Minimizing Financial Risk in a Consumer-Driven Environment

healthcare eligibility and enrollment service representative

When examining today’s consumer-driven approach to healthcare, there are multiple factors to consider in order to minimize financial risk and ensure appropriate reimbursement. Understanding your patients is the first step. Patients have gained increased control in the business of healthcare over the years, especially given the expansion of virtualization as a fixture within the current healthcare landscape. Providers need to keep up with the transition towards a patient-centric, consumerist model.

Now more than ever, from a customer service perspective, a provider’s marketability hinges on the patient experience from start to finish. Today’s patients are doing more online research, increasing overall patient education surrounding costs of services, success rates, and even Amazon-style reviews of patient satisfaction before deciding on a healthcare provider. They’re also focused on using telehealth as a viable mode of care. Perhaps most importantly, patients are evaluating the entirety of their experience, from point of entry and presumed affordability to the ease of the billing and payment process.

At the same time, patient liability has increased as well, with patients taking greater ownership over their own health. With the burden of healthcare tilting towards patients, it’s no wonder most patients consider the medical billing and payment experience when choosing a healthcare provider. Further, as patients assume more financial responsibility for their care, their service level expectations will increase accordingly.

Despite the growing influence of the savvy patient, however, there’s still a substantial number of patients who require assistance and coaching as they pursue care. Leveraging patient segmentation, providers can compartmentalize those patients whose circumstances pose a greater financial risk for the provider, including the uninsured and underinsured. These individuals may be unfamiliar with healthcare policies or available community programs, and they may not be native English speakers.

This patient population will benefit greatly from eligibility and enrollment support services, helping them identify and enroll in programs that provide healthcare coverage and financial assistance. Oftentimes, eligible patients are not aware that they qualify for certain programs, let alone whether such programs exist at all. Patients in this category conflict with observed trends towards self-sufficiency and patient-driven outcomes. When patients are uneducated about their healthcare options, we may see negative impacts on reimbursement or failure to seek care altogether.

While helping the uninsured or underinsured necessitates time and resources, these initiatives are imperative to the overarching goal of achieving proper reimbursement and minimizing financial risk. Just as patient segmentation allows us to catalogue our “high financial risk” population, the same concept can be used to identify patients who need less support throughout their experience.

This group includes insured patients, who are more likely to have a clear understanding of their benefits. Such patients may be equipped to make payments more easily upon request, and are potentially more comfortable addressing health concerns and accessing various options for care. If we can defer these “low touch” patients towards digital channels for the bulk of their intake and billing processes, we can free up and mobilize resources to focus on the segment of patients who need further assistance in navigating the healthcare journey.



Modern Healthcare

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