Speaker 1: Hospitals are redesigning their billing processes to improve the patient financial experience. Music Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Hederle with AHA Communications. The AHA is developing tools to help hospitals create a better billing experience for their patients. We will continue to highlight how hospitals are successfully doing this work and share resources designed to help hospitals implement the AHA patient billing guidelines, including issues around financial assistance and collections practices. In this Members in Action podcast, Julia Resnick, Director of Strategic Initiatives at the AHA, is speaking with Rob McMurray, Chief Financial Officer at Christiana Care in Delaware. They'll be discussing how Christiana Care is tailoring their billing approach to better meet the needs and preferences of their patients. And now, over to Julia.

Speaker 2: Rob, thank you so much for joining me today to talk about this. Let's get started with some background on Christiana Care. Why was there a need to change how you were billing your patients, and how did you know it was a concern?

Speaker 3: Yeah, thanks, Julia. And thanks for having me today. We're excited to talk about this topic. And at Christiana Care, we have values and behaviors. And to summarize up, it's excellence in love. And when we think about the billing experience for all the members of our community, we see that there's ways to enhance that experience. And, you know, going back, we looked at the revenue cycle, what we used to traditionally call the revenue cycle. And we said, you know, from a financial perspective, we broke it up, and there was like 13 steps in the revenue cycle. And we were thinking about ways to improving all the processes. And when we got right into it, we realized that seven of those steps were facing the patient. And what we used to think of as a billing department was really a department that has a lot of opportunity to interact with our patients. And that got me to thinking, well, this is not necessarily just a back office department. We're here to serve our community, right? We're here. We anticipate the needs of others. In this case, the members of our community, our patients. How can this back office, this traditional back office function enhance patient experience? And, you know, we looked at the bill, the bill that goes to patients. And it was in a traditional paper form, stuffed in an envelope and mailed out frequently, right? And while that's a good method of billing for many people, and, you know, there's different methods for preferences for all generations, whether you're a millennial, baby boomer, Gen Z, Gen X, right? We all have our own preferences and the paper billing is good for some members of our community. When we thought about it is there's maybe a better way, a better experience that we can provide to other members of our community, particularly often the younger generation. And we looked at the opportunity to say, how can we make it better? And what about some type of not just online billing, but something through the phone? We talk a lot about how whatever care can be digital will be digital. But it's also about the experiences and whatever experiences can be digital will be digital. And we took advantage of that. And we turned to CDER to implement this technology or this enabler to enhance that experience.

Speaker 2: So what is that experience like now?

Speaker 3: The experience now, again, it's multi-formed. We give patients the opportunity to receive their billing information electronically. That can be via email. That can be via text. Or they can receive their billing information in a paper form, the traditional paper in the envelope. I can tell you, Julia, that my parents like that paper coming in the envelope. And that's fine. That's good for them. That's what makes them happy. I can also tell you that my 23-year-old son, he wants that billing done via text. He doesn't want to spend a whole lot of time with it. So now the experience is tailored to meet the different desires, right? Again, it goes back to that value of anticipating the needs of the members of our community. And for some generations, the need is more electronic, and some it's more traditional.

Speaker 2: And I know that medical bills tend to be really complicated. Have you guys been doing any work to make them easier to understand?

Speaker 3: Yeah, and that's a good question because they have been complicated. And I can tell you somewhat admittedly as a finance professional in this space, my own bills have been complicated. And I had to take some time to understand them. And that was part of what drove us to enhance this billing experience because it wasn't just about, you know, let's get something electronic because it's quick or that's what somebody wants to receive. But we wanted to make sure that it was a pleasurable experience, a good experience for a patient. So what's part of that experience? Understanding what you're paying for, reducing the complexities of the information, summarizing the information where we can, putting the information in what I will call, you know, more plain English or common layman's terms on that. And we've been successful in doing that.

Speaker 2: Do you have any stories or examples that would help this come alive for our listeners?

Speaker 3: Yeah, I do. And I promise you, I'm not violating any type of HIPAA rule here, but we rolled this technology out in October. And in December, my wife used Christiana Cares services and she got a bill via text. And I remember this clearly because it was a weekend and I was at home and my wife gets a text and she gets excited. She goes, oh, yeah, check this out. I'm going to pay my bill. Look at that. And she click click and she does it and she goes, OK, going to leave some comments. And she commented something like, oh, yeah, this was easy. And she was done. And before I could even comment to her, like to say, hold on a moment. Before you comment, throw in some good words about me. Right. Because I'm the CFO. I could use some good feedback here. The process was done. Julia, it was a matter of probably less than a minute. It was that fast. And and again, it was easy. My wife will tell you that she's not the most techie savvy type person, but she knows her way around an iPhone. And this met this met her needs and she it was a good experience for her. So I saw it firsthand. And while I still get a little, little disappointed that she didn't throw the good experience about me, she did give some comments into the process. And we've been able to collect a lot of feedback, too, from patients. It's it's fascinating the types of feedback you get. And it's a bit eye opening when you get to read that anything stand out. People will comment that it's easy. It's fast. Those are the types of comments that I would expect convenience, different types of payments, Apple pay, Google pay, credit card. Again, all of these focus on the experience. But I want to call out one particular example of feedback that we received that really made this meaningful to me. And especially as you consider what we do, the mission that we serve the community. And when you think about you've heard of the triple name, you talk about cost, you talk about experience, you talk about outcomes. There was a particular comment by a patient of ours, and this is a real comment, Julia. A patient commented that, well, let me back up. Part of the experience or the the ease ability of the of the application is that there's artificial intelligence built in that can understand patient demographics. And it will highlight to a patient up front, perhaps if they could utilize something like a payment plan. And we have historically offered payment plans. We don't charge interest for it. We do it for the convenience of our patients so that they're not overburdened with medical bills. This message comes up to this patient and this is through a text. And this patient read this message and immediately got comfort. And I know this because in this patient's comment, they said I was presented with payment plan options up front. Meaning she didn't have to work through a billing department, either in person or on a phone. I was presented with the option to have a payment plan up front and it made me comfortable to make that payment. And ultimately, this patient commented that they no longer have to avoid care because they're worried about making a payment. Think about that. That's not just cost. Right. It's not just experience. That's outcomes. And that was something that really had an impact on me because I thought, wow, we did this for what we thought was absolutely every right reason. We knew it. You know, putting it in place. We're going to do the experience. The payment's going to be easy. It's going to be fast. It's going to be almost fun. And then one of our first comments talked about someone who clearly in their experience has avoided care because of payment, because of perhaps the burden of the billing system. And now they know that they can receive care and to think about it. And it's maybe not just the AAA. Maybe it's the quadrupling, too. Maybe it's also provider experience, because I think of if that's a primary care physician, they suddenly have a patient that's more engaged. And that's meaningful to the physicians at Christiana Care. So, Julia, that's my favorite example that I could give you. There's a bunch that we have and people commented. I'm still waiting for someone to say, well, the CFO that was in charge of this really did great. We love it. But I haven't seen that yet.

Speaker 2: Wait for your wife to get another bill for that to happen.

Speaker 3: Maybe that's what it has to be. I'll have to try to interject a little better.

Speaker 2: Those are really great stories. And, yeah, just thinking about it from a point of pride as a person receiving a bill to not have to ask for a payment plan and just have that be an option.

Speaker 3: You really start to think about the experience. We talk about patient experience. And naturally, so we tend to think about the clinical experience. And I'm a believer that predominantly the clinical experience is outstanding. But the administrative experience, perhaps there's opportunities. And if there was something in the administrative experience that was causing or that is causing patients to forego care, that's something we need to address. And that really opened our eyes. And it's something we're proud of.

Speaker 2: That's really great. And beyond these wonderful individual stories, have you all been measuring how this has impacted patient experience?

Speaker 3: Yeah, well, the overall survey responses are favorable. They're high in numbers. We bill probably, I would say, between 26,000 to 30,000 bills a month through the CDER platform. So you're thinking maybe it's close to a thousand a day. We're getting a 90 percent response rate on the surveys. Ninety percent response, nine out of ten people. It's like 900 a day are responding with feedback. Think about how rich that information is to us as we continue to try to enhance the patient experience here at Christiana Care.

Speaker 2: That is wonderful. So I know that hospitals across the country are really thinking about the patient billing experience and trying to do that better. What have you learned over the course of implementing this new system that you think would be useful for other hospitals?

Speaker 3: Again, I think the timeliness between the service event, I'll say the physician visit with the patient, the timeliness between that and the bill. Right. That shortens and that's meaningful and valuable to a patient because they know right away, oh, I just saw my primary care provider and I'm getting a billing notification. I know what that's about. That's been something we've learned. It's really important. And I would suggest to other organizations, don't shortchange the value there because not only does that, yes, that helps with collection timeliness, but it helps on the experience from a patient because, again, they can connect that bill with that service that they just received.

Speaker 2: That is great advice. And I'm sure that you are still on your journey as it relates to patient billing. So what's next?

Speaker 3: Julia, I'd love to say we knew everything about the future, but we don't. But I can tell you this, going back to love and excellence, one of our behaviors is we commit to being exceptional today and even better tomorrow. That means a lot to us. We take that very seriously. We take all of our values and behaviors very seriously here. With that in mind, again, not knowing the future, we'll continue to work on improving the overall experience that comes to the patient through this platform. And we believe we're an innovative organization and we believe we're on the leading edge of this service, this enabler, this technology that supports a positive patient financial experience. And we'll continue to innovate and work to make it better. So, again, I wish I had a crystal ball to tell you exactly what's coming next, but I can tell you there's a lot of energized people. There's a lot of energized people on my side, too. Taking people that were in a billing function that typically look at a lot of paper and a lot of checks in the mail or credit card remits and so forth, give them the opportunity to shift what they're doing. A lot more of our payments are made through CDER now, be it a text or an email or online, right? We have people that now think, OK, I can now look to enhance the patient financial experience. And they've brought that out. They've called that out to me to say that, oh, I get to do this or that. You know, it's more than just hospital billing. It's a win for all of us, Julia.

Speaker 2: Yeah, that's great. And I feel like it's such a great opportunity to help people tap into their purpose and why they do what they do.

Speaker 3: Yeah, we're fortunate. We have, as caregivers at Christiana Care, all 13,000, 14,000 of us, we have a real treat to be able to serve the members of our community. And it is fulfilling. And I share that with my friends when they ask me, you know, how's your job going? And I tell them I love my job. It's going great. And I tell them, you know, look, I get to go home every single day. And I mean this, Julia, I go home every single day fulfilled. Giving everybody the opportunity to do that is meaningful. And when I think about it, though, people that have been traditionally in hospital billing are changing the way they do things to impact a patient experience. They know now that they really are caregivers. We've used the term caregivers for a number of years and initially someone that was in an administrative role may think, well, I'm administrative. I'm not I'm not a real caregiver. Well, that's not true. And I can make a lot of arguments why they are caregivers. But now they're seeing and experiencing firsthand and they can put their passion into this and make a difference. And that's again, that's meaningful. It's fulfilling. It helps employee engagement and caregiver engagement and so forth.

Speaker 2: At the AHA, we like to say the value is a team sport and that really every part of a hospital plays a role in improving value. And I think you've really illustrated that perfectly.

Speaker 3: Well, this was fun, Julia. Thank you for the opportunity to share our story.

Speaker 2: Thank you so much, Rob, for joining me today and sharing this important work that you're doing on the patient financial experience. And I certainly look forward to hearing about how it continues to grow for our listeners. If you are interested in more podcasts and resources to help you promote value in your community, please visit the value initiatives website at AHA dot org slash the value initiative. That is it for today. Thank you to Rob for joining me. And thank you to you all for listening.