Consumers increasingly are looking to the Web to manage everyday tasks such as finances, social life, research and entertainment. Many believe it’s now health care’s turn to make it easier to do business, as well as a mechanism for value-based self-services that can bolster the health status for many while garnering increased customer loyalty.
A few examples of how self-service is ramping up quickly:
- Seeking to offer online services to tech-savvy patients and speed payments, 10-hospital Saint Luke’s Health System in Kansas City, Mo., has rolled out an account and document management system from doxo, a Seattle-based vendor.
- Health insurer UnitedHealthcare in July 2013 introduced a new self-service for 21 million of its covered members that enables them to electronically pay medical bills owed to providers through the payer’s member portal (myuhc.com). The payments can be made to physicians, hospitals and ancillary medical providers inside or out of UHC’s network.
- Cullman (Ala.) Regional Medical Center was the recipient of top honors in Health Data Management’s 2013 Nursing Information Technology Innovation Award for a simple Web and telephone service that helps patients better remember instructions and payment responsibilities after they are back home following a hospital discharge (http://bit.ly/16Bzy0D).
- Beth Israel Deaconess Medical Center in Boston is automating its paper-based development of treatment plans to make the patient more of a partner in care and armed with more information.
But health care organizations building up their self-service offerings have learned quickly that it’s not your usual software implementation. New efforts must be made to understand how, why and where patients need services and information, so developers need to understand their community, not just their I.T. environments. In addition, the success of patient self-service functions often hinges on convincing physicians of the value of
changing how they interact with patients and document care.
Managing the mundane
Saint Luke’s new financial services portal vendor, doxo, serves multiple industries and was looking to expand into health care, so the delivery system became a development site for the vendor’s health care push. The portal enables patients to access bills, explanation of benefit statements, and other documents related to episodes of care, as well as pay bills or set up automated payment plans. Not only does the service enable patients to better
manage their health care documents, but other documents from other service providers as well, including insurance, telephone, cable and banking. And it’s free for the patients.
Saint Luke’s portal can be accessed via PCs or mobile devices for documents to be downloaded, printed and backed up to a hard drive or cloud storage vendor. The delivery system worked with doxo on the portal for about a year before going live, says Diane Watkins, vice president of revenue cycle.
The hurdles came from Saint Luke’s existing patient statements and hospital financial systems vendors, who had other priorities and needed some prodding to support the new service. “Start the conversation early with your vendors so they have plenty of time to help support the transition,” Watkins advises. Saint Luke’s is promoting creation of doxo accounts with inserts in patient statements explaining to patients the benefits and how they can sign up for free. Uptake so far is slow, with about 10 payments coming in each week. But Watkins knows that online financial and document management services like doxo will gain traction and wants to be ready when consumers are, she says. “We want Saint Luke’s to be available to them.”
Payer aids providers
UnitedHealthcare’s new portal service went heavy on giving value-added self-services to members, making it easier for them to understand their coverage, while giving providers a treat by making it easy for members to also pay their provider bills while on the payer Web site.
Members can register on the portal to conduct online payments and enter financial information. When a member gets an e-mail saying that UHC has received and paid a claim, the member can log in, review the claim that has been translated into plain English, understand how benefits were applied and see how much they owe the provider. “It actually shows the member what the math was,” says Victoria Bogatyrenko, vice president of
product innovation at UnitedHealthcare. The member then can click a Make Payment link and send payment to the provider via a credit card, debit card, health savings account or bank account.
During the first eight weeks, the service yielded $6.5 million through nearly 64,000 paid bills, averaging about $100 per transaction. And members can view claims and pay bills for any dependent with one log-in. The payment service also enables members to flag a claim and add notes to it if they have a question, want a reminder or are appealing the claim.
Similar services being offered by other insurers could become common as consumers are looking for more self-service features from companies they do business with, Bogatyrenko says. “You can expect to see more innovations like this being released into the market.”
To prepare the patient payment program, UHC staff met with consumers in their homes to understand how they manage health care expenses and what their expectations are. And they watched as consumers tried to match their bills from providers and their explanations of benefits. The insurer contracted with market research firms to find willing consumers.
Then, UHC started to design the program and used consumer focus groups to guide every step. “We got consumers in a room, gave them scenarios and conducted usability tests,” Bogatyrenko explains. “We needed to think like a Silicon Valley start-up-keep it simple.”
The payments move through health care transactions processor InstaMed; consumers do not pay a transaction fee but providers do, similar to their existing merchant account fee for credit/debit card transactions. Some of the providers, Bogatyrenko says, have told UHC that they received patient payments before they even had a chance to send a bill.
To receive payments directly deposited to their bank account, providers must register for the UHC member online payment service through InstaMed, but can maintain existing relationships with other transaction processors. Providers who do not register will still receive the payments in the mail via an InstaMed-issued debit card. Providers use their existing merchant account to process these mailed payments, just as any other MasterCard payment from a patient; there is no additional fee charged. After a while, Bogatyrenko believes, these providers will see the value of signing up.
As patients are being discharged from the hospital, it’s a hectic time. They may be apprehensive about leaving and being on their own at home, or family members are packing up and bringing possessions to the car, and here comes a nurse with lots of paperwork and instructions, and here comes a representative of the finance department to talk about payment.
But the instructions from a nurse are important, such as changes in medication, how to change dressings, or how congestive heart failure patients should weigh themselves. And the finance department needs assurance that a patient leaves the hospital understanding their payment responsibility. And there still are all those forms to sign.
Consequently, many patients don’t remember everything they need to, or may leave the hospital without the sense that they-in addition to clinicians-are accountable for following through on discharge plans once at home to continue recovery and maintain their health, and to make payments. “When you get accountability, you get better outcomes,” says Cheryl Bailey, chief nursing officer at Cullman (Ala.) Regional Medical Center.
Starting in 2011, Cullman Regional began testing and rolling out Good to Go, a patient self-service program of Vocera Communications that uses a stripped down iPod Touch to videotape the discharge meeting and make it available to patients and family members via a Web site, or over the telephone via an audio recording.
Because the discharge meeting is being recorded, patients listen better and are more apt to follow up at home, Bailey says. The service now is available in a dozen units of the hospital, with use rates varying from 60 percent of post-op surgical patients to 95 percent of maternity patients and 98 percent of those from the step-down unit that treats acutely ill patients.
Being able to access at home the information received at the hospital also increases patient confidence. But if a patient accesses the service three or more times, that could indicate he or she is confused and a nurse will call to ask if there are additional questions. Within eight months of starting the service, readmissions fell by 15 percent and that level has been maintained, Bailey says.
While Beverly Sturm was being discharged from Cullman Regional, her daughter was taking her possessions to the car and did not hear the discharge instructions. Sturm, a 68- year-old widow with diabetes who lives alone, found having the instructions and other information from discharge readily available at home to be helpful as her children and dropin caregiver could listen to the recording, which included details on a changed medication.
“I just think it’s a great idea; it was really useful to me and my family.”
Making plans meaningful
Steven Freedman, M.D., had a vision to enhance physician-patient encounters by offering self-service tools to patients.
At Beth Israel Deaconess Medical Center in Boston, Freedman, a senior physician and a professor of medicine at Harvard Medical School, is part of a team developing Passport to Trust, a Web-hosted platform of services that facilitates development of a digital care plan that outlines diagnoses, prognosis and recommendations from a visit, with laymen’s language explanations of care plans to improve chronic disease management and medication adherence. “How can we start to add structure to the relationship with patients and families to make them true partners in their care?” Freedman asks. “This will start to create a platform to facilitate that.”
The program is digitizing and scaling an existing paper-based process for collaborating with patients to develop a treatment plan, educating patients on the plan and engaging them to follow through on the treatment. Freedman and Camilia Martin, M.D., assistant professor of pediatrics at Beth Israel, received a research grant in 2012 to develop an electronic version of a paper process the hospital already had tested. “We really had to put this in an electronic format that worked well with the hospital information systems,” Martin says. “We developed a prototype, but needed a vendor to scale up.”
They now are developing a suite of specialty- or unit-based Web portals in partnership with customer relationship management software vendor NexJ Systems of Toronto. Internal beta testing was done at Beth Israel and now the gastrointestinal clinic will pilot Passport to Trust.
The beta did not involve patients, but was designed to make sure that electronic processes enhanced workflow, Martin says. The beta demonstrated considerable ease in filling out treatment plans with such components as presenting problems and causes, conducting tests and treatments, instructing patients in managing their own care, setting timelines and identifying clinical alerts.
Now, with portals integrated with the hospital’s EHR, the pilot will test how easy it is to navigate within the EHR to develop treatment plans. The challenge for Passport to Trust, Martin says, will be acceptance by physicians.
At first glance, a physician may look at the steps in the program and think, “I already do that,” she acknowledges. Physicians may think they are being very clear in explaining a treatment plan and giving instructions; sometimes they are, but patients often are given educational content that is generalized, not specific to their situation, Martin says. “But providing a deliverable for the patient to take home allows them to revisit the visit. This is
something you’re both operating from.”