Brian: Hello, everyone. I'm Brian Zimmerman with Becker's Healthcare. Thank you for tuning in to the Becker's Healthcare podcast series. Today, I'm pleased to be joined by our guest as we discuss the art and science of creating meaningful financial experiences. Before we begin, I want to go ahead and introduce our guest today, John Talaga, Executive Vice President & GM for Healthcare with Flywire. John has been in healthcare payments for 25 years. Prior to joining Flywire, John was co-founder and CEO OnPlan Holdings, which was acquired by Flywire and launched healthcare's first automated payment solution. John, thank you so much for taking the time to speak with me today.
John: Thanks for having me, Brian.
Brian: Before we really dive into the topic here, I thought maybe we could start with the brief history of Flywire for the audience. Being that you were really pioneers in the idea of patient financial care and bringing consumerism to the financial side of healthcare. Can you start by giving an overview of Flywire and your history working in this space?
John: Sure. Flywire as a company is a fast-growing global payments company. We apply deep vertical expertise to serve highly complex industries that have consumers with high liability. This includes industries like higher education, travel, and of course, healthcare, which is the vertical that I lead. Flywire, from a healthcare perspective, is really a strategic combination of three pioneering companies.
Flywire, whose core was moving money cross-border for international patients traveling abroad for medical services... you can imagine that's a complex process for people wanting to use local currency. Then in 2018, as you mentioned, Flywire acquired my previous company OnPlan which introduced the first automated payment plan model in 2015 to address the affordability problems facing US patients. Last year in February, Flywire acquired Simplee, which launched the first digital wallet for healthcare bills in 2010 and introduced machine learning personalization in 2017. We now bring a single platform and solution with the combined capabilities that are leading the market with scale. We manage over $10 billion in patient responsibility and work with 4 of the nation's top 10 health systems.
Brian: Thank you, John, for sharing that helpful background there. I know you've long advocated for the use of data and analytics as key aspects of revenue cycle optimization. I think particularly with regards to leveraging it for the use of things like AI, machine learning, using that technology to automate manual tasks and create personalized touchpoints for patients across the financial journey. I'm wondering then, what are some of the guiding principles you would share for systems looking to tap into machine learning and automation that maybe haven't yet? How critical is having access to the right data in leveraging those processes?
John: Data and analytics are really the backbone of everything that we do. When it comes to driving a true financial journey, I'd say there's probably four guiding principles. The first one is data. You need to tap into both internal and external data. Internal is the health system's data, such as patient demographics, financial class insurance paid, how they paid the hospital in the past, or their payment history. Then external data is for things that will tell us more about a consumer's capacity to pay, such as debt to credit ratio or their employment status or income.
The second thing is using that data to personalize personalization. Using what we've learned from that data on the individual patient in applying their capacity to pay, and that's how much they can afford billing events, what we call the conversation profile, which identifies how that patient prefers to interact whether it's email, text, chat, or even paper in many cases.
Then the third component is matching. We take these things, and then we use the automation to match the capacity to pay with their conversation profile. That helps to engage the patient in the best way to drive response. We'll do even things where we're applying through automated machine learning through A/B testing that essentially tests different methods of those communications within the models to see how that patient will respond.
Then, of course, the last part which is critical in any kind of machine learning loop is the outcomes. We need to measure the outcomes of those interactions to teach the system what works to inform future interactions. Did they pay in full? Did they need a payment plan? Did they complete their plan on time, or did they default on their plan, et cetera? This coordination of automation and machine learning is critical to compete for the patient's attention and then be responsive to their needs.
Brian: Thank you for walking us through those key things there, John; I really appreciate it. I know you're a fan of saying, simply updating your digital infrastructure does not guarantee higher patient interaction or satisfaction. I think the phrase I've heard you use before is, "If you build it, they don't always come, and when they get there, they don't always stay." My question would be, what are some of the key strategies that health systems need to deliver on to guarantee the success of their digital initiatives?
John: Yes, as I described earlier, the process of automation and machine learning to engage patients is really a necessity to capture their attention. One key strategy is to pull this engagement to the front end. As more and more hospitals are looking to build more payments and interactions at pre-service, we need to allow an estimate to be communicated digitally and extend the payment options before service.
Engagement is only the first step, and it's critical to have a strategy around design for really a “frictionless” digital experience. We know that healthcare billing is highly complex. The old problem was helping the patient understand what they owed, which led to what many may be familiar with as patient-friendly billing. This hasn't gone away, it's still paramount to make it easy for a patient to understand how their insurance benefits were applied, how their deductible ultimately results in their balance due, and patient responsibility.
If you miss on that, you lose the patient, but when a patient accepts the fact of what they owe almost 50%, patients can't pay a bill for $400. The average balance at a hospital is about $1,000. There's a huge affordability gap that has to be solved. Solving the patient's affordability problem takes center stage at that point, and tailoring payment options (we call them offers) from the data removes barriers to payment.
Realistically, through this frictionless process, the patient's still going to have questions. I don't think in healthcare we're going to completely avoid all the questions and complications that we have, and nobody engaging digitally wants to make a phone call. Applying that AI chatbot technology also becomes a key component to the digital initiatives, which will help allow patients to get answers through the website or to a text, or even through their personal assistant like Alexa.
That way, the questions and answers teach “the brain” so that it improves more and more over time. And we have integrated authentication from the Flywire perspective that's in the process to even allow patients to see their estimates and payment options completely through the bot. It really is a win-win since it improves the patient experience while cutting phone calls and placements to collection agencies as well.
Brian: I really think that's such an important point around, you can't really avoid all of the questions that might come up throughout this process for patients, so it's really important to keep them in mind, what their experience is as you engage with them. Then thinking about that, I really want to hit on this: the consumer revolution really was big in healthcare in 2020. The pandemic drove higher demand for digital products and services, and many healthcare providers were equipped to meet, but a lot of those that did meet their challenge still struggled to deliver on the types of meaningful consumer-centric building experiences that people have come to expect from other industries.
As you've covered earlier, Flywire has long advocated that focusing on consumerism and affordability in the revenue cycle space creates that win-win situation you were talking about there. What advice would you give for providers looking to shift their focus more towards this consumerism piece here, and can you give maybe some examples of the results that shift has yielded for your clients?
John: Sure, Brian. Last week we were on a panel where I touched on some of these things as well. COVID's really exasperated the patient affordability crisis when it comes to paying on plan balances. We always have to remind ourselves that patients are consumers of all goods and services. By and large, we've entered what's known as a subscription economy, where it's commonplace for people to pay monthly for things like Netflix and Hulu, or even their digital subscription to a publication. This subscription economy has recently propelled a growing trend known as buy now, pay later, which helps consumers pay for common things that have a large price tag, like a washer and dryer, or you may recently have seen that you can even pay for your airline ticket over time.
Healthcare is no different for consumers. In fact, many argue that it's even more critical to allow patients to pay over time since medical expenses are very often unplanned and necessary. Health systems need to leverage these trends by making payment plans a strategic advantage rather than a tactic of last resort, which has really been historically the tactic of healthcare. This means applying data and payment options at the time of scheduling and pre-reg, as I mentioned, and then extending it through post service to final payment.
To answer your question about some of the results, we've seen clients improve pre-service payments by 46%. When I see that improvement, typically what you'll see at a health system that's really focused on it, maybe collecting 10% to 15% or maybe as high as 20% pre-service. To increase that by 46% is a huge benefit driving 15% to 20% increases in patient collections, and that's while driving 80% self-service payment plan activation.
By driving the digital, it's really helping these patients that otherwise would wait to be contacted by a collection agency, and by collecting sooner, we've been able to reduce the placements to early out and bad debt agencies in some cases by 30% and nobody wants to talk to a collection agency. Those are expensive collection events for hospitals, but necessary.
Finally, we're measuring patient satisfaction by collecting feedback through exit surveys that have shown Net Promoter scores over 50, and the typical health systems that we see for Net Promoter scores are typically in the low 20s. It's been a really proven model that's been out in the marketplace and especially with the giant health systems that Flywire works with.
Brian: Yes, that's some truly impressive numbers there, John. I just really want to thank you for taking the time to join today. It's always a pleasure to speak with you on the patient financial experience. I think you have some wonderful, thought-provoking things to say and some really valuable insights for our listeners. Thank you so much.
John: Thanks for having me. Appreciate it.
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