Since 2014, the HIMSS Revenue Cycle Improvement (RCI) Task Force has addressed the emerging dynamic of healthcare consumerism and the patient experience related to the provider’s financial and administrative performance and service levels. Its members include representatives from provider organizations, financial institutions, payers, retail health care clinics, mobile technology providers, vendors and consultants. The group has focused its energies on creating, socializing and encouraging the adoption of a vision for the next generation of revenue cycle management tools and processes that keep administrative cost containment, interoperability, and patient engagement front and center. A microsite articulating that vision can be found here.
In 2016 the task force conducted a gap analysis of the technical functionality required to execute their vision from the patient’s perspective, and compared that functionality against the functionality known to exist at the time to identify potential gaps. These gaps included not only technical functionality, but also the development of national standards and uniform operating rules to support initiatives, such as accurate patient matching and the ability to share complex data in a meaningful and actionable way. Findings of this analysis were published in the white paper, “A Roadmap to the Patient Financial Experience of the Future: Part I of a 5 Part Series.” In 2017, the task force conducted a similar gap analysis from the primary care provider’s perspective. The findings of that analysis, Part II of the 5 Part Series, will be released later this month. To follow up on this latest paper and see all the work products of the task force, please visit our website.
The task force’s next step requires your help. The HIMSS RCI task force is issuing a Call for Case Studies. The intent is to identify and celebrate work already underway that will lead to full realization of the Patient Financial Experience of the Future envisioned by the HIMSS RCI task force. Case Studies may address any or all of three distinct categories:
- Information Exchange
- Real-time exchange of meaningful health insurance benefit and financial information between multiple payers and/or providers to enable patient decision making
- Ability to electronically share patient information (including administrative, financial and clinical) between multiple disparate providers
- Ability to deliver accurate pricing at the consumer level for comparable services provided by clinicians located within a certain geographic area
- Consolidated Billing and Payment
- Ability to generate one bill for entire episode of care, regardless of contractual arrangements between providers
- Ability to generate one document that serves as both EOB and final billing statement
- Patient access to billing information at any point along the continuum of care
- Ability for consumer to utilize a stored “wallet” or consumer centric payment or financing tool
- Unique Consumer Financial Experience
- Decision-making tools that allow patient to consider health insurance benefits, patient financial experience and efficacy of treatment to choose between treatment options.
Entities that have developed, or are in the process of developing solutions that fall in to any of these three categories are invited to submit a formal Case Study. A submission may address one or more bullet points under a single category or a variety of bullet points from multiple categories. Accepted submissions may be promoted through HIMSS publications, webinars, podcasts, and/or conference presentations. To learn more and submit your case study, click here.
About the author: Pam has more than 25 years' healthcare industry experience. As the Senior Director of Health Business Solutions for HIMSS, she oversees the overall management and strategy development for HIMSS Health Business Solutions initiatives.