How Geisinger Health System’s Refund Promise Puts Patient Experience at the Center of the Enterprise

Typically, any talk about “consumers” has been firmly in the context of retail. A consumer is someone who purchases goods or services for personal use, right?


Consumers buy groceries, cars, iPhones, clothes, fast food, books, music – and they shop around to make sure they’re getting the best consumer experiences at the best prices.

Increasingly, however, the word “consumer” is creeping into the healthcare lexicon, too. And it’s not hard to understand why – in today’s world, where there are more options than ever before for people to shop around for the best healthcare and medical treatment, patients are undeniably consumers, too.

In the world of healthcare, providing the best patient experiences possible is fast becoming the name of the game if providers are to coax people through the front door, keep them coming back, and ensure that they recommend the services provided to their friends, family, and social networks. It’s about building trust, building loyalty, and understanding the modern patient’s needs. And that means providing both a first-rate patient experience and a 21st century consumer experience to boot.

A Guaranteed Refund for Unhappy Patients

At Geisinger Health in Pennsylvania, hospital officials are determined to keep their patients-come-consumers happy. They want to provide an unforgettable experience for everyone – and if they fail, they want to know about it and take steps to put it right.

This is the driving force behind Geisinger’s ProvenExperience program – a money-back guarantee that dissatisfied patients can claim in full for all expenditures, no questions asked. Particularly, what Geisinger wants to know is whether patients have experienced “kindness and compassion” in their care. If they feel they haven’t, they are encouraged to leave their feedback via the ProvenExperience app, and request a refund for their financial responsibility.

Patients can offer their opinions on everything from bedside manner to parking facilities, and then use the app to determine the amount of co-payment (if any) they would like to receive back. Geisinger Health System CEO David T. Feinberg, M.D, believes that this is precisely the sort of consumerist thinking that the healthcare sector has been lacking.

“The way I see it, if you go into Starbucks and you’re not happy with your order, they don’t sip your latte and argue that they made it correctly,” Feinberg said. “They just take care of you on the spot. What matters to me is that every patient is satisfied with their treatment, and so I started thinking, ‘What is our guarantee? What is our refund?’ We need to be disruptive to move the practice of providing great patient experience forward and so the decision was made to give unsatisfied patients their money back.”

Reorienting the Patient as the Center of the Enterprise

Perhaps unsurprisingly, some healthcare experts were skeptical of the idea when it first launched a little over 18 months ago. Some were so blunt as to call it a “dumb idea.” As Justin Matus, Ph.D., Associate Dean of the Wilkes University School of Business and board member of Wilkes-Barre General Hospital, put it:

“I’m agonizing over whether to use the word ‘dumb’ or ‘stupid’. It’s a stupid idea. It’s a horrible idea. It sends the wrong message to the patient.”

However, the success of the first-of-its-kind program has quieted the sceptics. Focusing on customer satisfaction is indeed a relatively new concept in health care – an area where doctors have historically called the shots. But Greg F. Burke, MD, FACP, Chief Patient Experience Officer at Geisinger, maintains that the initiative has only been disruptive in a positive sense, stating in a blog post for NEJM Catalyst earlier this year that it has “reoriented the patient as the center of the enterprise.”

“How can a health system that commits itself to the compassionate care of patients and families NOT return money to those who feel that they failed to receive the very service that they were entitled to receive?” Burke writes. “The practice of medicine has always had a financial and business component. The first time a patient exchanged durable goods with a physician for medical advice, a contractual event occurred. What has fundamentally made this financial reality different from others is that the patient-physician relationship is based on a professional ‘oath’ rather than a contract. Consequently, a somewhat uneasy truce developed among practitioners, hospitals, payers, and patients. The refund promise simply recognizes the financial sacrifice that patients make in order to receive the care that they need.”

“Making it Right” for Patients

Ultimately, the goal of the ProvenExperience initiative is to invite patients to speak their minds in order that Geisinger can learn and improve. And it highlights a somewhat paradoxical situation that has perhaps been left unspoken for too long – that customers in other sectors (such as retail) have often received better experiential treatment than they have in healthcare, where they need it most.

A year after the program was launched, about $500,000 in refunds have been paid – a figure that amounts to less than 0.5% of Geisinger Health System’s annual revenue of roughly $11.56 billion. What’s been found is that, far from abusing the program (one of the main concerns from detractors), patients who turn to ProvenExperience are raising genuine concerns and usually only ask for a portion of their money back to compensate – despite their right to request the full amount. And the payoff is that most refund requests point out clear opportunities for improvement.

“Now, a year after the initiative began,” Burke says, “we have learned that ‘making it right’ for patients following service failures has increased the amount of grievances received, has cost a relatively small amount of dollars in relation to the system’s budget, and has added to the overall process of care improvement as problems in service delivery have been discovered and addressed.”

Patients and Consumers Are More Alike than Different

The ProvenExperience initiative has led to a 23% increase in direct messages to Geisinger relating to episodes of care from patients and patient advocates. And this feedback has informed new customer service features, Geisinger’s new website design, and improved communication pathways that help patients find doctors and access their health information.

It may have seemed like a radical or “stupid” idea to many, but, ultimately, ProvenExperience has taught Geisinger some invaluable lessons about how to improve the patient experience, and at a time when patients and consumers are more alike than ever before, this can only spell success.

The last word goes to Feinberg.

“In the beginning, I talked to other health system CEOs and industry leaders about ProvenExperience and they all said, ‘Don’t do it.’ I really felt dejected. Then I thought about Kodak executives discussing digital photography. And Blockbuster talking about online video options. Were they also told, ‘Don’t do it?’ That’s when I said to myself, ‘We’re doing it.’”

Hear Greg Burke, Chief Patient Experience Officer, Geisinger Health System, at Next Generation Patient Experience 2017 this November.

Download the Next Generation Patient Experience Agenda to learn more.

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