The Healthcare Financial Management Association (HFMA) recently published the Consumerism Maturity Model as a new tool for providers of all types, including hospitals, health systems and physician practices, to assess their level of maturity as it relates to consumerization of their financial business model.
The model is meant to help healthcare providers identify current gaps, develop plans for improving their patient financial experience and assess progress toward becoming a consumer-focused revenue cycle of the future. If you’re not familiar with HFMA’s model, it has four components: Consumer Interaction Channels, Quality and Accuracy, Consumer Experience, and Measurement.
In this blog post, we’ll dive into each of the four components and explain why AI chatbots are essential to helping healthcare providers bridge the gap.
Consumer Interaction Channels
In HFMA’s Consumer Maturity Model, it implores healthcare providers to analyze and improve on appointment scheduling, information providing, price transparency and post-service communication, among others.
Imagine having a bot respond immediately to a community member on your website inquiring about the estimated cost of an MRI or seeking their benefit status for deductibles and other out-of-pocket responsibilities? This is something providers can do today.
Patients desire an Amazon-like experience, a digital transformation that forces healthcare providers to put patients in the position of power as healthcare consumers. The digital front door is more than just an entry point, it’s a wraparound experience that engages the patient and meets them where they are in their journey.
But what it all boils down to is creating a seamless, transparent consumer experience across all patient touchpoints. Providers need to integrate cost and information transparency tools with online scheduling and payment platforms and move to a more virtual healthcare marketplace. Those who don’t take appropriate steps in this direction face big risks by continuing to sacrifice the patient experience at every possible level. Frustrated patients may seek care elsewhere.
Healthcare providers can safely and securely support self-service with chatbots that gather relevant information, search their knowledge base from various sources, then guide patients on their journey. This approach is beneficial in moving toward a consumer-centric financial experience, allowing consumers to have an opportunity to be fiscally responsible or meaningfully involved in their care decisions.
Quality and Accuracy
This dimension of HFMA's model assesses medical records, bill generation, claims submission and access to provider quality ratings. From the patient perspective, their medical information should be available on an online portal and be accessible through multiple communication channels. They should have the ability to share their information electronically, without sacrificing security, across disparate systems.
Healthcare providers score higher when they deploy revenue integrity tools and electronic departmental controls to audit incomplete, inaccurate or untimely bills. They are measured on how they identify and verify insurance plans and eligibility requirements as well as automated processes to reverify claims that need editing. Minimizing manual intervention is rated higher in the areas of generating a bill and submitting claims.
In thinking about the Amazon-like experience, before making a purchasing decision consumers typically spend some time evaluating product and experience reviews. Until more recently, this has been very difficult to do in healthcare. Finding ways to compare providers based on Quality is not easy, but more and more tools are becoming available.
Through initiatives like HFMA's Consumerism Maturity Model, healthcare providers are slowly coming along. In order to score well, provider-specific quality ratings from CMS and private ratings (e.g., Press Ganey, etc.) should be available on their website, patient portal and mobile app. Are there searchable tools that allow consumers to easily compare hospitals, physicians and services within a healthcare system and with other healthcare systems? Are they using independent survey organizations to survey their own patients and post the results on their websites? This is where chatbots can play an invaluable role in adding value to the patient.
There is no consumer maturity without a good consumer experience. This component of the Model includes scoring on quality rating utilization, consumer feedback methods, digital experience, inquiry resolution, and satisfaction guarantee. In healthcare, organizations have long sought to understand the perspectives of their patients through patient satisfaction surveys. However, while some aspects can be objectively evaluated, patient satisfaction is largely subjective and depends on patient perceptions relative to their expectations. Providers need to capture and publish the most comprehensive view of patients’ experiences in every way, shape and form imaginable.
Consider the mobile apps Yelp, Vitals, Google, ZocDoc or RealPatientRatings. According to an NRC Health market insight, when it specifically comes to healthcare:
- 37% of patients use online reviews as a first step for a doctor search
- 60.8% of patients have avoided doctors based on negative reviews
- 59.9% have selected a doctor based on a positive review
Perhaps the most astonishing statistic is that today’s patients (47.5%) trust online reviews as much as a doctor’s recommendation (46.8%). This alone is enough incentive for any physician to push from not only monitoring their online reputation but addressing any negative reviews that might come up. Online reviews provide valuable insight, both negative and positive. The natural tendency is to run from these types of services. But, when providers respond timely and reasonably to any negative review, demonstrating their willingness to improve, they often gain trust. By establishing issue resolution solutions at every level of service of the patients’ journey, consumer maturity soars.
In what ways can this be accomplished? Ideally, a sophisticated bot could be the perfect catalyst. It can provide patients with relevant links to sources of ratings as requested so patients can easily compare providers from the convenience of their mobile device. Or it can offer direct answers, too. Bots can also gather immediate data on their own performance, on behalf of the healthcare provider. After their interaction with a patient on any channel, the bot asks whether or not the patient had their question answered adequately and asks them to rate the interaction. Through machine learning, the bot adjusts based on this feedback and dramatically improves responses over time. For every touchpoint of the patient’s digital healthcare journey, a bot can be an extremely valuable consumer experience tool.
Finally, the healthcare industry needs to be forward-thinking relative to its digital agenda and the user experience. Web and mobile-based bots scratch the surface. Healthcare of the future includes multiple omnichannel engagement strategies including text, email, interactive voice response, social media, Amazon Alexa and Google Assistant. Healthcare providers need to prepare for this movement by adopting the necessary technology today.
The Measurement dimension of the Consumerism Maturity Model identifies the Key Performance Indicators that are components of the overall Consumerism Maturity Index Score (CMIS). The CMIS is linked to HFMA’s MAP keys, an industry-standard approach to revenue cycle benchmarking.
In order to calculate the Maturity Model score, each section above is scored on a scale from 1 - 5, representing the maturity level indicated by the provider and then are added together to form the Maturity Model component of the Index. The other component of the Index is captured from the results of the financial KPIs/calculations. The two components are fed into the correlation formula to produce an index rating score. Organizations can then identify where they fall on the rating scale:
- Consumer-Centric (above 75): The organization has mastered the capabilities needed for meeting and exceeding consumer expectations related to the financial experience.
- Emerging (60-75): The organization has demonstrated a commitment to improving the consumer’s financial experience and has made significant progress toward the development of the requisite organizational capabilities.
- Initiating (50-59): The organization has begun the process of developing organizational capabilities for improving the consumer’s financial experience.
- Undeveloped (below 50): The organization has yet to demonstrate that it is developing organizational capabilities for improving the consumer’s financial experience.
In order to calculate where organization’s fall on the CMIS rating scale, the CMIS score is converted into a percentage. Each of the KPIs’ scaled score per metric is converted into a percentage, which then determines the overall score for the organization. The overall performance score is then applied to the CMIS scale to correlate their true Maturity Level. The Maturity Levels relative to the percentage are as follows:
Level Attained Overall Score
Consumer Centric 90 percent and above
Emerging Between 70 and 89 percent
Initiating Between 60 and 69 percent
Undeveloped Below 60 percent
Higher levels of Consumerism Maturity is not possible without digital transformation in healthcare. And the digital transformation in healthcare is not just about process automation. It’s about modernizing core platforms, creating seamless information-driven experiences across all touchpoints, and leveraging artificial intelligence and analytics to guide the patient through their entire healthcare journey. It’s a cultural shift to true patient-centricity. Ai chatbots are the future of consumer-centric healthcare.