Five Critical Operational and Financial Capabilities Required for Healthcare’s Financial Survival - Industry Analysis by Loyale Healthcare

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As the American healthcare industry moves into the next tenuous phase of the COVID-19 crisis, it must find an equilibrium between two menacing threats - resurgent COVID-19 infections and hospitalizations and the suffering caused by the economic shutdown. Clinicians are planning for “disease suppression” - but for healthcare providers, long-term financial and operational stability calls for a different set of capabilities.

Hospitals and health systems are adjusting to new realities for the next phase of the COVID-19 crisis.

It has become increasingly apparent that, as a nation, we have concluded that we must somehow find a way to begin restoring our economic well-being and protect against an unmanageable resurgence of infections - Kevin Fleming, CEO, Loyale Healthcare

As shelter-in-place and social distancing orders are relaxed and economies across the country begin to reopen, Americans and their healthcare providers find themselves in what is proving to be an uneasy transition. As health experts feared, the resumption of more normal business and social activity is, in a growing number of instances, leading to a resurgence in infections. Currently, twenty one states in the process of reopening their economies have documented a worrying rise in new coronavirus cases and hospitalizations, causing a few states to suspend further “opening up.”

Some observers have been critical of governments’ decisions to relax the restrictions that effectively “flattened the curve”, leading to these more recent surges. Others have called attention to the widespread suffering caused by the lockdown itself, including more than 40 million lost jobs, deferred healthcare and disproportionate risk - both health and economic - for already disadvantaged citizens.

Many governors whose states are seeing resurgent infections are resisting suggestions to again shut down their economies. Seeking some kind of middle ground, it has become increasingly apparent that, as a nation, we have concluded that we must somehow find a way to begin restoring our economic well-being and protect against an unmanageable resurgence of infections by the still very present coronavirus.

This is the balancing act that we and our healthcare providers are now facing. On one side - growing economic hardship unlike anything we’ve experienced since the great depression. On the other side - the possibility of hundreds of thousands of deaths and millions of people sickened. In the middle, we find an economy capable of beginning its recovery and public health policies and behaviors that force infection rates back down until a more permanent solution can be developed.

Realists by necessity, healthcare providers have already begun preparing for that reality. According to an article published by NEJM Catalyst (part of the New England Journal of Medicine) on June 9, leaders in epidemiology, clinical quality, care management, community health and research at Kaiser Permanente acknowledge that COVID-19 has presented healthcare providers and their communities with a conundrum: “Without aggressive disease mitigation strategies like social distancing and shelter-in-place orders, surges in Covid-19 infection can rapidly overwhelm healthcare capacity and exacerbate death rates. However, with aggressive mitigation strategies in place, radical changes to social and economic activity can have profound consequences on a community’s ability to meet its citizens’ basic needs.”

Stated more briefly, the article finds that, “The risk of outbreaks reemerging as non-pharmaceutical interventions (NPIs) are lifted must be balanced with the grave risks of failing to successfully reopen our communities and restart our economies.” To help maintain this balance, Kaiser is focusing on developing eight specific capabilities to help it, and its community partners and other providers effectively achieve sustainable disease suppression.

These capabilities include:
1. Robust testing programs - While continually scaling capacity for direct testing, closely examining other leading indicators such as call center activity trends around cold, cough, and flu symptoms. Other sources may include secure topics between patent and their providers. Upticks in these types of questions and conversations generally precede patient volume increases.
2. Contact tracing, case finding and isolation - Recognizing that multiple technologies are being explored to help facilitate contact tracing of infected individuals, Kaiser is making plans for the time-intensive work that is currently the only proven model for effectively locating and isolating potentially infected people to reduce the spread of the virus.
3. Community health care - The threat is bigger than any single system or provider can handle on its own. Success will depend on a collaborative, coordinated response to the virus. For Kaiser, that means sharing information publicly and collaborating with other providers and community groups to reach out to populations facing the highest risk.
4. Care of patients in the home, whenever possible - Most healthcare providers have recognized by now that virtual care makes sense medically, operationally and financially. At Kaiser, 95% of adult and family visits in Northern California were conducted virtually during the initial phase of the COVID response. Looking beyond the crisis, many are convinced that virtual patient engagement will become a much more prominent characteristic in the healthcare ecosystem.
5. Maintaining community-level surge capacity - In addition to planning for the possibility of surges, sharing patient capacity for acute care with other healthcare providers and innovating a purchasing inventory program to ensure a secure supply chain for medical supplies.
6. Targeted and safe health care reopening - Kaiser is using a “careful and graded approach to reinstituting elective surgeries and other care to ensure that the risks of infection are minimal.” Using “carefully developed, evidence-based guidelines and targeted risk stratification to identify population subgroups that will likely benefit from targeted interventions”.
7. Ongoing research to combat COVID-19 - Collaborating with other providers and researchers to better understand the highly unusual patterns and vexing properties that distinguish the COVID-19 virus.
8. Effective Communication - Engaging patient and communities in an ongoing dialog about the pandemic and the best measures to help ensure their health and well-being. Employing websites, member handouts, secure mobile messages, call center scripting and email, leveraging every channel to enlist citizens and patients in the battle against this virus.

Five Operational and Financial Capabilities for Sustainability in Healthcare

We at Loyale commend Kaiser Permanente and other providers, who are vigorously collaborating with patients, peers, competitors and their communities to find ways for America to manage the health aspects of the COVID-19 conundrum. Just as important, however, are strategies to ensure that healthcare providers will have the financial wherewithal to continue delivering care to an increasingly stressed population of healthcare consumers. To that end, we at Loyale have identified five operational and financial capabilities that hospitals, health systems and other providers must embrace to secure their futures. Many of these are based on the same data- and evidence-based principles described above. They include:

1. Contactless patient financial engagement - Patients now represent the healthcare industry’s second largest source of revenue, behind only Medicare and Medicaid. As consumers, they have become accustomed to communicating and doing business online. Just as providers have rapidly scaled sustainable home-based delivery of care (item 4 above), they must also leverage more robust digital tools to interact with their patients in other dimensions of care.
2. Patient Population Segmentation - Just as providers are using data to identify population subgroups for more focused clinical intervention (item 6 above), data analytics enable providers to more intelligently develop policies that serve the financial and logistical needs of demographic subgroups in their communities.
3. Scalable, personalized OmniChannel communications - Before high deductible health plans were as prevalent as they are today, health plans and other insurers were the source of most provider revenue. And, although their rules for providers were extensive, they were predictable. The systems that healthcare providers developed over the decades to receive reimbursement from these payers spawned a large administrative discipline called revenue cycle management. Unfortunately, the systems that worked for insurance companies don’t work very well with patients, who are diverse and difficult to predict. Consequently, providers are looking to other industries like technology and retail, for communication models designed to connect more meaningfully with consumers. That calls for using every communication tool at their disposal, just as in item 8 above.
4. Affordability options - Long before the pandemic, patient concerns about the out-of-pocket costs for healthcare were suppressing demand. Depending on the research, as many as half were either avoiding care or delaying it because they simply couldn’t afford it. Here again, healthcare needs to look to other industries that have found ways to bring “big ticket” purchases within reach for consumers. The segmentation and communications strategies above allow for the development of a digital front door capable of interacting with patients to offer up multiple payment scenarios that support the providers’ operating requirements and bring care within reach.
5. End-to-end patient payment analytics - Partly because of the outdated revenue cycle systems described above, most healthcare providers don’t have visibility into the performance of their patient-pay portfolios, a topic we covered in another article. But using systems developed exclusively around the patient’s financial experience, that can be remedied. Consequently, providers have access to the business intelligence they’ve never had to more effectively manage this critical revenue source.

Importantly, all of these operational and financial capabilities will prove valuable long after the COVID-19 crisis has taken its place in history. By leveraging data and digital communication channels, providers will build the operational “muscle” to meet complex patient requirements and the flexibility to adapt to unpredictable variations in the healthcare marketplace. By optimizing patients’ financial experiences, providers will also optimize revenue performance and enhance their competitive presence in a market that has been primed for innovation and disruption.

Loyale Healthcare enables all of the capabilities described above today for thousands of healthcare providers across the country. We’re privileged to help our clients connect more successfully with their patients to bring care and payment within easier reach.

Kevin Fleming is the CEO of Loyale Healthcare

About Loyale

Loyale Patient Financial Manager™ is a comprehensive patient financial engagement technology platform leveraging a suite of configurable solution components including predictive analytics, intelligent workflows, multiple patient financing vehicles, communications, payments, digital front doors and other key capabilities.

Loyale Healthcare is committed to a mission of turning patient responsibility into lasting loyalty for its healthcare provider customers. Based in Lafayette, California, Loyale and its leadership team bring 27 years of expertise delivering leading financial engagement solutions for complex business environments. Loyale currently serves approximately 12,000 healthcare providers across 48 states. Loyale is proud to have an enterprise-level strategic partnership with Parallon which includes the deployment of Loyale’s industry leading technology at all HCA hospitals and Physician Groups.

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