll go to the next slide, the adaptive financial assistance and the methodology and the thinking about that. Again, like I had said previously, moving from a mind shift of patient responsibility to patient ability to pay and how that affects the health entity bottom line.
Katie Babcock: Sure. Tim raised a really good overview, all of the applications in the suite, but we want to dig a little deeper into one of these, one that's being talked about on a national level. The Adaptive Financial Assistance or AFA is one component of a broader approach inside of EA Collect, which as you said, is the comprehensive suite of these customizable applications. The goal of both is to drive patient financial interactions and workflows.

We had previously discussed the importance of behavioral payment economics and being able to adjust more dynamically to provide a revenue need, but also to patient economic diversity, and AFA is one way that we can do so. As I mentioned previously, we conducted a study on over 750,000 patients that incorporated behavioral economics, gain theory principles and most importantly data on hundreds, thousands of patient provider financial interactions.

These were then used to model optimized discount strategies for certain groups of patients that have similar characteristics and through different balance ranges. So in a traditional approach towards patient collection, which most providers are still using today, the patient weighs the personal value they place on being in debt. So the patient is thinking about their social and moral responsibilities for paying that debt. They're thinking about their fear of legal recourse, the impact on their credit, the impact on their tax return, and in a general financial loss aversion.

They're going to take all those thoughts, compare them to the disposable income that they have to cover the debt and decide if and when they'll pay this medical bill. In this situation, the patient financial services team would drop a bill based on a fixed balance amount, and then the patient is often unable to afford that which generally results as you've seen in the patient not paying their medical bills.

The premise for AFA is that patients don't pay when the financial assistance isn't enough, right? When it's insufficient, either because they can't or because they elect not to. So if you have a bill for a $10,000 and the provider discounts it to 7,000. It may seem a lot for the provider. But if I'm making only 50 to 60,000 a year, I'm still probably unable or unwilling to pay for that obligation in full.

We know that paying in piecemeal that's not nearly the amount that paying in full does psychologically. So paying $50 a month for 10 years doesn't feel nearly as good as being able to completely pay off a debt and therefore patients are less likely to do so if it's a balance that they can't really run under. So we can see in these graphs in the lower right hand side, the expected revenue. I know they're a little bit hard to see, but the expected revenue is much higher when the out-of-pocket cost is lower, which makes sense. Right? So it's only a $100 or 200, patients are able to run under that balance. At a certain point obviously it's going to start dropping again. What we're trying to find is that maximum intersection point.

What we saw in this study is that if the amount of financial assistance is targeted specifically to that patient's circumstances, they're more likely to pay in full and their payment will help providers achieve their highest possible revenue. Well, this approach again they can call adaptive financial assistance. If you had a model, the probability of payment are different balance ranges for groups of patients and it's going to take into consideration their economic demographic and behavioral context. So it's really a way to discount smarter and to not just use the federal poverty line to make those discount ranges, which we know is not proven to give a whole financial picture of a person or of their financial state.

We also know context of care, like I said earlier, is going to have an impact on how patients pay their bills. It should be taken into consideration. Somebody who goes into the ER in an emergency situation is going to feel differently about paying their medical bills than somebody who has a scheduled outpatient procedure that they're saving for and elected to participate in.

There's also just obviously the social and moral aspect of paying your bills and how patients feel about paying them if they have other obligations that seem a little bit more necessary at the time. Being able to understand patients across these levels and to understand what triggers a favorable payment response, and to be able to identify optimal discount strategies that are really going to maximize the expected return for the provider, is what's crucial.

It's important to maximize the revenue for the provider while providing viable payment options for the patient. It's really working together to find the best case scenario for both of those while improving your patient experience and satisfaction. So we're not suggesting to give certain patients better discounts, but start to do it fairly, but that we should be discounting smarter. We're already discounting arbitrarily.

I had a client this week tell me they're doing a 40% on any patient responsibility that walks in the door based on another health system in their area. If each patient who fits into this segment, in this group of patients is put through the same algorithm. It's fair and it's a more precise way of discounting instead of just using the federal poverty line or balance range or an income.

Like I said before, AFA is just one component of a broader approach inside of EA Collect. That's just one example of how you would take a specific group of payments patients and treat them individually to increase the payments on and obviously a full patient financial care system would include many different treatment approaches, one of which, so potentially the AFA.

We can go onto the next slide, let's see. And I think it's the poll actually.
Moderator: Yeah, so we have now reached polling question number three. Do you currently use analytics to monitor your patient collections? A yes, B no, C not applicable. Please remember in order to qualify for your CPE Certificate you must remain logged in for at least 50 minutes and respond to three out of the four polling questions. We'll give everyone a few more seconds to respond. We are now closing the poll and sharing the results.
Katie Babcock: Perfect. We can see that this poll is pretty flat because you are currently using analytics to monitor patient collections, but almost just as many are not at the current moment, but as the second most of you are using some type of analytics. We can go on to the next slide Lexi. We wanted to touch a little bit on the importance of having, obviously we said before an analytical foundation, but also of having a dashboard that is accessible and actionable.

We wanted to show you just a quick, a snapshot of that dashboard and the visibility that you should expect from your vendors in real time. Understanding, as I said in real time or on a day to day basis who your patients are coming in the door, understanding how are you doing collection wise, how are you doing seasonally and through different parts of the year and understanding how much insurance you're finding. Can you use this dashboard to figure out how much charity care you're currently presumptively qualifying or could be qualifying in real time?

Wait a bit there, there we go. Here's just an example of it, and if we set up a caller or individual depressions with anybody, we can obviously walk through in detail the different pages of this dashboard and how you might use it on a day, everyday basis. But we want to show an example of analytics that you should expect your vendors and from everyone who's working to provide this patient financial care so that we can have a hand on managing it the same way that you would have a hand on managing your stock portfolio or a business that hasn't been as widely accepted as it is in healthcare.

I want to talk a little bit about EA Collect initial approach to building these patient financial care systems. The first step as you said before is understanding where you are currently. You need to understand how you're collecting, interacting with patients at the current moment, and then the next part is obviously to understand the potential, where you could be.

As we talked about previously, we don't want to understand how we're doing historically compared to how we were doing last year, or really how are we performing compared to our peers, comparing to our peers across the country who have these same segments of patients and how are they implementing some of these strategies to increase that as well?

Then obviously the most important thing is to understand where you are, and where you could be to figure out how to get there. That comes to the implementation phase. In the implementation phase, it's a collaborative process, so we're continually learning and improving and customizing these systems and applications to our clients. Like you said earlier, working with small rural hospital systems to ambulance companies, and multi-billion dollar health systems to design these and to help all those different providers work with patients in their community, with their specific market demographics, and to really figure out how to build a patient financial care system that is going to work with them and help them to interact most effectively for revenue for them and to be economically and compassionately interacting with their patients.

I think we have one last polling question today and then we can fully finish up. So we'll do that last poll and then we will...
Moderator: Perfect.
Katie Babcock: Go ahead.
Moderator: Great. We have now reached polling question number four. Would you welcome a short call to discuss your patient collection challenges? A yes, B no, C not applicable. Please remember in order to qualify for your CPE Certificate, you must remain logged on for at least 50 minutes and respond to three out of the four polling questions. We'll give everyone a few more seconds to respond. We are now closing the poll and sharing the results.
Katie Babcock: All right. We want to just take one more second to thank all for participating today and for listening, and we talked a little about patient financial care. Thank you again also tuning in and Tim, I'll turn it over to you for any last remarks.
Tim Gorton: Yes, thank you, Katie. Thank you also, Lexi, and if anybody has any questions after this, our contact information in the slides.
Moderator: We hope you enjoyed today's webinar, please look out for a follow up email with a link to this survey and presentation. For those who meet the criteria, you'll receive your CPE Certificate from within 14 business days of confirmed course attendance. Thank you for joining us today.

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