Interoperability and Population Health: Working Across Disparate Systems to Impact Care Delivery
The Tegria Blog Mar 29, 2021
By Lincoln Popp, Managing Director of Revenue Cycle Management, Tegria
A hospital appointment always strikes me as a cold, impersonal, bureaucratic experience. A parking garage ticket, long, antiseptic corridors, and a stack of forms start the process. I then have to navigate my insurance requirements and finally interpret a virtually indecipherable series of bills from the hospital or associated physicians to determine what or who I actually owe. For self-pay patients – who need care but may not be clear about how to finance it – there is an even greater likelihood of anxiety, confusion, and desperation.
This experience often feels decidedly industrial, a sensation entirely at odds with the charitable origins and motivations of healthcare provider organizations. Most large hospitals, including Providence and its affiliates, grew from small groups of generous, compassionate people offering healthcare to those in need.
As I think about the next generation of services for providers, one of my personal goals for Tegria is to reinforce the link between our roots in providing for the needy and our modern operations. We are pursuing approaches that demonstrate not just operational excellence as it relates to large populations seeking care, but also personal empathy as it relates to the needs of individual patients.
The importance of empathy within Tegria gets reflected in our internal culture. A leader in our operation recently shared some personal experiences facing a series of medical needs within her family. Even as an informed consumer in the healthcare space, she juggled the need to understand the clinical situation along with the financial implications, and of course, all the daily requirements of being a wife, a mother, and a daughter. In sharing her story, she closed by challenging her coworkers to avoid the assembly line approach of getting a patient through the office or off the phone:
Please don’t treat me just like another number or call but as someone who really needs your patience and understanding.
Tegria takes her challenge seriously, and we take care when designing approaches that meet business needs to recognize patient needs at the forefront.
I believe we can expedite the patient experience using technology. Nobody likes to stand in line, especially when they need care and particularly when the line fulfills an administrative function.
We want to give patients the ability to complete administrative functions at their convenience, not ours. Pre-service needs can be met using online portals, process automation, mobile access, and a variety of strategies that give the patient control of the process and access to the guidance they need when they need it. As an example, we are exploring technologies like biometrics to swiftly move patients from arrival to care.
Completing non-clinical tasks like gaining payer approvals is a fundamental need in running a clinical business, but we should never let those needs interfere with care delivery. Too often, payer approvals impact the type or timing of care received by a patient. A payer denial of an authorization can be resolved, but may delay the previously scheduled service. Using advanced analytic techniques, we can anticipate when a payer may be hesitant to authorize care and take remediation steps to avoid inconveniencing the patient.
Perhaps the most vulnerable patients are those with significant health needs and uncertain financing mechanisms. For most providers, this population contributes heavily to bad debt and charity care and makes up the most significant source of financial leakage. Solving these problems demonstrates our commitment to serve the needs of each individual patient while acting responsibly as a steward of our resources.
We believe we can create active policies to not only provide immediate care to these vulnerable populations, but also find insurance solutions for more stable access to care on an ongoing basis. Every hospital has a financial counseling function to set up payment plans or complete Medicaid enrollments, but we want to supercharge that process. Numerous studies show that patients without insurance coverage have worse health outcomes than those with insurance, so our goals should be not just to finance the immediate episode of care, but to guide the patient through a comprehensive approach to their care.
In their most vulnerable moments, our patients rely on our staff to be conduits to care and to help resolve barriers. Whether through innovative technology or playing a more proactive role with payers or by designing programs that go beyond traditional payment solutions, Tegria has bold plans to dramatically improve the patient experience, to understand individual needs, and to provide a more human approach to healthcare.
It is good business, but more importantly, it is good practice, reflecting our focus on patients who need care but have barriers to getting it. Our charitable roots demand no less.
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