Consumer Satisfaction = Better Reimbursement

By Monica E. Oss, Chief Executive Officer, OPEN MINDS

Do you know how “satisfied” consumers are with your organization’s services? Who tracks those metrics? What does your executive team do about them?

Consumer satisfaction is currently not a key metric for many health and human service provider organizations. But focus on consumer satisfaction is going to ramp up as retail organizations enter the field—organizations (like Amazon and CVS) with executive teams obsessively focused on the consumer experience.

IIn addition to getting ahead of the retail competition for consumers, there are other reasons to focus on consumer satisfaction and consumer experience—to expand health plan partnerships and succeed with their value-based reimbursement (VBR) models. And we heard more about the satisfaction/success connection from Netsmart’s Denny Morrison, Ph.D., Chief Clinical Advisor, and David Strocchia, Senior Vice President and Managing Director of Human Services, in their session It Takes Tech To Make A Thing Go Right: How Data Helps Partnerships at our 2021 OPEN MINDS Strategy & Innovation Institute. My takeaway? Consumer satisfaction drives provider organization success with health plans in two ways—by meeting the many consumer-focused measures of value in health plan contracts and by improving consumer health outcomes.

Health plans (and payers) value consumer perceptions, and pay for it. Many VBR arrangements incentivize performance on selected HEDIS measures—typically those focused on access/availability of care and the experience of care. For example, HEDIS measures include medication adherence (12 weeks for acute care and six months for effective continuation phase treatment); preventive screenings for depression, and consumer engagement and satisfaction. More than 90% of health plans use HEDIS measures to assess provider organization performance in value-based models.

For acute care settings, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores are critical, as they make up 30% of the overall performance score of value-based purchasing. HCAPHS measures include how well nurses and doctors communicate with patients, how responsive hospital staff are to consumers’ needs, how clean and quiet consumers’ hospital rooms are, whether key information is provided at discharge, how well consumers understand the type of care they will need after leaving the hospital, and consumers’ overall rating of the hospital and whether they would recommend it to family and friends.

Better HEDIS measures translate to better scores for health plans—and better rates. The HCAHPS is used to rate hospitals and is used in rate setting as well. For example, in the Medicare Hospital Value-Based Purchasing (VBP) Program, the Centers for Medicare and Medicaid (CMS) reimburses hospitals for acute inpatient services based on quality of care (in addition to service volume), of which 25% is the patient experience of care assessed through the HCAPHS survey. As we see the shift to value, there will continue to be more focus on the consumer perspective on the care they receive.

Consumer satisfaction (or lack of it) drives outcomes and service utilization, affecting reimbursement. Many emerging VBR models look at the total cost of care and use of emergency room visits as measures of value. And these metrics are directly affected by consumer satisfaction and consumer engagement.

Satisfied consumers who are able to access care easily and know that transacting and communicating with their health care provider organizations is convenient and seamless, are more likely to show up for appointments, follow up on care, be involved in decisions about their care, and stick with the treatment plan. As Dr. Morrison said, “Customer service is as important as clinical outcomes in access, service, and engagement. People who come to us wear two hats, one hat of a patient and one hat of a customer. Their decision to stick with treatment depends almost exclusively on the customer hat that they wear and not the patient hat. That’s because most of the time, they really can’t judge the quality of care that’s rendered in a behavioral health care setting. So they look at the things they can recognize—did they have to wait a long time for an appointment, was the waiting room dirty, could they find parking, and so on. So good customer service is key throughout the patient experience and especially in the clinical encounter.”

So what should provider organization executive teams do if their consumer satisfaction scores are not up to par? Our panelists had some great suggestions. Simple changes can yield positive results. Offer quick appointments at times most convenient to consumers (one provider organization program to offer rapid access to care reduced disengagement from 22% to 2%). Change scheduling policies and workflows—research has shown that a significantly larger number of consumers will attend afternoon appointments rather than morning ones. And send appointment reminders, by email or text, and augment with phone calls. Clinical workflow design to provide data-based decision supports to clinical professionals and enable shared decision making with consumers can be a game changer. Integrated care and care coordination can play a key role in improving the consumer experience. Provider organizations that have the capability to offer digital closed loop referrals and collaborate with other health and human service organizations in the community to give consumers seamless access to their health data across the system, will have the advantage. As Mr. Strocchia said. “ “Your technology should make it easy to connect with the rest of health care. To participate in alternative payment models, you need to know more about an individual than just the care that you’re providing.”

Delivering on health plan expectations in the new paradigm of value-based care requires a deeper understanding of consumers and significant improvements in the consumer experience of care, that transcends current silos and information gaps. Provider organization executives need to be leveraging data and technology to improve consumer satisfaction, and improve the bottom line.