How a Price Transparency Strategy Laid the Rails for Patient Satisfaction: A Case Study with OrthoSC

Making it Easy for Patients and Staff: How a Price Transparency Strategy Laid the Rails for Patient Satisfaction, Practice Excellence, and a Vision for the Future.

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“With HealthMe, we are able to give patients the autonomy and the information that they need to make good decisions about their care so that they can make a holistically good decision for themselves, for their family, for their life.” Andrew Wade, CEO, OrthoSC

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INTRODUCTION

At OrthoSC, returning patients to doing what they love is their number-one goal. They pride their practice on accessibility, availability, and experienced orthopedic care, and they consider patients to be members of the extended OrthoSC family.  As someone who bristles at the frustration endured by both patients and staff under the avalanche of forms, confusing bills, and complicated language, OrthoSC CEO Andrew Wade, MBA, FACMPE, FACHE, exclaimed that one of their guiding principles is to “make it easy for patients and staff.”

Except in healthcare, making it easy is rarely as simple as it sounds.  This case study will explore the dynamic partnership between OrthoSC and HealthMe, and how by working collaboratively, they have been able to excel in the deployment of a bundling strategy based on price transparency to best serve their patients who want to pay directly for their care.   While staying true to their core values of compassionate care, they sought to partner with HealthMe to “make it easy” for patients who pay for their care out of their own pockets.

BACKGROUND

OrthoSC serves a diverse community that is also experiencing significant population growth in recent years due to various factors, including an attractive business environment, cost of living, and lower taxation. The patient population includes retirees, young families, students, and a wide range of individuals seeking orthopedic care.  Many of these patients are on high deductible plans, are “in between jobs,” are members of sharing ministries, or have made the cost/benefit decision not to carry traditional health insurance.  Offering transparently priced care and a platform to pay for and access care directly has been a win for the community and the practice.

Despite the presence of competition from other healthcare providers and hospital systems in the region, OrthoSC views competition as an opportunity to continually improve and provide better service to its patient community. This particular group of patients is both growing and notably underserved by healthcare providers.  As such, OrthoSC took direct aim at healthcare equity and patient satisfaction in their practice by partnering with HealthMe.

SITUATION

Making it easy for patients who do not use traditional insurance comes with a slate of challenges and obstacles.  

• Frustration with Healthcare Technology: Most health leaders and consumers want healthcare to be on par with basic e-commerce and information sharing platforms like Amazon or Google or Shopify.  The situation is that the technology in most cases lags way behind; and the process should be more modern and user-friendly services like booking flights or hotels.
• Data Collection Overload: Patients are often overwhelmed with the excessive amount of information collected during the intake process. Patients are frustrated that they spend too much time and question the necessity of collecting so much data. OrthoSC works to get rid of the “med-speak” that just doesn't make sense to patients and tries to make it the least abrasive as possible for people to get the care that they need.  
• The Need for the Right Information at the Right Time: The importance of healthcare providers having access to the right information when making decisions about patient care is critical for diagnosis and treatment. According to Wade, “I need my surgeons to be able to walk into the exam room with the information that they need to make good decisions.”
• The Potential for an Unsatisfactory Patient Experience: Patients deserve to have their time spent with providers focused on care and treatment instead of complicated and redundant administrative paperwork.
• Bundling and Pricing of Services:  The good news is that even more emphasis is placed on the role of price transparency healthcare.  The challenge faced by OrthoSC and others across the country is how to automate, streamline, and present these prices in clear and understandable ways that can help patients best navigate their care and recovery—without the worry of surprise bills.

APPROACH

As one of the largest independent practices in South Carolina, OrthoSC has long embraced thoughtful innovation as a competitive differentiator.  Andrew Wade and his team felt that despite the avalanche of new healthcare technologies, none were able to capture the experience on “the other side of the counter.”   The partnership with HealthMe was built on the shared commitment to remove the “med-speak,” make the billing process less opaque, and to ultimately humanize the patient journey with clear and transparent pricing to create a user-friendly experience for their rapidly growing base of self-pay patients. OrthoSC embraced the HealthMe platform as a tool to enhance the patient experience and improve the efficiency of their practice.  Remaining true to their goal of helping patients get back to the life they love, they are firm in their belief that patients will have a better overall experience when the stress of financial uncertainty is removed.

SOLUTION & RESULTS

As an early adopter of the HealthMe platform, there was a collaborative effort to challenge the system and to figure out a way to make it easy for self-payers.  Instead of doing things they’ve always done, OrthoSC realized that with HealthMe their revenue wasn’t whittled away by all the authorizations, phone time, unnecessary paperwork and slow payments.  They were paid in full when the service was delivered.

Additional key findings on how OrthoSC was able to integrate HealthMe into the core operations of the practice:

• Increased Patient Volumes: Since January 1, 2022, OrthoSC has had 1,720 unique patient engagements with HealthMe.
• Informed Decisions: OrthoSC values providing patients with the right information at the right time, so together with their physician, they can make informed decisions about their healthcare. The HealthMe platform allows patients to access information about their care and its associated costs.  For OrthoSC, “price transparency is not a nice to have, it’s a must have.”
• Meeting the Needs of Self-Pay Patients: OrthoSC has experienced a significant conversion of patients from self-pay to utilizing the HealthMe platform to understand and manage their healthcare costs. Patients appreciate the transparency in pricing, the ability to plan for and even obtain affordable financing for their healthcare expenses.
• Empowering Staff: With support from HealthMe, OrthoSC took a unique approach by educating their team about how HealthMe works and integrating it into their existing workflows. This approach allowed them to adapt to the new system and gain a deeper understanding of its impact.
• Challenging Conventional Practices: OrthoSC challenged conventional practices and contractual requirements in the healthcare industry. They encouraged their team to question assumptions and look for ways to improve processes and the patient experience. This included reevaluating the need for authorizations and other traditional healthcare practices.
• Honoring their Skilled Team: OrthoSC emphasizes the importance of having a highly skilled and dedicated team who can embrace technology like HealthMe which allows them to extend access to high-quality care. Their team members are smart, adaptable, and committed to the well-being of their patients and the community.
• Competing in a Highly Competitive Market: OrthoSC competes based on the experience they provide for patients and part of that experience is financial, which contributes to the patient's physiological well-being.  Their highly trained surgeons and staff work as a team to restore their health and mobility.  But the equation remains should be simple in what they ask patients:  “Do you feel better, and was it easy?”

MOVING FORWARD

With the cost of doing business going up coupled with the continual decline and reimbursement from payers, OrthoSC is unwilling to accept the status quo.  They will begin offering surgical bundles and also will engage in direct contracting with self-funded employers.  This strategy is built on real results and revenue growth derived from having published pricing available along with the potential for dramatic growth in networks and participants in the direct pay ecosystem.  Wade also sees explosive growth opportunities in syndicating their services, participating in value networks, and staying ahead of the curve as the move to self-funded strategies becomes more prevalent.