The healthcare financial experience and CX transformation

Patient and member financial experiences are frequently neglected as part of the overall healthcare consumer experience (CX), which often results in significant lost revenue for health plans and health systems.  

In a roundtable discussion at League Connect 2023, Jon Freedman, Principal in the Chartis Consumer Access and Digital Transformation practice, and Prashant Karamchandani, Director and Co-Leader in the Chartis Revenue Cycle Transformation practice, shared ways that health plans and health systems can improve the consumer financial experience within larger digital transformation efforts to increase overall consumer engagement and revenue. 

Reality check: what data reveals about consumer financial experiences in healthcare

The discussion began with a look at the current healthcare landscape, where payers and providers face increasing levels of dissatisfaction when it comes to the financial aspects of CX. 

Freedman set the stage with some statistics that highlight the challenging state of healthcare CX: 

• Nearly ⅓ of consumers delayed care because of financial concerns
• 50%+ of people who consider themselves poor delayed care 
• 46% of young people won’t get care because of how expensive it is
• Over 50% of consumers believe their local hospital puts profits above care; this sentiment is much worse for payers 

The Chartis team identified the main source from which this negativity stems: consumers have almost no visibility into the actual cost of their care or exactly what they are paying for when receiving care.  

How to improve the member and patient financial experience as a part of a larger CX transformation

Karamchandani noted that the first step in contextualizing and addressing issues related to financial experience is recognizing the economic realities facing health plans and health systems. 

“You want to do right by the consumer, but there are economic realities that organizations face: cost pressure, volume issues, market dynamics,” said Karamchandani. “They are all very real.” 

The Chartis team went on to note that there’s an enormous amount of pressure on payers and providers to reduce costs and wasteful spending. The solution to what seems like an impossible situation is that organizations need to have real discussions about who they are, the patients and members they serve and how they can focus on their core competencies. The idea of being all things to all members and patients is going away. Instead, healthcare organizations need a granular level of specificity when it comes to exactly what they do. While there are numerous specific areas to be addressed, some of the relevant questions include:

• How might health systems and payers collaborate to automate and simplify prior authorization, a significant cost driver and consumer pain point? 
• How might call center traffic be reduced by introducing or enhancing online bill pay, including adding clarity to what’s being paid for and seamless integration with contemporary payment tools such as Venmo, Apple Pay and PayPal?
• What healthcare financial literacy education content may be presented to consumers in meaningful and personalized ways to help consumers navigate and plan their healthcare budgets?

Part of this self-evaluation process should focus on the upstream and downstream aspects of consumer financial interactions. If a health plan or system identifies its core services, it should then consider how consumers will interact with these services financially. This opens the door for healthcare organizations to consider how the financial experience can be incorporated within CX initiatives and become an integral part of larger healthcare digital transformation efforts. 

Payers and providers can leverage this self-evaluation as the foundation for streamlining and truly “consumerizing” the financial experience. Ultimately, providing realistic and actionable pricing transparency in a comprehensive manner that informs consumers’ decision-making, more effectively educating people about what they actually owe and precisely what they are paying for — and then engaging them with digital tools to make the interaction simple, are all factors required for a consumer-friendly financial experience in healthcare. 

How transforming the healthcare consumer financial experience helps reduce costs and generate revenue 

The discussion concluded with a focus on how healthcare organizations can turn their financial experience into a competitive advantage. That initiative begins with framing the consumer financial experience within overall CX transformation.  

Freedman and Karamchandani asserted that while the economic realities facing healthcare organizations are significant, current conditions have also opened the door for digital tools to play a major role in modernizing healthcare experiences as well as how members and patients pay for care as a part of their overall experience.

When members and patients are able to understand, navigate and pay for care as easily as they interact with other consumer services, this will fundamentally shift the way they approach healthcare. Regardless of the payment model, when consumers are able to receive healthcare services with convenience and financial transparency, healthcare organizations will benefit via increased levels of engagement, improved health outcomes for individuals and populations, better brand loyalty and, ultimately, demonstrable ROI. 

Ultimately, healthcare organizations have an opportunity to not only improve their financial experience but also leverage it as a key part of healthcare digital transformation initiatives. From improving member and patient satisfaction to helping boost revenue, modernizing the financial experience is a critical component of health plan and health system success.