The following is a discussion I had with Manoj Chabra, CEO, DCS Global and Ed Caldwell, Chief Revenue Officer at CarePayment about the integrated vendor partnership they began in 2017, and how they are helping healthcare revenue cycle professionals adapt to the new patient (or self)-pay dynamic.

The partnership between CarePayment and DCS: What does it say about the self-pay crisis?

It says the self-pay healthcare crisis isn’t on a trajectory to improve, and any serious effort to change that trajectory is going to require focus. Everyone has skin in the game, especially hospitals and physician practices that are facing disappearing margins.

If more people lose healthcare, the problem is only going to get worse. In any event, we think the right focus is patient engagement. It’s proactive, it’s positive, and it empowers patients by educating them on their choices. It ultimately makes them loyal patients, and repeat patients. Satisfied patients tend to figure out a way to pay their bills.

Has behavioral science played a role in your business model?

You can’t understand the healthcare revenue cycle without taking human behavior into your calculus. Only recently has anyone had the data to back up what we’ve known anecdotally for a long time: Getting people to make payment arrangements is a matter of driving the right conversations, to the right patients, at the right time.

Will vendor fatigue keep healthcare providers from offering patients more ways to pay for healthcare?

From a provider perspective, having one vendor figure out a patient’s propensity to pay at the top of the rev cycle, and then having a different vendor, if any, step into the patient financing and collections portion of the lifecycle---it’s a lot to manage. Providers want end-to-end help with patient financial matters. They’re clinicians, and for them, vendor fatigue is very real.

The hospital systems probably have no choice; to stay open, they’ll all have to think about how they’re going to offer patient financing beyond a four-month duration. So they’ll likely engage vendors for that, so they can stay efficient and keep a focus on clinical care. By integrating CarePayment with DCS, we’re hoping to provide the market with a solid, integrated choice.

What did DCS add to what CarePayment was already offering in the marketplace?

There’s a whole early-cycle experience patients can ideally have, and it hinges on good estimates of a propensity to pay, as well as good transparency for the patient about her estimated patient responsibility. When a patient goes for care, they may not be in a position to really face the financial aspect of the encounter. DCS takes the opportunity to profile the patient based on their past payment behaviors, using a soft hit on their credit files. The financial counselor then has a set of materials, tailored to that patient, that makes them aware of their payment options at the point of service. If they’re not able to take action on one of those payment choices up front, they’re offered a CarePayment plan.

Essentially, DCS added a robust and very sophisticated tech-enabled on-ramp for patients. It’s a nice workflow that triages the patients and quickly identifies various work streams that providers need to take to maximize their collection efforts. Providers weren’t doing this very well---this up-front work of identifying those patients that can and will pay their balance up front either in full or with a prompt-pay discount. Those who can’t pay in full, and are facing an out-of-pocket expense they can’t fund all at once, those patients have an opportunity to work with CarePayment.

Will these sorts of vendor partnerships get more prevalent?

We think so. One, the issue of becoming effective at collecting outstanding balances from patients is going to keep accelerating. The pressure is getting more and more intense. Hospitals and physician ecosystems are simply not geared to collect from patients. They don’t have people, processes and technology to collect from thousands of patients. Integrated partnerships between complementary vendors will help make things simpler for providers.

Are there any regulatory implications of your business model?

Of course, the CFPB does treat any payment arrangement of four payments or more as a lending environment. While no one is exactly policing that right now, that is bound to change and once it starts, it will be like wildfire. So yes, there is regulatory risk, and it’s going to grow. This is why vendors that are not making a significant investment in their compliance function will not survive. In the healthcare space, we of course also have IRS 501(r) guidelines. So, overall, we definitely see the regulatory environment as a market issue and we’re monitoring it very carefully as it develops.

Do you see CarePayment and DCS changing the patient finance and revevenue cycle game?

It’s clear that this market is evolving fast. There are many new entrants working to solving the patient finance and revenue cycle issues hospitals and providers are facing---and they often don’t have---the healthcare specialization track record and background to fully understand the issues. So we are uniquely positioned. Our work has the potential to cause a tidal change in financial behavior.

It’s easy to change the behavior of those who want to have their behavior changed. We have to start addressing financial literacy at the beginning of the patient journey. We recognize that the revenue cycle has long been a business-to-business conversation. With the patient-as-payer reality, we are helping hospitals change that. Unless you’re going to provide finance options to all patients, you’re not trying to change the game. We’ve all seen that a patient in the middle of a clinical encounter may not be ready to talk payment arrangements until later in the rev cycle, and we’re prepared for that moment when they are more ready.

Do you think providers and their collections teams have been missing a critical moment in the patient financial lifecycle?

Providers don’t traditionally have a great engagement strategy to reach patients 60-75 days after the clinical encounter, when they are most likely to be struggling with the reality of the bill, and most prone to accept new information about their payment options.

We’ve done a lot to analyze collection activity and subsequent success of providers (prior to a CarePayment engagement) and what we know is that a provider is going to bill a patient for 120 days. We routinely see that they’re going to collect 80% of what they are ever going to collect in the first 60 days. And between days 61-120, they’ll virtually not collect anything more. So when they engage us, we take over an educational phone call and outreach to let the patient know “Hey, we know you owe $2,000 and we want to make sure you knew that your provider is subsidizing a program that will allow you to pay over time, at zero percent interest, etc…” We catch them in that critical window and use an opportunity---one that is typically wasted---to engage them.  

From a data perspective, there are definitely moments in a patient’s financial journey that are more or less ripe for outreach. This is a key value we add to the provider rev cycle capture.  Many patients are not ready to deal with the financial matters exactly when providers are, but when they are ready, we want to be there to capture the benefit of that receptivity. A full 80% of the cash we drive is captured in this “second-chance” period. It can’t be wasted!  

What was DCS focusing on before patients became such a huge payer demographic?

We were tracking insurance companies to see how they paid on claims, and forecasting outcomes for the revenue cycle. With the landscape changing, we pivoted and now we track patients to learn more about how they behave, and how we can best motivate their behavior. DCS was finding the same gaps in the revenue cycle that CarePayment was: Hospitals can’t really offer payment options more than four months in duration. This kept them between a rock and a hard place. The insights DCS provides can bring hospitals a level of insight about propensity to pay that’s very valuable in making the most of the patient journey.

What do you think the future holds for the hospital revenue cycle?

I see tighter vendor integration in the nearing future. Qualifying for extended healthcare financing should be like it is in the auto loan industry: Patients should be able to see in minutes whether they’re approved for certain options or not. Tech moves fast, but the truth is, business and regulatory drivers set the pace.

There are many ways we can improve looking forward. Further to patient education, I’d like to work on helping patients truly understand their bills. We want them fully knowing why something is subject to deductibles, or why their co-insurance calculates out a certain way. We need help from insurance carriers to provide better transparency to patients. It’s happening, but it’s happening slowly.


DCS Global is a software solutions firm specializing in healthcare process improvement and information management. DCS Global provides an integrated suite of solutions for Patient Access/Revenue Cycle and Patient Experience in a single source environment, iPAS, which allows for lower cost of ownership. iPAS provides seamless patient access workflow, paperless operation and advanced data analytics to our provider partners. Our suite of product helps hospitals get paid in a timely manner. iPAS includes front end and back office revenue cycle tools like order manager, authorization, eligibility, payment, e-Forms and e-Signature, patient payment estimation, patient tracking, claim status and denial tracking. iPAS is HFMA peer reviewed and is also ranked by KLAS.

CarePayment is a patient financial engagement company that accelerates providers’ transition to the new consumer-driven healthcare market. Powered by advanced technology and analytics, our innovative patient financing solutions improve patient satisfaction and loyalty while delivering superior financial results. By partnering with healthcare providers to make affordable financial options available, CarePayment helps patients get the care they need, when they need it, while protecting the financial health of provider organizations so they can continue to offer valuable care to the community. CarePayment’s patient-friendly financing is compliant with applicable state and federal consumer credit laws, requires no application, and is supported by a friendly US-based customer service staff. Accounts for the program are issued by Republic Bank & Trust, Member FDIC.


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