Friday, June 28, 2024

AI agents: The solution to common pain points in health care administration

When patients visit family clinics to address health issues, they expect quality care, and an easy billing process. However, these interactions can be stressful, especially when issues like incorrect patient bills arise. Such situations can be particularly challenging for individuals who are primarily focused on meeting their families' basic needs and may not have the bandwidth to deal with unexpected financial statements.

The frustrations experienced in healthcare settings, including billing discrepancies, service levels, wait times, and other aspects of the patient journey, often stemming from underlying administrative challenges. Underneath their cool patient-centered focus, well-meaning healthcare providers are struggling with admin issues. A key contributing factor is the ongoing struggle to maintain an adequate workforce in the back office, which is essential for the smooth functioning of healthcare practices. This challenge is exacerbated by the current labor market dynamics, as highlighted in reports on the shrinking talent pool.

At the same time, their claims denial rates continue to rise as insurance providers frequently alter their contracts, making reimbursement increasingly challenging. Healthcare providers lacking the administrative resources to meticulously review each claim and service find securing reimbursement from insurance companies increasingly tricky.

These three areas are particularly problematic, and addressing them is critical. The solution? A new introduction to the market, AI Agents, offer a promising pathway for family clinics and other healthcare providers to mitigate claims denials, enhance reimbursement rates, improve patient experiences, and refocus their efforts on core healthcare services. Healthcare back-office AI Agents are capable of various roles including:


Patient eligibility verification


Family clinics often handle a high volume of patients, including both scheduled appointments and walk-ins. Each patient comes with a unique reimbursement plan, making it difficult to determine their eligibility and available healthcare services quickly and on a large scale.

Reimbursement eligibility is nuanced and complex. It includes various factors such as an evaluation of the services covered by health insurance companies, the levels of reimbursement, and unique criteria that can qualify or disqualify a patient's services for reimbursement. This landscape is constantly changing as patients frequently switch insurance providers or plans, and their basic profile information, such as home address, may also change over time.

This complexity makes it difficult for family clinics to know what will be reimbursed, which leads to an unnecessary amount of claim denials without proper patient eligibility verification.

Thankfully implementing an AI Agent-powered eligibility verification function in their revenue cycle departments can help healthcare providers like family clinics. The AI Agent can sort through heaps of information quickly to verify each appointment and walk-in, ensuring that the services provided are eligible for reimbursement, and enabling them to inform the patients immediately if not, leading to improved patient satisfaction.


Claims processing


Healthcare providers, such as family clinics must ensure that their claims are highly accurate for acceptance by clearinghouses and insurance providers. Due to the complex nature of claims, there are many opportunities for a claim to be blocked or denied.

Mistakes leading to claim denials often occur when Revenue Cycle Management (RCM) teams are overworked, leading to fatigue from handling repetitive processes. This results in additional time spent in claims processing as healthcare providers must spend extra time investigating and resubmitting claims. Some family clinics try to address this compounding work by hiring more staff. However, this approach often leads to a cycle of issues due to difficulties in hiring and retaining RCM staff, which result in turnover rates three to 10 times the industry standard.

Family clinics that employ AI Agents to ensure all information in their claims is correct and aligns with insurance companies’ expectations achieve extremely high collection rates. For providers who are comfortable continually hiring, training, retaining, and investing in more RCM staff, hiring more people is an option. Alternatively, they can configure an AI Agent once and benefit from 100% accuracy and infinite scalability.


Payment posting


Family clinics’ administrative challenges often extend to payment posting. Each patient’s insurance plan can vary significantly, making it challenging to manage and apply payments correctly, especially if a claim is denied or requires adjustments or necessitates additional follow-up and corrections. If a healthcare provider lacks the capacity to post payments accurately and promptly, it’s difficult to fully understand the financial health of its operation.

This also negatively affects the patient experience. An inaccurate ledger at a family clinic might lead to sending out incorrect bills or bills that shouldn’t be sent at all, leaving the patients frustrated and confused.

With AI agents, family clinics can ensure high-quality and timely payment posting, leading to a smoother back-office operation and an improved patient experience.


The bottom line


The combination of staffing shortages and reimbursement challenges presents significant hurdles for family clinics, especially amid aging population and growing healthcare demand.

Fortunately, integrating AI Agents throughout their operations empowers family clinics to optimize profitability, alleviate the perpetual cycle of hiring and training, and unlock operational excellence. This transformative approach enhances business outcomes and improves patient experiences, marking a pivotal step forward in healthcare delivery.

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Thursday, June 27, 2024

How practices can reduce patient acquisition costs

Do you know how much it costs to attract a new patient to your practice? If the answer is “no,” you might be overspending on your patient acquisition. Your patient acquisition cost, or PAC, is one of the foremost measures of your practice’s profitability. Since the costs of acquiring new patients are often so robust – from marketing to overhead expenses, they can add up quickly, and quickly eat into your profit margins.

Because your PAC is so important to potential profitability, it’s crucial for physician practices to ensure that this figure remains lower than a patient’s lifetime value (PLV), or how much they are expected to spend with you during their lifetime as a patient. As a general rule of thumb, practices should widen the margin between the two and aim for at least a 3:1 PLV to PAC ratio.

So how can you get everything to line up properly? Marketing is by far the largest cost component of patient acquisition, which is why the key to achieving that golden ratio is to do your due diligence and spend efficiently on your marketing efforts. There’s a few ways you can do this.


Targeting highly-engaged patients


The most engaged patients are the ones who prioritize their healthcare and recognize the significance of quality care over cost. You can identify these individuals and attract patients with similar attitudes. “Engaged” can be characterized by one or more of the following traits:
  • Those who are more likely to bring in referrals
  • Those who pay on time (or even pay full price)
  • Those who are most loyal and choose you for all of their healthcare

Create personas based on the needs and characteristics of your most engaged patients to determine tactics that help to maintain their loyalty. Once you do this, you can refine your communication, healthcare marketing channels, and even your website.


Optimize PPC ad spend and performance


Is pay-per-click (PPC) working for you? It might take some time to refine your approach for the best results. As a benchmark, consider a few average metrics for healthcare marketing and patient acquisition search ads:Click-through rate: 
  • 6.11 percent
  • Cost per click: $4.22
  • Conversion rate: 7.118 percent
  • Cost per lead: $53.53

One of the best ways to measure the full effectiveness of a PPC campaign includes determining which search keywords are driving offline phone call conversations: how are keywords, ad groups, and campaigns performing?

Additionally, there’s a few things you can do to help your ads. First, refine your copy. Healthcare advertising copy can move the needle for both click-through rates and conversions, especially if you use the right language and calls to action. Second, remember your ads are leading somewhere—so give your landing pages some TLC. Make landing pages relevant to both your keyword and your ads, ensuring they have clear calls to action to help visitors navigate and provide their information.


Investing in SEO


Search engine optimization can not only help improve your online performance, but it’s also generally less expensive than running PPC ads. It’s baked into your organic efforts, so when you write and optimize content, you improve discoverability and build authority online.

This can be a mixed approach though and it’s important to balance incorporating both the right keywords and topic relevance to potential patients. When you want to see how your efforts are performing, consider using tools that can help with tracking your healthcare marketing ROI.


Leveraging opportunities to enhance patient care


The continuum of care is constantly changing for patients by age or evolving needs. Recognize when there are opportunities to expand services that provide the best possible care, such as encouraging patients to opt for premium health services or increase the scope of their treatment.

Dynamic forms help to expand your patient services. If your office provides specialty treatments related to a patient’s chief concern, once they indicate this on the intake form, you can automatically ask follow-up questions or direct them to more information. Or, if a patient indicates a specific concern on the form, you can likewise direct them to alternative treatments they might not be aware of.


Constantly measuring patient satisfaction


If there’s an opportunity to improve, be open to it by welcoming feedback. Net Promoter Score surveys can help determine satisfaction and assess the likelihood that patients will refer to your practice. Remember, referrals are the most cost-effective method of patient acquisition.

Using surveys can separate patients into a few groups to help you increase overall lifetime value:Word-of-mouth promoters who are the happiest and can help you grow organically through referrals.
Passive patients who need to be wooed to both come back to you and recommend your practice.
Detractors who are unhappy but can still be swayed if you address their problems.


Increasing Google reviews


Reviews are one of the driving forces behind helping to make informed decisions. This is particularly important when consumers are searching for more personal health concerns. It should come as no surprise that patients are more likely to use a practice with multiple five-star reviews.

These votes of confidence provide a competitive edge, increasing the likelihood of friends and family recommending your practice. The recipe for success is pretty simple: Show your best at every turn. Earn positive reviews by providing excellent patient care, asking for feedback, and using feedback for engagement and continuous improvement. It’s a low-cost way to build your reputation and improve the profitability of your practice.


Earning referrals


Referrals are often a top source of patient acquisition and come from all over—including insurance companies, other physicians, and friends—usually at a minimal cost. Healthcare is still very word-of-mouth-oriented, and the better a practice meets diverse needs, the more likely it can pull new patients in. Driving down that PAC goes a long way towards the bottom line.

To do this, consider refining your referral management process. This may mean enabling online submissions with unique URLs based on the referral source. Additionally, establish protocols to proactively contact patients referred to your practice to scehdule an appointment.


Looking ahead: Maximizing the value of your acquisition efforts


Outside of the day-to-day of running the practice and providing healthcare services, you spend significant time, money, and effort bringing new patients in via marketing. However, just as crucial as bringing in new patients is maintaining a healthy profit margin, which ultimately reflects the most fundamental pillar to the long-term health of a physician’s practice. By leveraging the suggestions outlined above, practices can reduce PAC and increase PLV to achieve the 3:1 PLV to PAC ratio, which is one of the primary ways for a practice to become more profitable.

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Tuesday, June 25, 2024

17 inches: Health care lessons from a college baseball coach

As healthcare has become more complicated, physicians are often asked to perform tasks and accept decisions from others that negatively impact the doctor-patient relationship. I am certain that there are times when we are put in a position by our patients, our staff, our colleagues, and payors to bend the rules or to make concessions that are not always in the patient's best interest. We have been in situations where we are forced to compromise on what we should do and end up accommodating others out of expediency. I want to share a speech by baseball coach John Scolinos, legendary baseball coach for Pepperdine University, who gave advice from his many years as a baseball coach and advice that can apply to all of us in the healthcare profession.

Coach Scolinos was invited to address the American Baseball Coaches Association's convention.

He said, "You're probably all wondering why I'm wearing a home plate around my neck. I stand before you today to share what I've learned about home plate in 78 years in baseball." He began by asking how wide the baseball home plate was for Little League, and someone in the audience answered, "17 inches." He then asked about the plate width for high school, college, and major league baseball, and the answer was always 17 inches.

Scolinos asked, "What do they do with a Major League pitcher who can't throw the ball over those 17 inches?" After a long pause, he said, "They send him to play in Siberia or the Minor Leagues."

"What they don't do is say, 'We'll help you out and make it 18 inches or 19 inches. If that still doesn't work for you to throw strikes, we'll make it 20 inches, so you have a better chance of hitting it. If you can't hit that, let us know so we can make it even wider, say 25 inches.'"

Scolinos asked, "Tell me, what do we do when your best player shows up late to practice? What is your reaction when your team rules forbid facial hair, and a guy shows up unshaven? What if they are caught drinking? Do we hold them accountable? Or do we change the rules to fit them? Do we widen home plate?"

Coach Scolinos continued, "This is the problem in our homes today. With our marriages, how we parent and discipline our children. We don't teach accountability to our kids, and there is no consequence for failing to meet standards and follow directions. What we do is widen the plate!"

He paused, then pointed to the top of the house, removed a red and blue Sharpie, and drew a small American flag. "This is the problem in our schools today. The quality of our education is going downhill fast, and teachers have been stripped of the tools they need to be successful and to educate and discipline our young people. We are allowing others to widen home plate! Where is that getting us?"

"If I am lucky," Coach Scolinos concluded, "you will remember one thing from this old coach today. It is this: if we fail to hold ourselves accountable, a standard of what we know to be right; if we fail to hold our spouses and our children to the same standards; if we are unwilling or unable to provide consequences when they do not meet the standard, and if our schools and churches and our government fail to hold themselves accountable to those they serve, there is but one thing that will occur "… dark days are ahead!"

His message can be applied to the practice of medicine. We fault young doctors for only working eighty hours a week and not developing the resiliency that older physicians experienced as young, training doctors. Our burnout rate exceeds 50% of physicians, fellows, residents, and even medical students. Yet, many in our profession still need to address this problem, which has reached epidemic proportions.

We expect patients to accept that the doctor is 30-60 minutes delayed in seeing patients because the previous patients took more time. We can do better; the plate is still seventeen inches!

We tolerate employees who do not dress professionally. We don't admonish staff using their cell phones while at work and checking their Facebook non-medically related messages.

We have accepted insurance companies denying requests for procedures and medications that are appropriate for patients without reacting to the fact that this is not in the best interest of our patients.

We have tolerated being told we cannot communicate with patients about their weight, smoking status, and lack of exercise because it isn't politically correct.

We have all accepted patients calling us in the evening or on the weekends asking us to refill their medications that they have been using for months or years but forgot to call during office hours. When we asked for the number of their pharmacy and agreed to refill their medications, we lowered the bar and increased the plate size. You can be sure the patient will call you again at their convenience rather than yours.

Bottom Line: Coach Scolinos's message resonates way beyond baseball and has applications for the entire healthcare profession. Let's begin questioning what our country, government, and profession have become and how to fix it. Coach Scolinos' take-home message is, "Don't widen the plate; it's still 17 inches!"

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