Why Healthcare Payers are Eyeing Patient Experience | Binary Fountain

June 10, 2020

Why Healthcare Payers are Eyeing Patient Experience

By: Erik Fessler


Superior patient experience is not just the concern of providers and health systems. Payers are also recognizing the costs of poor patient experiences and benefits in elevating the experiences of their members.

Reimbursement models that rely on “fee for service” have contributed to a poor patient experience across the healthcare industry. Providers are forced to see high volumes of patients each day to keep their practices profitable. It’s lowering the quality of care for patients and causing burnout among physicians.

Members are also fed up with the unintended side-effects of “fee for service.” They’re not willing to tolerate barriers to access and the long waits that are notorious in the healthcare industry. Long billing cycles, surprise billing, and billing mistakes also draw the ire of patients. Thanks to the rise of healthcare consumerism, patients are increasingly expecting a level of service on par with other service industries.

As a result, payers are moving away from traditional reimbursement models and working on alternatives. The models are being designed with two major concerns in mind:

  1. How can we improve the quality of care for our members?
  2. How can we reduce the costs of our members’ healthcare?

New models need to address both of these overarching concerns simultaneously. Payers are beginning to notice that patient experience has the potential to do so.

Patient experience is becoming a crucial business metric for insurance companies and managed care organizations. In this article, we’ll cover the reasons why positive patient experience should be a factor in any reimbursement model.

Reversing the Public Health Decline

The sagging overall health of the public is a primary driver of more patient-centric approaches.

Troubling data shows that United States citizen’s health is falling behind that of other developed countries. Morbidity rates are high. American women, in particular, have an alarmingly high maternal morbidity rate.

The reasons for our country’s decline in health are complex and often debated. But many experts agree that deficiencies in health services are a contributing cause. The U.S. has access to some of the most advanced medical research, technology, hospitals, and specialists on the planet. But shortcomings in access and quality of care provided are hurting overall health outcomes while costs soar.

Positive patient experience has shown potential in turning the tide on these figures. Studies have shown that improved patient experience metrics are linked to better clinical outcomes. One study found that positive interactions with providers correlated with greater care plan compliance and quality of life.

Positive patient experience, such as provider attitude and positive primary care performance, has been shown to increase adherence to treatment plans. Good communication with providers proved to be particularly beneficial at encouraging plan adherence. The quality of this relationship was shown to be especially prominent among patients in disease management. Researchers note that chronic conditions tend to require stronger commitment from patients to work with providers to achieve positive results.

A supportive patient experience during care has been connected to better long-term health outcomes outside of chronic conditions. This is particularly true for the quality of provider communications. Studies of patients hospitalized for heart attack have repeatedly shown a viable connection between patient experience and health outcomes. One study even linked patient experience and health outcomes up to a full year after discharge.

Lowering Member Healthcare Costs

Payers’ customers, and patients in general, are increasingly discontent with healthcare pricing.

Healthcare costs have been rising for decades, and the increases are hitting patient wallets. Per capita, out-of-pocket expenditures have grown from around $600 (present USD value) in 1970 to $1,150 as of 2018. The average employee saw their deductible rise 120% between 2006 and 2015 alone. And most patients can’t afford the average surprise $600 healthcare bill.

Patient experience can help lower healthcare costs in surprising ways. Relationship quality is an indicator of patient loyalty to providers, as well as an important element of patient experience. Patient loyalty can keep members in-network, healthy, and satisfied with their overall experience and care journey.

Efforts to increase patient experience have even been linked to elevated employee satisfaction, which in turn reduces turnover. Longer provider tenue offers patients consistency in care and greater clinical accuracy. This can reduce the consumption of medical services and cut costs further.

Patient experience tracking can even detect the potential risk of medical mistakes. Poor patient experience is associated with, and even predictive, of malpractice risk. One study found providers in its “very poor” patient experience group were 21.7% more likely to be sued for malpractice.

Patient Experience in Payment Models

Declining public health and medical costs outrage has healthcare payers looking at patient experience as a reimbursement metric.

Positive experiences in healthcare have been proven to improve health outcomes while simultaneously lowering costs. Patient experience can meet the core goals of new reimbursement systems while improving service for its customers.

The case for patient experience is only getting clearer with each additional study. The healthcare payers that embrace patient experience first will profit the most.

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About the Author

Erik Fessler
Marketing Coordinator

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