Every healthcare organization stands as the apex of business complexity—fusing all of the traditional challenges and opportunities of any company with the work of making a difference in the equally complex health outcomes of patients. And as vice president of revenue cycle at Michigan’s largest health system, Beaumont Health, Denise Waters fulfills a powerful duty in being able to impact touchpoints throughout that massive web. That’s become even more true as the insurance world has gone through extreme change.
“All of our initiatives are focused towards the patient and our ability to provide them with the service that we did five, ten years ago, and yet have them still be able to afford to pay the cost share with it,” Waters says. “Employers and insurance companies have changed over time and shifted more of the cost of healthcare to that patient. There’s a growing balance after the insurance of true self-pay debt that’s owed to us, but we remain focused on the patient.”
After earning degrees in accounting and an MBA in healthcare business management, Waters quickly learned that the revenue cycle sits at the center of the viability and success of organizations. This was further reinforced when she took her first position, beginning at HCA Healthcare, remaining at the organization for about ten years. “The leaders at HCA really understood the importance of consolidating revenue cycle into the shared services organization,” she says. “We invested in the technology and those processes and people to build that strength. I learned the importance of working with a team of ethical, passionate workaholics.”
One of the most important lessons Waters learned at HCA was that the revenue cycle never stops changing. But rather than seeing that as a hurdle, she saw it as an exciting opportunity to constantly learn and grow. The role involves work with so many different partners—vendors, hospital leadership, care management, and patients alike—which of course requires a collaborative mind-set. “You have to evaluate all of the different constituents that you’re working with and make sure that that partnership worked for both of you,” Waters says.
Waters joined Beaumont Health in 2017, looking at the opportunity to continue that collaborative leadership and transformative mind-set. Upon arriving, she immediately set her sights on something that Beaumont considers its overarching goal year after year: patient- and family-centered care. “No matter who you are within the organization, we all contribute to that. If a patient can be financially cleared and not really have to worry about their future bill, they can focus on their health,” Waters says. “So, all of our 2019 revenue cycle priorities are aligned but focusing on improving that revenue cycle from the patient’s point of view.”
As such, the organization has moved towards clear patient estimates and smart statements, pricing transparency, presumptive charity, and payment plans. They’ve invested in artificial intelligence, propensity-to-pay data, and other technological advancements that will make it easier for staff to accomplish objectives without compromising patient care. “It’s all about putting yourselves in the shoes of that patient, while also trying to integrate those processes,” Waters says.
“It’s all about putting yourselves in the shoes of that patient, while also trying to integrate those processes.”
The Affordable Care Act, she explains, was built with the intention of delivering patients with further transparency on pricing; however, when the rubber hit the road, not all hospitals and systems were actually providing patients with an experience that reflected that. “Patients aren’t going to be able to tell heads or tails of what it’s going to cost you to go have an MRI with contrast just because we can post chargemasters online,” Waters says. “So, last year at Beaumont, we started focusing on providing our patients what we think their cost share is going to be before it happens.”
But this was a lot more than sharing a flat cost of what a procedure generally costs. “We also know that something might go wrong, or that they might have other charges before our bill gets sent, which may change their deductible,” she adds. “But we want them to have an estimate, so we set up patient SMS so we can send an estimate at the time that they’re doing their pre-service. They can then calculate out the different costs for self-pay and insurance and look at other adjustments.”
That focus on improving patient escrow permits is constantly updating and being tweaked to further improve clarity for patients, Waters explains. Also, at time of service, Beaumont has begun to run a propensity-to-pay check on patients in order to build out a stronger drive for presumptive charity. As a provider of patient-focused, family-friendly care, Beaumont leadership wanted to use artificial intelligence to ensure they were giving back wherever possible and not putting undue burden on the community.
“If a patient comes in and has insurance with a $5,000 deductible, rather than asking me for the $5,000 deductible, our system may note that that patient qualifies for presumptive charity, which allows that registrar to have that conversation with the patient,” she says. “The artificial intelligence will be able to tell based on credit availability and insurance costs what a patient can afford from a payment plan, which takes the guesswork out of it and it doesn’t put that pressure on that patient.”
This initiative, Waters explains, is like all of the organization’s recent efforts: focused on patient responsibility. “When you look at the amount of balance after insurance and self-pay, in 2018, Beaumont Health had more debt owed to us than 74 percent of what Michigan banks loaned out. But we’re giving people these interest-free loans so they can stop looking at numbers and focus on their health,” she says. “And by working AI into that process, we can free up our staff to make sure Beaumont Health remains strong financially while delivering better care to patients. It’s all about jumping through and over the problems that we have to actually accomplish the goal of better care at the end of the day.”
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