As patients become more financially invested in their healthcare choices they are demanding greater predictability and flexibility in their healthcare financial experience. Tune-ups and incremental bolt-on solutions to existing processes and hardware are no longer sufficient to meet this growing demand.
The HIMSS Revenue Cycle Improvement Task Force created the following infographic to illustrate our vision for the Patient Financial Experience of the Future, focused on tools and processes that keep administrative cost containment, interoperability and consumer engagement front and center, regardless of the reimbursement methodology being applied. To learn more about the Task Force and its approach to designing the infographic, please read our white paper.
Among the many assumptions made in this infographic is that financial transactions between patients and their providers may become a thing of the past. The infographic allows for the possibility that a third party may take responsibility for managing all financial transactions related to healthcare encounters behind the scenes and allow the patient and provider to focus on their clinical relationship, with money being discussed only as it pertains to a patient’s ability or willingness to pay for a particular treatment option.
Health Data Intelligence Hub (Hub)
Logs into user-friendly Hub using standardized digital identity/authentication techniques.
Researches provider options based on reason for visit, medical history, health insurance coverage, provider pricing, provider quality scores, and other patient-centric search criteria.
Schedules appointment with selected provider; receives confirmation; reviews information regarding patient financial responsibility and chooses payment option; and completes and submits any required forms online.
Receives written confirmation with details of appointment and payment option chosen.
Indicates preferred method of contact for appointment confirmation, reminder of appointment, and any additional follow up required prior to office visit.
Submits payment, if appropriate.
24 hours prior to scheduled appointment:
Receives request for appointment through Hub. Confirms health plan coverage and gathers medical history from internal and external resources, as appropriate, using the Hub to collect information from outside source.
Using patient’s preferred method of contact requests any additional pre-visit information necessary to ensure provider has complete understanding of patient’s physical condition and medical history.
Reconfirm patient’s health insurance coverage within 24 hours of scheduled office visit.
Arrives at office; uses standardized digital identity/authentication techniques to log in.
If appropriate, submits payment according to arrangements made during the scheduling and registration process outlined above and receives receipt.
Completes any necessary steps to prepare patient for clinical encounter.
Ensure provider has necessary clinical history available in user-friendly electronic format.
Patient and Provider engage in collaborative discussion of diagnosis and treatment options or next steps, including the cost of those options and steps.
Provider completes clinical assessment. Makes diagnosis and identifies possible treatment options.
Accesses information from Hub regarding health plan benefits, estimated cost and efficacy of treatment options being recommended and cost, quality, location and availability information for providers and/or facilities to choose from for follow on care.
Shares information with patient; identifies best treatment option for patient based on patient’s medical history, personal preferences, and financial situation.
Enters information into EHR.
Patient and provider work together to finalize next steps, if any, and complete financial transactions for this visit.
Provider confirms with patient the treatment plan outlined in EHR.
Using Hub coordinates patient availability with provider availability to schedule appointments, follow up care, order medications or DME, etc.
Discusses payment options for future treatment/next steps. Determines best option for patient and completes necessary steps to activate the patient’s choice.
Confirms information entered into EHR.
Completes final payment reconciliation for this visit to reflect any additional services provided during the visit. Patient provided with receipt or copy of payment arrangements that have been agreed to.
Immediately following the visit, patient receives access to online Patient Satisfaction Survey Tool.
Health plans, financial institutions and the provider receive feedback on services they were responsible for providing for this visit. This information is used to improve business processes and the patient experience.
* PHI - Personal Health Information
** DME - Durable Medical Equipment