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Riverside’s Innovative Solution to Price Transparency Extends to Cost of Care Estimates

Riverside’s Innovative Solution to Price Transparency Extends to Cost of Care Estimates

Nothing is more important than health. That’s why the team at Riverside Health System explains every step of a patient’s treatment plan in detail while allowing patients to access their health information 24/7 using MyChart, the online tool for a personal health record.

Riverside extends that same transparency to cost of care.

Congress passed the No Surprises Act effective Jan. 1, 2022, that is designed to protect patients from receiving surprise bills. Per the new regulation, health systems must publicly post the costs of items and their services online so consumers can estimate their cost of care and not be surprised by unanticipated costs.

Riverside not only met the federal regulations but seized the opportunity to exceed its requirements.

Riverside’s Shared Solutions Program is an annual program that provides Riverside team members with the opportunity to submit innovative projects that are making improvements in the delivery of health care at Riverside. During the 2021 Shared Solutions program, one award winning team focused on ensuring patients and loved ones had access to tools and resources to navigate price transparency and the cost of health care.

Jacqueline Parker, Riverside’s Director of Central Scheduling and Insurance Verification, and Allison Berry, Riverside’s Information Technology Director for Epic Access and Revenue Cycle Applications, spearheaded a Price Estimates Module that is both effective and accurate. “We created resources and tools to help our patients understand price transparency and what that means for their individual situation,” Berry said. “Patients may delay care due to concerns around cost – we don’t want that. We want to ensure that our patient’s focus is on getting well.”

Berry and Parker relied on Riverside’s electronic medical records system, Epic, to implement a Price Estimates Model that provides estimates for current patients using MyChart and “shopper” estimates for anyone wanting to see projected costs prior to scheduling a service. The online tool was live as of May 4, 2020, roughly seven months before the federal deadline.

Riverside’s Estimates Accuracy is in the top 5% of the Epic community and gives Riverside a competitive advantage not just in the region but nationwide.

The Personal Touch

Riverside’s cost estimates are as specific to the patient as possible.

“Our Care estimates are personalized,” Berry said. “It’s based on your physician’s order, your insurance, your benefits package, if you have a deductible or co-pay, etc. We make it as personal as we can, so it matches the statement you get after care is received.”

Both MyChart users and shoppers benefit as:

  • Both groups can generate an accurate estimate on their own, at their convenience, customized to their insurance plan.
  • Our Guest Care Estimates tool collects no personal identifiable information about shoppers. Shoppers do not need to create an account to login
  • The tool is user-friendly, requiring one click to begin. Patients login to their MyChart account. Shoppers login here.
  • For MyChart users, an electronic version of the estimate letter is automatically filed and available for pre-payments.

The No Surprises Act requires organizations to create an estimate tool for at least 300 shoppable services. Riverside exceeded that minimum.

“We have over 1,600 templates available,” Berry said. “If you’re looking at primary care or you’re a new mom or you need lab work, you can come here, add your insurance or skip that step, and get the quote in real time.”

After login or accessing the guest portal on riversideonline.com, users are directed to categories that include birth, cardiology, imaging and laboratory. Each category is further broken down into services. For example, the laboratory category includes 21 services, such as a Basic Metabolic Panel, CBC with Differential, a COVID-19 Antibody Detection Test and a Gestational Diabetes Screening Test. MyChart users benefit from having their insurance details already inputted into the system. Shoppers can input their insurance details and receive an estimate that they can email to themselves.

For those who prefer to speak to a representative, Riverside can provide the same cost estimate via phone.

The cost estimates are as comprehensible as possible, showing what is included and excluded.

An Industry Leader

Riverside’s estimate tool provides patients a quote than can be used to compare estimates with competitors, and applicable discounts are automatically calculated.

Riverside offers options for meeting a patient’s estimated amount due for a scheduled service. They include partial prepayments, payment plans and applying for financial assistance.

“They can also set up a payment plan before care or after they receive their statement,” Parker said.

If a service is not emergent, using the estimate tool to plan is especially helpful. “Depending on whether you’ve met your deductible, for example, can affect when you decide to schedule a service,” Parker said. “Having information ahead of time helps you plan for non-emergent care.”

While Riverside is well ahead of most major medical systems nationwide in working toward compliance with the No Surprises Act, the team continues to perfect the cost estimate tool.

“Our shared solution was not one and done,” Berry said. “Whether you can find what you’re looking for or you need assistance, we tried to make it as consumer friendly as possible. If patients can’t find what they’re looking for, we encourage them to reach out to us.”

Templates are consistently being monitored and altered if necessary to ensure prices are up to date.

While Berry spearheaded the project from the technical side and Parker from the operations side, Riverside received buy-in from multiple departments, including marketing, patient experience and the various specialties.

“It was an integrated workgroup,” Berry said. “Everyone knows that we provide great care at Riverside. We want to provide the same level of financial care and support as the excellent medical care provided by our physicians, nurses and other medical professionals.”