Healthcare organizations have been talking for years about the importance of the patient experience. Yet, healthcare organizations have hit several challenges that have kept our patient-centric promise from becoming a reality. As a result, we all have at least one story about a personal experience when our ability to receive timely care for ourselves or a loved one was inhibited by an outdated, ineffective administrative process.

Consider the patient who has recently changed health plans. She wasn’t feeling well and made an appointment to see her primary care provider. When she arrived at the office, she realized she hadn’t yet received her insurance card from the new health plan. She also remembered that when she signed up for the new plan, she canceled her secondary insurance coverage. She thought the coverage might still be active through the end of the month but wasn’t sure. She didn’t have that card either as she didn’t think she’d need it any longer.

Because of the lack of information, the front desk staff had no way of knowing what the patient’s new insurance would cover, what her co-pays and deductibles were, or whether the secondary insurance might still pay a part of the visit. The patient was told she would need to pay the entire amount of the visit up front and then work it out with her insurance companies on her own after the visit.

It is unfortunate that our healthcare ecosystem is so dependent on a patient’s memory and a physical insurance card to be able to ascertain a patient’s primary and secondary coverage information, along with their financial responsibility. These issues can also impact claims processes and can increase manual work for the payer. This is just one of many examples of how administrative processes make it difficult to deliver on the patient-centric promise.

Where’s the disconnect?

These administrative processes need to be improved. We know the answer: healthcare systems need to become more interoperable. We have made progress. However, research from the ONC shows that in 2019, more than one in every three physicians still relied solely on fax (paper or electronic) or standard mail to share patient information—like ultrasound results—with providers outside their organization. In fact, just 34% engaged in bidirectional electronic sharing of patient information. Why?

A significant challenge to achieving interoperability is that healthcare’s current data-sharing infrastructure is built upon one-to-one connections. These connections are expensive and resource-heavy to implement and maintain. The result is a lack of transparency that has caused distrust between payers and providers. At the same time, providers are faced with increasingly complex payer requirements that are hard to keep up with, which adds to their already overwhelming administrative load.

A new way forward

These issues could be mitigated or eliminated through a new type of interoperability that allows all healthcare stakeholders to easily connect to a single, decentralized network and then access, in real time, the needed information without the request/respond processes of today. In a world where this type of interoperability exists, the provider in the above scenario would have been able to easily discover the patient’s new coverage information and find out whether her previous secondary coverage was still in effect—all in real time either before the patient arrived or while she was checking in.

In a fully interoperable healthcare system, data wouldn’t need to be requested, aggregated, and validated each time it’s needed. Instead, it would be continuously refreshed, always current, standardized, and always accessible in real time via a secure and direct peer-to-peer network to those who are permissioned to access it.

Imagine a network where every authorized participant would have permissioned access to the same information while, at the same time, no single entity could control, modify, delete, or change the rules of how the network can be used. Each permissioned participant would retain its own data instead of sending it to a third party (centralized); the data would remain in the participant’s control (decentralized). Leveraging formats such as FHIR, all data would be standardized and ready to be accessed. This type of network would eliminate the payer-provider friction that has plagued our healthcare system for far too long—friction that ends up creating a poor patient experience, reduced outcomes, and increased costs for all.

Delivering on the promise

At its heart, all healthcare is human. At the center of every procedure, every diagnosis, and every transaction is a human being who expects to be treated with dignity in moments when they are most vulnerable. The only way we will be able to meet that expectation is by improving the back-end processes that support and facilitate high quality care. But that requires us to completely reinvent how healthcare is administered. It’s the way we will truly transform the care experience.

We’re building a new way of doing the business of healthcare and you can join. Learn more by contacting us.

From complicated appointment scheduling and crowded waiting rooms to tardy doctors and rushed appointments, healthcare interactions can be frustrating and uncomfortable for patients. And that’s before adding in hard-to-understand medical jargon and confusing insurance hurdles. Is it any wonder that two-thirds of respondents to the 2021 Accenture Health and Life Sciences Experience Survey said they’d had a negative healthcare experience?

That simple truth matters because a negative experience with the healthcare system doesn’t just result in a bad day; it can lead to additional consequences for both the provider and the patient. In fact, more than one-third of participants in the Accenture survey said that after a negative experience, they changed providers or treatments or were less likely to seek medical care the next time they needed it. Other respondents decided not to continue their treatment and chose not to fill their prescription. Just 12 percent said the bad experience did not affect them or their future healthcare choices.

So what exactly does an ideal patient experience look like? In a word: communication. Whether in personal interactions or data administration, it’s crucial to keep the lines of communication open. Avaneer Health’s unique vision for exceptional outcomes — starting with secure data sharing and streamlined administrative processes — can help accomplish this goal.

Continue reading to learn more about the key components of the ideal patient experience and explore our vision further.

The Ideal Patient Experience

The patient experience spans every interaction an individual has with the administrative staff, nurses, and doctors in any healthcare facility as well as the communication they have with their health plan. While the patient experience involves a lot of moving parts, researchers have found that people look for several key elements as they navigate their health journey. These elements include:

• Clear communication
  More than half (55 percent) of respondents in the Accenture survey said having a provider who explained their condition and treatment clearly was the most important factor in creating a positive healthcare experience. According to the 2020 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) study, this type of communication requires that providers take the time to discuss treatment plans in laypeople’s terms so patients thoroughly understand the information being conveyed.
• Responsiveness
  Research suggests diligent attention to a patient’s emotional and physical needs — which can be demonstrated by responsiveness to the call light, the communication of up-to-date wait times and clear and accurate status reports, and more — can positively impact the patient experience.
• Whole-person care
  When patients are treated as individuals, they tend to view their interactions in a better light than when care is driven by a system that gives little thought to each person’s emotional and physical needs. Consolidating vitals checks and medication administration (rather than waking a patient multiple times during the night), as well as discussing private information when roommates or visitors are not present, for instance, puts the patient first. Whole-person or patient-centered care also means honoring patients’ wishes regarding autonomy and how involved they want to be in their own healthcare journey. Compassion and emotional encouragement are key as well, with 52 percent of respondents in the Accenture survey ranking a provider who listens, understands their needs, and provides support for what they’re feeling as the most important element of a positive experience.
• Communication between care teams
  Establishing great connections between different care teams is another crucial factor patients seek, with more than one-third (35 percent) of Accenture’s survey respondents saying well-coordinated care and excellent communication between providers was their number one criterion for a good experience. On the other hand, patients not only find contradictory feedback from different healthcare providers and changes in care plans frustrating, but also an indicator of disorganization and conflict among their care team.

Ways to Ensure an Exceptional Patient Experience

While some of the criteria for an ideal patient experience depend on individual healthcare providers, healthcare interactions start well before patients see their doctors. At Avaneer Health, we recognize that the patient experience starts with the care and detail devoted to administrative efficiency. Top strategies to improve the administrative experience include:

• Providing accurate data
  Ensuring the provider has the most accurate and current data available at the first point of contact with the patient sets the tone for a positive interaction. A thorough digital patient intake plus an in-person review of personal contact details and insurance information can save time and reduce patient, provider, and administrative frustration.
• Improving access to benefit and coverage information
  Having access to patient benefits and coverage information in real time at or before the first visit is a key component of whole-person care. With more benefits and coverage transparency, patients can feel empowered to make more informed decisions and confidently pay their share upfront instead of waiting for a statement to understand their responsibility.
• Ensuring timely billing
  In cases when it’s not possible to know or collect the full payment for a patient’s share upfront, it’s critical that the billing process with the insurance company moves smoothly and quickly. Reviewing billing and insurance information and automating basic billing functions (including denial prevention) can cut down on the time it takes for patients to see how much they owe and make a payment. The faster the provider’s administrative staff can receive payment from the insurance company, the more promptly they can bill the patient for their portion.
• Standardizing health data
  Health data should be stored in a standardized format that makes it easy to share among providers. Data standardization encourages collaboration in a patient’s care and consistent messaging about their treatment.
• Creating a seamless administrative experience
  A seamless healthcare administrative experience with clear expectations and thoughtful, efficient processes can make a positive impression and play a crucial role in patient satisfaction before and after a visit with a doctor. When benefits verification, prior authorization, and billing feel as simple and easy as swiping a credit or debit card at any other merchant, patient trust and the likelihood of continuing treatment go up while the fear of inaccurate charges or surprise bills goes down.

While there is work yet to be done to solve the complexity and lack of standardization in administrative processes, the benefits are well worth investing in improving the patient experience.