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Use patient segmentation and targeted messaging to increase revenue


Automation can help physicians improve the patient’s billing experience and boost revenue.

The patient’s clinical experience is often treated as separate from their financial experience, but it should be, according to Dan Peterson, founder and chairman of Loyale Healthcare, a healthcare technology company.

In the early days of medicine, Peterson says, “The family doctor was someone who really knew you and people believed they really cared about you.”

Peterson says that the relationship between patient and physician has been negatively impacted by insurers, who have gotten in the middle and caused a “fundamental disconnect.” 

He says that the shift toward value-based care presents opportunities to push physicians back toward working on improving the patient’s billing experience. One solution is to use what he calls patient segmentation and targeted messaging in billing. 

Patient segmentation 

Through the use of analytics and artificial intelligence (AI)-based automation, physician practices can use data to divide their patients into quadrants. Starting with two basic measurements: a patient’s ability to pay, and willingness to pay, he recommends breaking patients down into four segments:

  • Willing and able to pay
  • Willing but unable to pay
  • Able but unwilling to pay
  • Unable and unwilling to pay

The most powerful segment to target, he says, is the able but unwilling quadrant. 

“Most of us who have a job and health insurance actually fall into that quadrant. That’s the place where our clinical experience may have been superior but it doesn’t match up with the administrative or financial experience we had,” he says.

This may be due to patients receiving too many or confusing bills, inaccurate totals on their bills, limited payment options and other frustrations.

Targeted messaging

Loyale uses analytics and demographic information, such as non-intrusive credit checks and health data to help physicians shape the messaging of billing communications. 

“If I’m sending you a bill as a physician, and you’re the grantor but the bill is for your child, I can frame that communication in a way that is going to resonate with the way you look at the world and significantly improve your propensity to respond positively to that invitation to pay,” he says.

Targeted messaging can also help encourage patients to take better care of their health, and get them in office more often, which also can increase their likelihood to pay any outstanding balances, Peterson says.

“If you’re the kind of person who really takes responsibility for your health-you eat right, you exercise regularly-then we would put together a template that says ‘As someone who has already demonstrated your willingness and ability to take responsibility for your health, we want to remind you that it is time for your colonoscopy this year.’”

This kind of messaging, he says, has been shown to increase a patient’s positive response.

To track the effectiveness of this kind of messaging, he recommends physicians conduct a test by sending out targeted letters to half of a patient population but not the other, and tracking who pays more quickly and more often. 

Both patient segmentation and targeted messaging are really only made possible, however, through automation. 

“You have to bring automation tools into play, otherwise it would be overwhelming.”

These tools, he said, are changing, too, to reflect the way healthcare billing has changed. “For the last forty years, tools have been built, basically, around trying to figure out how to get the insurance company to pay you, whose job it was to pay you as little as possible. Now, increasingly, it’s more about collecting money from the patient.”

Peterson says this is a positive shift. “We’ll go back to viewing patients as a customer and a person, rather than as an instrument that justified an insurance payment,” he says. “Caring about people is a terrific way to get paid.”




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