A Call for Case Studies

A Call for Case Studies

Since 2014, the HIMSS Revenue Cycle Improvement (RCI) Task Force has addressed the emerging dynamic of healthcare consumerism and the patient experience related to the provider’s financial and administrative performance and service levels. Its members include representatives from a broad cross-section of stakeholders, including provider organizations, financial institutions, payers, retail health care clinics, mobile technology providers, vendors and consultants. The group has focused its energies on creating, socializing and encouraging the adoption of a vision for the next generation of revenue cycle management tools and processes that keep administrative cost containment, interoperability, and patient engagement front and center. A microsite articulating that vision can be found here.

In 2016 the task force conducted a gap analysis of the technical functionality required to execute their vision from the patient’s perspective, and compared that functionality against the functionality known to exist at the time to identify potential gaps. These gaps included not only technical functionality, but also the development of national standards and uniform operating rules to support initiatives, such as accurate patient matching and the ability to share complex data in a meaningful and actionable way. The task force published its findings in a white paper, “A Roadmap to the Patient Financial Experience of the Future: Part I of a 5 Part Series.” In 2017, the task force conducted a similar gap analysis from the primary care provider’s perspective. The findings of that analysis, Part II of the 5 Part Series, will be released later this month. To follow up on this latest paper and see all the work products of the task force, please visit our website.

The task force’s next step requires your help. The HIMSS RCI task force is issuing a Call for Case Studies.The intent is to identify and celebrate work already underway that will lead to full realization of the Patient Financial Experience of the Future envisioned by the HIMSS RCI task force. Case Studies may address any or all of three distinct categories:

Information Exchange

–Real-time exchange of meaningful health insurance benefit and financial information between multiple payers and/or providers to enable patient decision making

–Ability to electronically share patient information (including administrative, financial and clinical) between multiple disparate providers

–Ability to deliver accurate pricing at the consumer level for comparable services provided by clinicians located within a certain geographic area

Consolidated Billing and Payment

–Ability to generate one bill for entire episode of care, regardless of contractual arrangements between providers

–Ability to generate one document that serves as both EOB and final billing statement

–Patient access to billing information at any point along the continuum of care

–Ability for consumer to utilize a stored “wallet” or consumer centric payment or financing tool

Unique Consumer Financial Experience

–Decision-making tools that allow patient to consider health insurance benefits, patient financial experience and efficacy of treatment to choose between treatment options.

Entities that have developed, or are in the process of developing, solutions that fall in to any of these three categories are invited to submit a formal Case Study. A submission may address one or more bullet points under a single category or a variety of bullet points from multiple categories. Accepted submissions may be promoted through HIMSS publications, webinars, podcasts, and/or conference presentations. To learn more and submit your case study, read on!

HIMSS Revenue Cycle Improvement Task Force

Case Study Submission Form

ITEM I: SUBMITTER INFORMATION

Name:

Organization:

Title:

Physical Address:

Email Address:

Phone:

ITEM II: SUBMISSION CATEGORY

Case studies submitted for review should involve a solution that addresses at least one of the capabilities outlined below. A case study may address only one sub-bullet under one line item (e.g. 1.1a), multiple items under the same heading (e.g. 1.1a-b and 1.2b), or line items under multiple headings (e.g. 1.1a, 1.2a, and 2.1b). In the box to the left of each item, please indicate which of the items is addressed in your submission.

Category I: Information Exchange
1.1 / Real-time exchange of meaningful health insurance benefit and financial information between multiple payers and/or providers to enable patient decision-making.

Does the proposed solution facilitate the exchange of information between and among health insurance plans and disparate providers, and make that information available to patients or their representatives in a way that allows them to choose a treatment plan that best meets their personal financial situation?

Does the information exchanged include treatment options being considered, health insurance benefits applied to these options, deductible, co-pay, health insurance financial accumulator information, and provider quality ratings?

1.2 / Ability to electronically share patient information (including administrative, financial and clinical) between multiple disparate providers
a.Does the proposed solution include the exchange of pricing and health insurance benefit information, such as coverage for services being proposed, patient deductible, co-pay, co-insurance or health insurance accumulator balances?
b.Does the solution being proposed include the exchange of radiology or other clinical diagnostic results?
1.3 / Ability to deliver accurate pricing at the consumer level for comparable services provided by clinicians located within a certain geographic area
a.Does the proposed solution allow the patient or their representative to choose between two or more healthcare providers based on the price of the clinical service(s) being considered and provider quality ratings?
b.Does the proposed solution include a clear description of the service provided so that that the patient or their representative will know if one provider offers a more comprehensive or different scope of care than another for a service of the same name?
c.Does the proposed solution make this information available to consumers in an easy to find, easy to navigate electronic solution?
d.Does the proposed solution include any price guarantee or disclaimers regarding the accuracy of the pricing? Is this information presented in a way that makes it obvious to the individual using the solution?
Category II: Consolidate Billing and Payment
2.1 / Ability to generate one bill for entire episode of care, regardless of contractual arrangements between providers
a.Does the proposed solution consolidate charges from all providers involved throughout the episode of care on one statement, even if those providers are not affiliated with the same health system and/or use the same core health information system?
b.Does the proposed solution allow for two-way data exchange at regular intervals between the solution and all parties involved in the patient’s episode of care in order to ensure all relevant billing information is as near-real-time current as possible?
2.2 / Ability to generate one document that serves as both EOB and final billing statement
a.Does the proposed solution combine billing and health insurance benefit information in a manner that makes it easy for the patient to understand what their total financial responsibility is for a particular episode of care, how their health insurance benefits have been applied and what their remaining financial responsibilityis?
b.Does the proposed solution exchange data with applicable payers to update benefits as a result of the episode of care?
c.Is the proposed solution designed using modern user experience design principals specifically to help patients understand the information presented and take payment action?
2.3 / Patient access to billing information at any point along the continuum of care
a.Does the proposed solution include the ability for patients and authorized providers to access all pertinent patient financial information relevant to a specific episode of care, including price estimates, billed charges, application of health insurance benefits, payment history (patient and third party), and past statements and receipts?
b.Is the proposed solution designed for usability across all browsers and devices?
2.4 / Ability for consumer to utilize a stored “wallet” or consumer centric payment or financing tool
a.Does the proposed solution allow patients to securely store preferred payment methods including ACH, Debit and Credit Cards, HSA and FSA cards, or connect to consumer payment applications such as PayPal, Google Wallet, Apple Pay, or Android Pay?
b.Does the proposed solution allow patients to pay all providers involved in the episode of care from a single login and/or through a single payment (e.g. does the solution allow the patient to make one payment that a third party will distribute among multiple providers, as appropriate)?
c.Does the proposed solution provide information about multiple payment options, including payment plans and eligibility requirements for charity care, and enable patients to request 1:1 financial counseling, apply for financial assistance, or establish a payment plan?
d.Does the proposed solution enable patients to apply for charity care payment options?
Category III: Unique Consumer Financial Experience
3.1 / Decision-making tools that allow patient to consider health insurance benefits, patient financial experience and efficacy of treatment to choose between treatment options.
a.Does the proposed solution provide patients with access to price and quality comparisons for the same or similar treatment options between local providers?
b.Does the proposed solution present patients with network coverage information to assist patients with choosing between treatment options?
c.Does the proposed solution present patients with financial experience scores or reviews to assist patients in choosing between providers and treatment options?
d.Does the proposed solution provide patients with access to treatment efficacy scores or medical reviews to assist them in choosing between treatment options?
e.Does the solution provide consumers with an innovative view of some other component of their healthcare financial journey to enable improved transparency and/or decision making, such as suggested healthcare coverage, recommendations for long-term financial planning for healthcare expenses, or a long-term financial plan to deal with a specific healthcare issue or diagnosis?

ITEM III: SUBMISSION OVERVIEW

Please provide a brief summary of your submission that includes the following information:

1)Detailed description of the solution itself;

2)Participants involved in the Case Study, if completed. If Case Study not yet completed please identify industry partners who have agreed to participate or whose participation you would like to secure (if looking to secure participation, please identify the stakeholder group you would like to engage, i.e. payer, small provider, hospital system, financial institution, etc.);

3)Roles and responsibilities of participants;

4)Length of Case Study;

5)Measures of success;

6)ROI achieved, if Case Study completed; and

7)Lessons learned.

ITEM IV: SUBMISSION INSTRUCTIONS

Submit this completed form and case study to . A Committee of four task force members, representing provider and financial organizations will review your submission and respond within 14 business days.

Questions? Contact Pam Jodock, Senior Director of Health Business Solutions at (312) 507-9924 or