Following the passage of the Affordable Care Act, about 16.4 million previously uninsured individuals have obtained healthcare coverage, according to survey analysis by the Office of the Assistant Secretary for Planning and Evaluation. Coverage expansions have contributed to a 35% reduction in the uninsured rate, effectively expanding patient access to care.
These industry trends can also contribute to rising patient volumes at healthcare organizations, and as requests for services grow, organizations may need to modify revenue cycle processes to meet these demands and optimize their financial well-being.
Palomar Health, a three-facility, 714-bed public healthcare district based in Escondido, California, has experienced a similar situation as formerly uninsured patients enter its local healthcare marketplace.
This change has not only contributed to growing patient volume, but also greater patient financial liability from high-deductible health plans. This prompted Palomar Health to reorganize its self pay management and to leverage the industry-leading technologies and practices of a revenue cycle management partner.
Palomar Health looked for a partner to improve its self pay collection strategies while providing patients and staff with a high level of service and professionalism.
At the start of the project, MediRevv came
By working closely with Palomar Health onsite, MediRevv was able to both replicate current processes and implement best practices to optimize collections.
Palomar Health chose MediRevv based on its ability to leverage technology enhancements—such as propensity-to-pay software, call recording capabilities, and self pay segmentation—and its educated team of employees.
MediRevv collaborated with Palomar to set up a platform in which it could view and work within Palomar Health’s information systems. MediRevv then took full ownership of
In addition, MediRevv’s partnership with Palomar Health’s long-term payment plan vendor allowed MediRevv to share responsibility for initiating and managing payment plans.
Once MediRevv began providing these
The partners hold weekly status meetings to discuss project operations and service improvements. At the end of each month MediRevv also provides Palomar Health with performance and engagement trends, such as call volumes, wait times, and abandonment rates—insights to which Palomar did not have access with its prior technological limitations.
For each of the 18 months since the new self pay model began, MediRevv has provided Palomar Health with operational summaries based on key performance indicators to report financial performance within account workflows. Among other metrics, this data has illustrated that more than $19.4 million in self-pay collections have been secured since the project’s beginning. Moreover, Palomar Health’s net operating margin is projected to increase to 17.5% over the project’s lifespan. Palomar’s engagement with MediRevv has allowed the organization to keep pace with patient volumes while increasing its net operating margin.
In addition, MediRevv’s data transparency has illuminated opportunities to further optimize the self pay program, such as identifying and implementing processes to address an increase in patient inquiries. While MediRevv put its phone number on billing statements and processed the majority of inquiries, some questions were better suited for Palomar Health to answer. This observation prompted MediRevv and Palomar Health to develop a system for more efficiently resolving patient concerns. Successfully restructuring patient inquiry workflows was made possible by leveraging SharePoint, a collaboration software tool, to communicate with one another on a daily basis.