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Health Care Reinvented: Streamlining Billing, Increasing Customer Satisfaction

Interview by Jonathan Kersting

Health Care ReinventedFor Allegheny Health Network (AHN) and Highmark, the goal isn’t just to reinvent health care, but to also provide a seamless and supportive patient experience right down to the details of patient billing.

After all, patients can get overwhelmed by the disconnected bills and explanations of benefits piling up in their mailboxes. Not only can it compound stress patients already have about their health, but it can also lead to missed payments and costly customer service inquiries.

In this episode of Health Care Reinvented, we explore how ANH and Highmark leveraged technology and a leading-edge health care IT company, Cedar, to deploy a solution that not only increases payments but reduces patient stress around the billing process.

Listen in to Neil Kulkarni, Vice President of Customer and Clinician Experience Solutions at Highmark Health; Kimberly Wilkinson, Director, Central Business Office, AHN; and Shanti Krishnan, Vice President of Sales at Cedar, detail their journey to radically simplify their customer financial experience by implementing Cedar Pay. With the Payer Intelligence Layer, Highmark members who receive care at AHN have access to uniquely integrated billing information and insurance data.

In less than one year with Cedar Pay, AHN added $17 million in patient payments, thanks in part to the integration with Highmark. But the clearest signal that payer-provider partnership was working came from patients themselves, who gave the integrated experience a 90% satisfaction rating.

Listen and learn how embracing technology can create so much positive impact and how more projects are in store for the future.


You're listening to the healthcare reinvented podcast series. And I'm your host, Jonathan Kersting. With the Pittsburgh Technology Council. This podcast is all about the intersection of technology and healthcare. And we talk about it at every single level, whether it's in the operating room, whether it's about virtual visits, and everything in between. It's where technology is making a positive impact. And today, it's all about how technology is simplifying the payer provider system. Simplifying just makes it sound, dare I say too simple, because it is super complex. But you want a streamlined system, you want a sensible system, you want an easy system and understandable system, so the customers don't have to be stressed out when it comes to paying and understanding their bills. And joining us on the podcast today is Neil Kulkarni, who's the vice president of customer and coalition experience solutions at Highmark Health. We have Kimberly Wilkinson, who is Director of Central Business Office at Allegheny Health Network. And we have Shanti Krishnan, who is vice president of sales at Cedar. Thank you so much for hanging out with me today. I'm excited to explore this conversation. And I always love starting with introduction.

So our listener knows who is who. So why don't we just start down the list and I went through Neil, let's start with you your background real fast, and what you do, how you do it off the ball, Jonathan, thank you so much for having us and really excited to be able to kind of talk about this with the group today. I've been at Highmark, for a little under five years. And really what my role is all about is how do we transform our delivery system? And how do we make things easier for our customers? How do we make it easier for our clinicians? How do we think about simplification experiences being more practice personalized, and then working with our provider partners to really deliver a seamless and blended experience for people and so we say customer because it doesn't really matter if it's a insurance member or a provider system patient than today, it's a person. And healthcare is really complicated. And so I'm excited and unfortunate that I get to spend kind of my day thinking about how we think make things easier from a system perspective.

And you make it sound easy. And that's very complicated, because it's like, like I said, In the beginning, it's one of those deals where it's like, you're dealing with people here, we need simplicity from a very complex system. And that's when you get to work on every day. And that's just improving the quality of people's lives. I love that is so cool, Neil. So Kim, how about yourself and what you do at Allegheny Health Network?

Hello, everybody. I'm Kim.  I'm the director of the Central Business Office for Allegheny Health Network. And my team is compromised of our Customer Care Center, which is our call center where patients are calling in inquiring about their bills, our Single Billing Office cash management, enrollment and credit balance. So as you can imagine, my areas are very involved with the patients and answering their questions as healthcare is very complicated. And we're, as Neil said, trying to make it uncomplicated for our patients and it easier for them to navigate and understand their bill. And not make it so stressful, because they're stressed enough. That's what I was gonna say. I mean, you're often talking to customers that are at an inflection point in their life where they're dealing with maybe a medical crisis or something and you're just stressed out like crazy. And all of a sudden, they you're getting some, some bills, or some get some questions, and you can't figure it out. So it's just increasing that stress. And you don't want your folks to be stressed out. So that's why I love what you're doing, because let's bring the stress down and help people heal.

Right. Right, and make it easier for them make it easy.

That's what I'm talking about. And of course, we couldn't have this conversation without our friends from cedars. So Sean cheap. Tell us about yourself and really like what cedar is all about, because I love the fact that like Highmark comes in and uses these tech partners like this to make these things happen to make that simplicity happen based on a technology platform.

I'm Shanti Krishna and vice president of sales at Cedar I've been with the company for almost four years now. So we've evolved quite a bit over that time. But really thrilled to be here today. And of course, just so excited to have such wonderful partners in Miele Kim and the rest of the Highmark and AHN teams. What cedar does is that we have a platform that really aims to make it easier and more intuitive for patients to navigate and ultimately fulfill their financial and administrative obligations in health care. We know this is a real pain point for patients and as Kim just alluded to, it's often coming at a moment that is already stressful because of some sort of healthcare incident. And so our view is if we can take the stress out of what is already a pretty stressful situation, you know, we're doing our job. And so, we aim to do this in two kind of key related ways. One is just bringing the best of other consumer industries to this known pain point in the patient healthcare experience, making it more personalized, more intuitive, really leaning on data and design science to help inform the experience And the second is really bringing disparate parties such as payer and provider together on one platform because we know that patients don't see these things as being entirely separate. They're actually very related, yet our system treats them as totally separate. So, again, an area where agent and Highmark have just been such fantastic partners and really helps us to realize this vision.

Yeah, I was looking at your website. And you have, I mean, you have the biggest clients out there. And of course, Allegheny Health Network. Highmark, they're right there with you guys. So you're, you're helping lots of lots of big organizations solve these very tough problems. So that's, that's cool stuff. Certainly a privilege. Most definitely. So let's get the conversation rolling. I guess maybe starting off with talking with with Neil Kim about maybe some of the problems that were that Highmark was looking at knowing that you needed to find a solution around this. Can you guys set the stage for us?

Yeah. So happy to kind of chat through that. So I think the last couple of years, as we've been looking at how do we drive a better experience for our customers, I really started to break that down into a bunch of buckets of things that we want to focus on. But one of the major ones is around kind of the end and healthcare financial experience to say, hey, people struggled to understand financial costs, they struggled, they don't get treatment at times, because they really don't understand that as well. So that relates is often delayed care, when they actually get then care, then there's really complicated payment processes, we don't do a good job of connecting people to financial services and advocacy programs that they might have access to. So that entire ecosystem is really, really complicated. Everything from kind of understanding what costs are known, giving, comparing cost options, making it easy for people to kind of pay their bills, helping them understand the benefits that they have, as well. And so once we started kind of looking at the space, we said, hey, this is an area that we really need to kind of dig in and and tackle, and we're not doing a good enough job today. And so about three years ago, we really started kind of looking into, Hey, what are the set of partners because this is it's complicated, like it's talked about, it isn't something that we're going to solve completely on our own. And we know that there are other organizations and kind of other companies that are really partnering to drive this experience. And so we started looking at who are the center partners that are doing that. And so through that process, we identified initially, a company called boot up as a place that we wanted to start and that transition into cedar. And so I think one of the interesting parts, which I think we'll talk a little bit further about, and kind of our discussion is, one the place to start might not be completely the place that yet. And so if this was a one where hey, everyone solve it in healthcare, it's easy, go do it, just go implement a solution, and we're good that it would be easy to go saw. And so we started experimenting and working with the senior team on Hey, initial concept, here's what we think, how would you scale it? How would you deploy that? And so we iterated on that with them. And with hm, team over time on how do you start making these things really easy? How do you bring the best of kind of other experiences that as a person, you've gotten used to whether it's financial services, whether it is retail, other things in your life that you're doing, and we really worked collaboratively to go through that with them. But that was been a three year journey to say where we started and the product that the solution that we started with right now is very different than what we actually have live. But I think that's a good part of this partnership to say, hey, continue to iterate, change, really meet the customers understand what they need, and deliver a set of capabilities or experience to a customer that really makes it easy for them to understand on the provider side, what they need to pay on a payer side, does that match what their payer has paid their EOB and really bring all that together in a really seamless way. So that's, that's really kind of what brought us to Cedar in the partnership between cedar age and a hybrid on ours. That's super interesting. And you bring up the point of fact that like, it's not like this is one of these places where you go, you buy the software, you plug it in, and though your problem solved, but know that this has been an iterative process, you don't end up where you think you're gonna end up. Because as you're discovering things along the way, it changes and of course, time changes, the industry changes, and that you got to, I guess, continually be addressing this as an issue as it goes along. Because you never fully get to like, let that's the one solution. We're done. So, Kim, I'm curious. From your side, obviously, you're much on the front lines, when you're hearing from the customers and so forth. What were some of the key things that they were kind of bringing up realizing like we got to keep improving? Like, how can we make sure that our customers are number one, and that we can we can do right by them all times.

The one thing that we were lacking was the ability to provide an electronic communication, ie the text messages, the emails, or QR codes, things like that. So that partnering with theater has given us the ability to do that and evolve. And as you said, healthcare is ever changing. So as soon as we're getting one thing implemented, there's another section that you need to work on. And adding that payer intelligence for our Highmark members, has been a game changer for us, letting them know What their HSA and FSA balances are, and having that EOB comparison so that they can see. And again, helping them understand, as Neil was saying, with the payer and the provider, and linking that to that they can see that they are matching, you know, and helping eliminate that confusion. And just giving them access to some self serve options that they did not have before that we're now able to do has been a game changer for us as well. It's very empowering for the customer as well. I mean, I love that. But to get it makes, it seems like it's so easy, but you need a partner like cedar here. So I'm curious to hear from Shanti. And he obviously you come together with a client like this, and you know, this is a big project, right? And then it's going to evolve it. And it's what was it like kind of kicking this project off and kind of walking through this journey, as you're able to, you know, go through each step and then see ours as needs change, and then use those cedar products to help solve this problem.

Yeah, I mean, I think to Neil's point, when we started out this started on this journey over four years ago, I think it really came from a place of collaboration. And, you know, at the time, Gouda really wanted to solve this problem of payer and provider collaboration, payer and provider coordination for the benefit of patients, but obviously not wanting to do that in a vacuum wanting to do it with a partner that could really inform us of the key pain points, and really what was most feasible out of the gates. And so that's kind of how this journey started. And so where we are today is that the cedar platform is live on the post visit billing side at Allegheny Health Network. And we've incorporated additional functionality known as the payer intelligence layer, which is both Neil and Kim alluded to, enables patients to see elements of their benefits information alongside their bills, so they can see it, their EOB and Bill have been reconciled, they can see their deductible status, and they actually have the ability to pay their bills out of their HSA. So this is available for Highmark members presenting at h n, we're continuing on this journey. This is really just the start. I was gonna say found, yeah, we found that even just this this what seems like a very small kind of tweak and an otherwise typical billing experience has led to really, really, really positive impacts for both a financial perspective for both payer and provider as well as the patient and member experience perspective. So I would say throughout the entire journey, the entire the, the approach has been extremely collaborative. And we've really leaned on both these teams to kind of help direct us and where we can have the most impact.

Without a doubt, as I mentioned before, I was sneaking around on the cedar website, and I did come across that case study based on what we're talking about today. And the results have been pretty, pretty, pretty substantial. So far from these initial, you know, first steps of the rollout. Can you talk a little bit about some of the the results for lack of a better term so far? Sure.

So we've definitely increased our pace patient satisfaction, we put several initiatives in place to contribute to that we have flexible payment plans, allowing for Apple Pay as a source of payment or the QR code. Again, as we mentioned, the payer intelligence for Highmark members, the ability to do your cell service options, we've updated our statement format, enhanced our payment plans to allow patients to consolidate their many visits into one payment plan so that they're not making multiple payments. And cedar has also assisted us with our customer service area. And this has helped us tremendously with reducing our abandonment rates. So when patients are calling in, you know, we are under the industry, industry standards for our abandonment rate now, which is that the standard is 3%. And we are well under that at an average of 1.3%. Our POST call surveys. And the results were first call resolution are up a percentage of 82%. And again, our satisfaction scores tend to increase as well. So I feel like we're servicing the patients in a better fashion, answering their questions. And again, giving them that ability to self serve as they feel need.

Yeah, I think some of the other things, at least kind of but also more broadly, I think we've seen a big impact on collections. So I think it's over 17 million in income, incremental patient payments. That's not even accounting for it. We have a huge influx of people that are out on payment plans that didn't have payment plan options before. And so I think even from a customer experience perspective, hey, cost of healthcare is high and it has an impact on affordability that has an impact on the rest of your life to say Hey, can you pay your mortgage, can you pay your phone bill, you need to make a trade off decision on on some of that type of stuff. So really that payment plan functionality and things that we've done have been really impactful. I think the two other really big ones for us that we've seen is really a 33% lift in HSA FSA. So health spending accounts, utilization. And so to me, that's a big thing to say people in identical plans, they have these things, but I know what happens for me, I forget my car, I forget that you have that available.

And then actually, right by reading my mind, Neal, you're reading my mind. If I remember, I was like, where's my HSA card and said, I don't keep it in my wallet with me at all times. And so one nudging and reminding people that they have these funds available to use for a payment has been really, really big. And so we've seen a big effect of that. Also on the Highmark side, we look at it in terms of what is our net promoter score or customer experience holistically in a segment and industry in a market right now. And so we've seen really good improvements overall in western Pennsylvania, with our net promoter score with the types of solutions that we're implementing in the space. So I think it's been a win win all round to say, a big impact for HN, but also a really big benefit for Highmark, in terms of making it easy for our customers to access care and pay for Kevin, you get to have so much fun doing what you're doing, because you're actually seeing a positive impact. It's only got us invigorate you more and more on both sides on the theater side on the high marks actually, like basically, we came together we're going through this journey, we're actually seeing the results we wanted. And we realized there's still more opportunity to do more. So you must be pretty stoked.

We are really excited, we have a big roadmap and backlog of things that we want to tackle. So I think some of the things that we're we're really starting to lean into. So Shanti alluded to something that we call the payer intelligence layer. And so that is the component that is a Highmark insurance oriented to say, how do you provide a differentiated and unique experience for a high mark customer that might be going to a system like Allegheny Health. And so if we want to make it so much better, so much more streamlined and easy that you don't need to think about certain things, if you have a that type of a partnership? So a couple of things that we're working on, one is continuing to expand and scale that payer intelligence layer to other providers systems in other parts of the market to say, how do we work with not just ah, and in western Pennsylvania? How do I work with other systems and other geographies that Highmark operates in to really offer the same types of capabilities that we're really offering in this place. But that is one of the things that we're kind of working with the Cedar Key more holistically to expand that, I think we also have, I'll say, new capabilities and new use cases and new experiences that we want to launch as part of that payer intelligence layer that can go directly to a patient specifically with age as well. So a good example of that would be, hey, there's a treasure trove of information and things that we know, on an insurance side about a person, and we actually want to allow them to engage in those types of things. And so cedar and HN, they have eyeballs they have, they have engagement. And that's a moment that matters for a person when they're paying a bill. And so can we remind them to say, hey, you might have a need for colorectal screening, you might have a need for getting your flu shot. And there are certain things that we think are really valuable to help people manage their healthcare holistically, that we really want to use this platform to kind of start offering to our customers as well. So that's a second thing that we're kind of looking at in terms of a payer intelligent expansion of those capabilities. And I think the third one is, when you go to a system like Allegheny Health, there's still a lot of I'll say, secondary or tertiary providers that yet to say, hey, might be called a Gen, you might still get a separate bill right now. And in your mind, as a customer, you don't necessarily see that as up that was a 10 as a system, why am I getting a separate bill from this doc for a thing? You don't always know that? Are they employed? Are they not employed? And as a customer, I would not expect you to know that or figure that type of stuff out. And so how do we start working on things like consolidation of those types of bills to say, hey, it's all together, whether it is a different different entity that operates our end, if it's a different entity operates our neighbor and hospitals, but all of that if that sits under that age, and banner and brand, how do we start really making that experience really seamless as well. So just a couple of examples of that the types of things that we're looking at our our roadmap for the next year to be able to continue expanding on this capability.

That's amazing. When I hear that you're able to take this and keep building on it and scaling it out for more impact me so exciting. Oh, my goodness. So yeah, like I'm confirming that you could have a lot of fun at work doing this. As far as that goes. How do you like prioritize and because I get it seems like the world just keeps opening up. How do you prioritize make sure that you can actually follow through on these things to make sure they happen because I'm sure it's got to be tough. And so it kind of goes with, hey, at the top kind of whether it's President leaders of the organizations, is there a strategic alignment in the direction that we're moving? And so we spent a good amount of time to make sure our leaders are kind of aligned at that level and are really working through that. I think then the next step goes into exactly what what Kim talked about, hey, we spent a lot of time right before the holidays on Hey, joint brainstorming and collaborative brainstorming on hey, let's throw 80 ideas over them. And let's see, what are all the things? Do they make sense for a provider system like Allegheny Health? Do they make sense for Highmark, but they make sense for Cedar? What's the Venn diagram of those types of opportunities? Let's start kind of figuring out what's the value? What's the impact on experience? What's the impact on financials? What's the impact on operations? And let's kind of collectively prioritize what makes the most sense across that organization? And then let's also short than that on a, what does the next 12 to 18 months look like? Well, we try to keep a forward looking roadmap across our organizations of the things that we want to go do. And then part of that turns into what am I learning from something I might be doing in a different space, my bringing that board to this discussion, other things that Allegheny Health Network is seeing in a completely different era that they think kind of makes sense on our roadmap as well. Then for Cedar? What are they seeing with other maybe payers or providers that they're working with as well? And how does that impact the things that we think that we're really what the I'll say, click into market and really deliver from a better experience for our customers.

I like it, I tell you what, we've been doing this podcast series for almost five years now. And we've covered so many different topics like technologies in the operating room to you know, virtual health and everything, and I'm always my mind is mesmerized. Now, I think this has been one of our most important conversations, because we're talking about technology at a level. That's that's all around just how like a customer is able to interface and understand what's going on, you know, as as the as they go through the pay experience. And to me, that's just so important, and the amount of horsepower it takes to do that, and the complications behind it. Once again, it just goes to show you how technology and healthcare just they go hand in hand and they intersect in such a cool way. at every single level. I have been blown away, but with today's conversation, because these are things I just didn't know. And now I know I'm kind of excited. So if you have any parting words, anything we haven't covered, the people just need to know about this collaboration. And really, I think the excitement that as this moves forward into 2024 and beyond.

This has been a great conversation. And again, I'll just kind of plus one to what Neil and Kim said, I think, for partnerships like this to work, there has to be some shared accountability, but there also really has to be alignment of mission and values. And, you know, I think at least from our side, we've definitely felt that and it's really enabled us to do what we've done so far. And we're excited about what's coming next. I love it.

I'm so glad you guys are working together. I had so much fun having this conversation and learning what it takes to make something that seems as simple as a bill and it being understandable to have that happen in a seamless way. I think it's just awesome. I can't thank you guys enough for hanging out with me here on healthcare, reinvented, fantastic stuff, everybody.

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