Here's How Prime Healthcare Is Prioritising Patient Financial Experience
The financial element of the US healthcare system has been a controversial topic for years, and there are many in our society who believe the way the country provides healthcare to its citizens is long due an overhaul.
More often than not, this belief manifests in the desire for a more socialised healthcare system - one that's akin to something like the UK's National Health Service (NHS). Under such a system, all tax-paying citizens would contribute towards the running of the service via a tax, with actual healthcare provision being free at the point of use and medicine prescriptions being at a low fixed price.
However, regardless of your personal feelings about healthcare funding, the fact of the matter is we are for the moment stuck with the insurance model in the US. This means healthcare providers have a responsibility to provide the best patient experience they can within the parameters of that system.
Insurance Underpayment
One of the biggest issues around making health insurance claims is the phenomenon of payment variance. This refers to the situation where a claim is made to an insurance provider for healthcare services delivered, but the amount received is different from what was expected. Sometimes this can mean an overpayment - but far more frequently it results in the insurance provider paying less than is expected.
Recent research from the Medical Group Management Association (MGMA) suggests insurers routinely underpay US healthcare providers to the tune of an average of 7-11%. On top of this, the MGMA also estimates the average cost to healthcare providers for reworking underpaid claims to be $25 per claim, and that 50-65% of these claims are never reworked and remain underpaid.
Clearly this poses a massive issue from a patient experience perspective. Regardless of how good your bedside manner is, delivering the news to a potentially fragile patient that their claim has been underpaid and they may need to make up the difference themselves is going to sour the patient experience instantly.
Even worse is if you have to send the patient a corrected statement months after the treatment has been completed. This is bound to lead to poor patient satisfaction, and MGMA estimates the cost to a provider of a patient walking away for good could rise to over $1 million over a lifetime of healthcare.
Prime Healthcare
Prime Healthcare is one of the country's most highly regarded providers of healthcare services - especially from the perspective of patient experience. Seven of the California-based medical system's hospitals were recently awarded a prestigious five-star rating from the Centres for Medicare & Medicaid Services (CMS) - an accolade fewer than 14% of the more than 3,300 hospitals surveyed have achieved.
"I am extremely proud of our hospitals for continuing to demonstrate the highest quality care for their communities," said Sunny Bhatia, MD, Prime Healthcare Region CEO and Corporate Chief Medical Officer. "The CMS ratings are confirmation of our commitment to clinical excellence and reflects what can be accomplished when we unite around a common mission to serve patients with clinically excellent and compassionate care."
Part of this ethos comes from taking the issue of insurance underpayment very seriously. Prime Healthcare has recently announced its intention to sever ties with major insurer UnitedHealthcare over the issue. Prime Healthcare claims the insurer has repeatedly paid significantly lower amounts than those offered by Medicaid, and it is no longer willing to accept the situation.
New disclosure requirements have empowered Prime Healthcare to compare repayment rates with neighbouring hospitals and allegedly discovered UnitedHealthcare to have paid much lower to Prime than to others in the same area, something Prime Healthcare claims has directly impacted its ability to deliver the kind of patient experience its clients expect.
"We are patient-focused and are committed to delivering the most compassionate care by exceptional physicians using state-of-the-art technology," said Dr. Sonia Mehta, Regional CEO and Chief Medical Officer of Prime Healthcare New Jersey. "Undercutting our payments is unacceptable, and so we are taking the necessary step of providing notice of our intent to provide care out-of-network. We realize it is a bold move, but a necessary one to separate our hospitals from organizations that work contrary to our mission and commitment to our patients."
Final Thoughts
The issue of healthcare insurance underpayment is a serious one and it can truly have a detrimental impact on delivering an exceptional patient experience. Healthcare providers have a responsibility to tackle underpayment when it occurs and assist their patients in getting the best value out of insurance claims as is possible.
You can hear Prime Healthcare's Chief Experience Officer, Amy Searls, speak at NGPX 2021, taking place in December at the JW Marriott Palm Desert Resort & Spa.
Download the agenda today for more information and insights.