Navigating Patient Access in the new age of health care

By Kelley Blair, nThrive Senior Vice President and General Manager and Erica Franko, Principal, nThrive Business Health | Posted: 11/21/2017

The goal of Patient Access is to educate and support individuals – patients, staff and providers – on their journey to obtain or deliver comprehensive, quality health care services. Accessing quality care can yield many benefits, including improved physical, social and mental health status through prevention of disease and disability, detection and treatment of health conditions, higher quality of life, preventable death and longer life expectancy.

Barriers to health care access

Some barriers to access of care include financial roadblocks such as lack of insurance coverage, high-deductible health plans and limited financial means, while others are social or non-financial, such as provider availability or access to childcare. Additionally, one study1 shows that 66.8 percent of adults reported both a non-financial and a financial affordability barrier, further compounding the problem.

From a financial perspective, approximately 11.7 percent of Americans were uninsured in the second quarter of 2017, up from a record low of 10.9 percent in 2016. A Kaiser Family Foundation study2 reported that one-quarter or 25 percent of adults without coverage went without care—for illness or prevention. Studies also show that patients without coverage are far less likely to receive preventive care or follow-up care, leading to a later stage diagnosis requiring more costly treatment and higher mortality rates.

For those who are insured, rising deductibles are blamed for delaying needed medical care due to unaffordable out-of-pocket costs. A survey by Commonwealth Fund3 found that 40 percent of patients whose deductibles equaled more than five percent of their annual income, chose not to see a physician, get a medical test or visit a specialist.

Compounding these problems are hospital closings, especially in rural areas. According to data from the North Carolina Rural Health Research Program,4 51 rural hospitals have closed since 2010, with 16 rural hospitals shutting down in 2014. As a result, many rural residents are not receiving needed tests or care due to lack of transportation to get services.

Pro-active engagement

Helping today’s patients and health care providers thrive despite these barriers begins when patients first engage with the health care system. With health care reform, shifts in payor mix and rising patient bad debt, Patient Access has become the first line of defense for every health system’s ability to pro-actively provide access and achieve a healthy bottom line. It has been estimated that the Patient Access staff is responsible for 80 cents of every dollar coming into a hospital facility.5

Patient Access as a revenue cycle function begins with the initial encounter – which may be a scheduled visit or a visit to the Emergency Department (ED) – to confirm patient identity and verify insurance coverage, and create an accurate estimate based on ordered treatment. Payor requirements, such as authorizations or referrals, and the patient’s out-of-pocket financial obligation are also discussed, with counseling provided to address questions and explore financial options based on the patient’s circumstance. Communication is critical between patients, health care providers and the Patient Access staff to ensure the best care management, patient experience and financial outcome. Effective communication is driven by the accuracy of the Patient Access processes.

The hospital Patient Access department

Patient Access in a hospital setting encompasses many different roles and responsibilities. According to the National Association of Healthcare Access Management (NAHAM), general responsibilities include:

  • Customer service
  • Positive patient identification
  • Patient/family information
  • Identification of special needs
  • Pre-admission services
  • Scheduling (resources/services)
  • Insurance pre-certification
  • Confirmation on appropriateness of care
  • Obtaining signatures/distributing required documents (Rights, Notice of Privacy, Important Medicare messages, etc.)
  • Infection control
  • Collecting accurate and complete patient information
  • Point-of-Service collections

Streamlining Patient Access

Today’s highest performing health care organizations are streamlining their Patient Access operations to maximize resources, better serve patients and gain more value for their services. Adopting a holistic approach, this involves implementing a broad range of integrated solutions, which include:

  • Engaging experts to optimize performance
  • Deploying technology for greater accuracy and efficiency
  • Educating staff to grow workforce skills
  • Advocating on behalf of patients to support financial challenges
  • Extending the revenue cycle to ambulatory, better facilitating care coordination and response to patient requests

Understanding the changing role of the front office is integral to better serve patients and reduce bad debt, an ever increasing problem due to high out-of-pocket costs. Informing patients about their obligations upfront and working with them to mitigate bad debt also helps to improve downstream billing, ensuring accurate and complete patient information across the board.

nThrive helps providers link front office dependencies across the revenue cycle through its Patient Access Services and Software Solutions, which include Eligibility and Enrollment, Patient Advocacy, Patient Access Operations Outsourcing, Technology and Patient Education.

The critical role of Advocacy

Offering services to help insured and uninsured populations meet their obligations improves access to care and the financial health of providers. Through the acquisition of Adreima, nThrive provides counseling and assistance for the uninsured to obtain payment through Medicaid and other charity programs. For the insured, services include education on benefits, as well as assistance on complex invoicing, especially when multiple providers are involved. Creating a meaningful experience improves patient satisfaction by segmenting patients into the appropriate program.

Patient Access operations outsourcing and technology

To dramatically accelerate collection of out-of-pocket dollars and circumvent claims errors, health care organizations can turn to nThrive’s Patient Access Operations Outsourcing. For instance, nThrive helped East Jefferson General Hospital in Metairie, La., increase collections by 80 percent through an outsourcing engagement.

One essential tool to improve estimate accuracy is CarePricer®, which enables hospital organizations to provide estimates within 90 percent of the final bill. Accurate estimates help patients make better educated choices on care and alleviate the stress of unanticipated charges following discharge.

Ambulatory and Education

To help health care organizations extend patient access improvements into a non-acute setting, nThrive Ambulatory integrates important enhancements such as one-call resolution to address patient problems. Patientco, an nThrive partner, also offers automated payment capabilities to make it faster and less stressful to pay, either in full or through payments using online technology.

Across the revenue cycle, education is critical to ensure Patient Access resources understand changes confronting the front end of the revenue cycle, as well as impact down the line. Adequate training has become an imperative with expanding roles, both to utilize the latest technology and to ask for payment upfront. nThrive offers a full suite of courses to address client needs.

Aligning business solutions to address key issues

Ultimately, the new age of Patient Access requires better alignment to address key issues facing organizations and the community. Helping clients identify issues and develop strategies with actionable plans supports leading-practice outcomes. nThrive Advisory helps clients develop optimal processes and governance to enhance successful adoption and integration of solutions – including outsourced services and technologies – through implementation into adoption.

The highest results are achieved through alignment between advisory, education, implementation and training, with education touching every aspect of access and advocacy helping to guide the patient journey.

The goal is to holistically integrate Patient Access within the revenue cycle for optimal performance, focusing efforts around people, process and technology to better address client needs. Achieving the highest impact requires strategies that address the patient as an individual consumer, adopting them at the center of the process. This includes incorporating human resources (HR) and education, as well as meaningful integration of ambulatory and acute scheduling with billing and collections, to create customized workflows for individual patients.

For more information on how nThrive can help you meet your challenges – from delivering an accurate patient estimate to streamlining POS collections and preventing denials, visit us here.

1Nonfinancial Barriers and Access to Care for US Adults,” J.T. Kullgren, C.G. McLaughlin, N. Mitra and K. Armstrong, Robert Wood Johnson Foundation, Health Research & Educational Trust, August 22, 2011.

2 The Uninsured A Primer 2013 - 4: How Does Lack of Insurance Affect Access to Health Care?” The Henry J. Kaiser Family Foundation, November 14, 2013.

3The Commonwealth Fund Report: 21 Percent of Adults with Health Insurance Spent 5 Percent or More of Their Income on Out-of-Pocket Health Care Costs.” The Commonwealth Fund, November 13, 2014.

4As rural hospitals struggle, solutions sought to preserve healthcare access.” Paul Demko, Modern Healthcare, May 16, 2015.

5Introduction to Patient Access Services.” National Association of Healthcare Management, Copyright 2011.