Billing, revenue cycle, Consumerism, Patient Care

Revenue Cycle Success: A Case Study in Patient Financial Communications Strategy

05_22_17_ Revenue Cycle Success-01

MaureenClancy

Maureen Clancy
Senior Vice President,
Revenue Cycle Management

For the second year in a row, Privia has been named a recipient of the Healthcare Financial Management Association (HFMA) MAP Award for High Performance in Revenue Cycle. This honor confirms what Privia physicians already knew; that our physician group is extremely innovative and effective in the area of revenue cycle performance. HFMA MAP Award winners go beyond just meeting industry standard revenue cycle benchmarks, they also implement patient-centered recommendations, best practices initiatives, and consistently achieve outstanding patient satisfaction.

How do we do we achieve such revenue cycle success?

Privia’s approach to patient financial communications is one of the differentiating factors that make our physician group so financially effective. With every patient we treat, we aim to make a difference in their experience, satisfaction, and health outcomes. Take the following story of a patient diagnosed with postural orthostatic tachycardia syndrome (POTs):

The Problem: A Privia patient diagnosed with the life-threatening condition POTs became a Medicare patient and was no longer receiving the coverage he needed for his treatments. His Privia primary care physician, Dr. Rex Ruiz, had been providing treatment at home through Coram Home Infusion Services, but a change in coverage forced the patient to pay out-of-pocket for his supplies, nursing, and infusion pump at a staggering cost of $1500 per month. Due to the financial burden, the patient was forced to stop the home infusion services. Since then, he had been admitted to the ER several times, a costly and ineffective treatment option.

The Communication Process: Dr. Ruiz submitted an original request to the Privia Care Team through our EHR. The care manager reached out to Privia’s pharmacist who now could play a central role in quarterbacking the care options for this patient given the urgency of the matter.  

The Privia pharmacist performed a “benefits investigation” to determine the best new course of action. In order for our patient to avoid having out of pocket expenses, the best option would be to shift him to an outpatient infusion center that was covered under Medicare.

The Conclusion: The pharmacist contacted our patient and explained both infusion center options. The patient selected the closer and more feasible option. The Privia pharmacist called the infusion center to establish a contact on behalf of the patient. She spoke to multiple stakeholders for the patient’s care and was able to resolve orders for the patient and continue outreach by the care management team. The patient expressed sincere appreciation for getting him the right care, at the right time, and at the right price, at no additional expense.

The Outcome:  The patient felt well cared for and his medical needs were attended to, but more importantly, he knew that he had an advocate helping him navigate a complex system. Privia’s coordinated care approach reduced both the patient’s financial burden and future financial burdens by preventing future ER visits, which are difficult for the patient and extremely costly. We were able to leverage Privia’s provider network to get the right care for the patient. We improved quality of care, convenience, and cost for the patient while navigating both payer coverage and shared price transparency.

Privia’s Care Center staff, providers, and population health support team wraps support around the patient by coordinating to ensure that care is delivered at the right time, right place, and at the right cost. Above all, our approach to patient financial communication is guided by compassion, patient advocacy, and education.

What’s your philosophy behind patient care?

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