Winter 2010

President's Message

Hospitals have turned to new technology to better serve their patient populations by segmenting outstanding receivables. As with any solution, hospitals are asking whether it is helpful or hurtful to the patient’s financial relationship with a healthcare provider.

Fortunately, leading hospitals are turning to advanced segmentation strategies to strengthen their community and patient relations, provide an unbiased approach, and improve their bottom line.

One of these hospitals is INTEGRIS Health, a large healthcare system in Oklahoma with 14 hospitals. After implementing a patient segmentation strategy in 2004, their organization has virtually eliminated all customer service complaints related to their financial experience. How? They use an automated probability of payment model across all of their hospitals in order to apply the proper collection activities to each patient.

Smarter Segmentation Based on Payment Likelihood

Predictive modeling is used to segment patients by using data elements to predict future behavior– in this case paying their hospital bills. The use of predictive modeling tools is growing significantly in healthcare, with hospitals using its results to improve their revenue cycle and prevent fraud.

In a nutshell, predictive modeling is simply an equation used for scoring and ranking patients, based on payment likelihood. Hospitals using predictive modeling to determine payment likelihood typically leverage three key performance indicators (KPIs):

-           History of behavior
-           Medical data available
-           Age of account (30, 60, 90 days)

In addition, most are also leveraging third-party services that offer credit and financial information. By adding these additional attributes to their modeling, hospitals can better derive payment advice specific to their patient population. 

With the use of predictive modeling, it is possible to examine groups of patients and determine their payment likelihood. These results will allow facilities to segment out patients with high probability of payment and approach them differently than they would a patient with low probability of payment.

It All Hinges on Communication

A patient’s impression of a healthcare facility is determined by their experiences, both with their clinical treatments and their financial interactions. Both rely on communication.

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