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The Evolving Role of Patient Access in the Pursuit of Exceptional Patient Experiences

Published on 4/1/2019

Estimated read time: 7 minutes

With an industry-wide focus on consumerism, many health care organizations are looking to transform the patient experience starting with Patient Access, the first and one of the most frequent contact points in health care. Patient Access often sets the tone for the patient’s perception of the organization and their overall care journey.

Consumers of health care are looking for the same conveniences, access to information and customer service that they are used to from other industries, such as retail and travel. Rethinking Patient Access from the perspective of the patient presents opportunities to better meet these needs through more personal, patient-driven experiences across self-service, call center and in-person interactions.

Here are some considerations for organizations undergoing or planning strategic initiatives around patient experience, with a focus on the important role of Patient Access.

1. Shift from process-driven to patient-driven interactions.

Many best practices in Patient Access are standardized, one-size-fits-all processes designed to ensure clinical safety and effectiveness, meet financial performance objectives and provide great customer service. To create more personal experiences and increase patient satisfaction, these processes need to be designed around the patient. Unfortunately, optimizing a process around industry standards that everyone can agree upon is much easier than optimizing a process around patient experience.

The following scenarios explore the complexity of optimizing a process around patient experience and the differences between process-driven and patient-driven health care interactions.

Question: For patient experience, is it better to complete a full pre-registration at the time of scheduling or to get the appointment booked quickly with the minimum dataset and handle any additional pre-service conversations later?

Answer: It depends. Does the patient want to know their out-of-pocket costs and payment options while booking? Does the patient prefer to pre-register through a mobile app? How busy is the patient at that exact moment – how much time do they have?

Question: For patient experience, is it better to schedule the patient’s next appointment before they leave the office or to follow-up later?

Answer: It depends. Does the patient prefer to plan out their calendar in advance or wait until closer to the requested appointment date? Does the patient prefer to schedule themselves online or in a mobile app?

Question: For patient experience, should the scheduler read all pre-visit instructions when booking the appointment?

Answer: It depends. Is the appointment today or weeks from now? Is the patient setup for appointment reminders through email, text or voice? Does the patient actively use their mobile app to access this type of information?

The right answer for each situation differs by patient, their preference and situation at that time. When rethinking these processes from the patient perspective, each step should be reviewed to determine whether it can be completed by the patient through self-service offerings such as scheduling and check-in. Self-service options create a “win-win” by creating convenient patient experiences for those who prefer them and freeing up representatives to help those who need or want to talk to someone.

Another important consideration is which steps (self-service and representative-facing) can be personalized versus those that will be standardized due to clinical, financial or other requirements. When doing this analysis, each required step should be challenged with questions such as:

  • How effective is the current process?
  • What options exist to create a better patient experience?
  • And, what if we did allow patients to complete this step at a more convenient time or opt out of this step entirely?      

For those that can be personalized, each patient’s preferences should be captured, retained and used to proactively drive the workflow and ongoing patient interactions. When creating these personalized, patient-driven processes, it is critical to ensure the right quality checks are built into the overall patient journey so that an excellent patient experience at one step does not turn into a poor patient experience down the line.

For instance, if a patient who prefers to schedule by phone and pre-register themselves using their mobile app, forgets to complete the necessary steps, it could result in a longer check-in time or unexpected out-of-pocket costs upon arrival, resulting in a poor overall patient experience. In this example, there should be processes in place, via email or text, to automatically nudge the patient to complete the steps. If they are still not completed in a reasonable amount of time, there should be prompt follow-up from a Patient Access representative.   

2. Leverage financial clearance intelligence and automation to improve transparency and personalization.

Many financial clearance best practices that have stemmed from Revenue Cycle objectives to accelerate cash and decrease cost to collect also provide opportunities to create positive patient experiences through greater transparency and personalized interactions.

“Shoppers” and more savvy patients are demanding more transparency around insurance coverage, expected out-of-pocket costs and payment options at the time of scheduling. With access to the right patient information and financial clearance tools, schedulers can provide this information upfront and set the appropriate expectations. Patient Access representatives can present the personalized financial pathway for each patient in advance (entire payment upfront, payment plan options or financial assistance) rather than asking for the full payment and putting the patient in the uncomfortable position of having to ask for help. This approach shows the patient that the health system knows them and wants to help them through the payment process to ensure they get the care they need.

Recent advancements in financial clearance tools and automation are making it possible to provide this same level of transparency and personalization in consumer self-service experiences. This can entail providing patients with their estimated out-of-pocket costs, personalized payment choices, and financial assistance options when appropriate.

3. Continue to expand upon Patient Access responsibilities and the scope of “one-call.”

With an increased focus on patient experience, Patient Access roles are evolving from more specialized focus areas to more comprehensive patient-centered customer service roles aimed to answer the question, “How can I help you?” on one call. The concept of one-call or first call resolution has long been a goal of Patient Access to improve the health care experience and be more proactive in meeting financial clearance objectives. In Patient Access call centers, first call resolution has become an important patient experience metric. However, the one-call is often limited to the scope of responsibility in each venue or department.

Scheduling is often organized within multiple call centers or departments where staff is specialized by service lines or venues of care, e.g. staff schedules across all primary care locations but not specialties, or a centralized call center for diagnostic imaging and a separate one for Physician office visits. Further centralizing scheduling functions (co-located or not) could lead to higher patient satisfaction and first call resolution for patients that need to book multiple appointments and prefer to do so by phone. For example, a patient that needs a CT scan and a follow-up appointment with their primary care physician could call one Patient Access representative and book both appointments at the same time. Centralized scheduling initiatives can help lead to more consistent patient experiences as well as reduced wait times.

Prescription refills, although not always thought of as a Patient Access function, are a high-volume request. Patients often call scheduling departments for refills because they are the easiest to reach. Providing staff with the training and tools to requests these on behalf of the patient can help drive patient satisfaction through one-call resolution without transfers.

As more and more of the patient financial conversations move upstream to Patient Access, patients may bring up more billing questions on these calls, such as, “You were so helpful with that conversation; can you also help me with my question about my outstanding balance from my recent MRI?” Providing Patient Access staff with a full picture of a patient’s outstanding balances across the health system and training them on how to answer some basic billing questions is another good opportunity.

Patient experience is crucial to the success of any health care organization and Patient Access plays an important role in these outcomes. Healthcare organizations that adapt Patient Access processes into more convenient, personalized patient-driven experiences will be better positioned to meet the growing demands of today’s consumers.

Cerner’s Patient Access solutions streamline information across your organization. Learn more here.