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The Problem with— and Solution to—Collecting Payments in Medically Underserved Areas


The debate over fee-for-service versus value-based payment models isn’t new. A couple years ago, The Wall Street Journal took a look at both sides of the debate in an article penned by Paul B. Ginsburg, from the University of Southern California’s Schaeffer Center for Health Policy and Economics and Richard Amerling, president of the Association of American Physicians and Surgeons. Each outlined a position that focused on providers and payors. Interestingly, neither mentioned healthcare consumers except in passing.

Were they ignoring the elephant in the room? It’s an important question—especially for healthcare providers attending to medically-underserved populations using a value-based payment model. In a world where payments depend on outcomes, activating healthy behaviors is critical to your success—and psychographic segmentation can help.


Engaging Medically-Underserved Populations More Effectively

According to the Robert Wood Johnson Foundation, more than 70 percent of U.S. healthcare spending comes as a result of behavioral or environmental causes. This is especially true among medically-underserved populations who often face a greater number of non-medical barriers to health management.

First, let’s look at how those populations are defined. The Health Resources & Services Administration (HRSA) uses the following criteria for its determinations:

Medically-Underserved Areas (MUAs) represent geographic areas with insufficient access to primary care services, such as a single county, a group of neighboring counties, a group of urban census tracts or a group of county or civil divisions.

Medically-Underserved Populations (MUPs) represent sub-groups within MUAs that face additional barriers to healthcare, such as homeless, low-income, Medicaid-eligible, Native American or migrant farmworkers.

Four factors help to establish these designations: the provider to population ratio, percentage of people below the federal poverty level, percentage of people over age 65 and the infant mortality rate.

the-new-york-times-well-large.jpgNon-medical barriers can be difficult to overcome. In a New York Times blog post, Dr. Dhruv Khullar recalled a remark a patient made after the doctor admonished him to pay more attention to his cholesterol and blood pressure. “‘Doc,’ my patient said, his voice a mix of amusement and irritation. ‘I ain’t got food to eat or a place to sleep. Took me two hours and three buses to get here. And you’re tellin’ me about some numbers?’”

Behavioral barriers, however, can be conquered if you take the right approach. It begins with understanding patients as individuals, rather than as a group categorized by income, age, race or diagnosis.

Instead, healthcare providers need to categorize patients by their attitudes about health, their motivations and their communication preferences. When you know where individual patients are coming from, and what their psychographic profile is—a Self Achiever who responds to a challenge, a Balance Seeker who  wants options or a Direction Taker who prefers clear instructions to follow—you can develop more effective approaches to activating patients and keeping them engaged over time.   


How Higher Patient Engagement Helps with Value-Based Payments

In an article about value-based payment models, RevCycle Intelligence cites a survey from Healthcare Information and Management Systems Society (HIMSS) which stated, “The transition from fee-for-service to pay-for-value has been referred to as one of the greatest financial challenges the U.S. healthcare system currently faces.”

WSJ_fig1_cost_drivers_opt copy.jpgWhile some hospitals—like the Cleveland Clinic—have had success with Bundled Payment programs supported by private insurers, many current value-based payment initiatives are driven by the Centers for Medicare and Medicaid Services (CMS).

However, the same circumstances that determine whether your patients come from a medically-underserved population often also determine whether they qualify for Medicare and Medicaid. As a result, hospitals that participate in the CMS value-based payment models may find that their ability to collect for services is made more challenging when patients remain unengaged.

By improving engagement with individuals based on psychographic segmentation definitions, hospitals and other healthcare providers along the care continuum can help the patients achieve better outcomes—which in turn helps keep reimbursements on the right track.

Technology can also be employed to facilitate collections. PatientBond is a platform for automating patient communications (emails, text messages, Interactive Voice Response) that personalizes messaging according to the patients’ psychographic segment using segment-specific words and phrases that motivate behaviors.  

“The transition from fee-for-service to pay-for-value has been referred to as one of the greatest financial challenges the U.S. healthcare system currently faces.”

PatientBond has been employed by a chain of Urgent Care Centers in its revenue cycle management strategy to drive payment collections while supporting patient satisfaction. More than 70 percent of all online payments have come within 48 hours of PatientBond communications and the Urgent Care Centers have doubled total payment collections.  Patients appreciate the outreach and connection with the Urgent Care Centers, resulting in high Net Promoter Scores. Learn more in this PatientBond case study.

With the CMS planning to expand value-based payments in the coming years, driving higher engagement among medically-underserved populations could well be a crucial part of protecting your hospital’s bottom line.

Psychographic Segmentation and its Practical Application in Patient Engagement and Behavior Change


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