‘Normal’ Isn’t Coming Back To Healthcare Because We Can Do Better

Trying to make big changes to how medical care gets delivered and paid for was a slow, uphill battle until COVID-19 hit, Ryan Krause, vice president at healthcare software company Epic Systems, told PYMNTS in a recent conversation. But the industry is making major pivots on how it provides services, as well as how and when it brings tech tools to bear to generate both better outcomes for patients and more effective resources deployment for providers.

“The system has changed, [and] consumers are really changing how they think and how they approach healthcare,” Krause said. He said the public is warming up to “things that maybe have had trouble gaining traction in the past.”

For example, Krause said that Epic has offered the capacity for telehealth video visits with doctors for seven or eight years, but enabled fewer than 50,000 appointments in February before the pandemic hit America. But after COVID-19 took off, that number jumped to 2.5 million by April.

And while he said consumers will eventually return to something more like normal office visits, the healthcare system can’t and shouldn’t go back to its old ways.

Krause said that too expensive, inefficient and ineffective to meet the needs of patients or providers. As Epic’s tools are getting wider use, he said, patients and providers are learning there are much better options.

Making Medical Care More Than Just Office Visits

Epic has been developing medical tech for some 40 years, and about 3,000 hospitals and more than 250,000 physicians currently use the firm’s software.

One priority for providers during the pandemic has been finding ways to continuously offer care even when their offices are shut down. A tool that Epic has long offered is the MyChart App, which providers currently use to connect with roughly 165 million patients worldwide.

Krause said the app serves as a digital clearinghouse where patients can interface with their physicians and electronically schedule appointments, make payments, transfer medical data and even keep up to date in real time on their COVID-19 status.

“We lead all patients through a symptom checker if they think they might have COVID-related problems,” he said. “The system will handle the triage and say, ‘OK, you should go to a mobile-testing site,’ or ‘We should set up a video visit with your provider,’ or ‘We’re actually going to need to see you for this particular issue.’”

The app’s features were popular before the pandemic, he said, but are enjoying much greater use as telehealth visits rise. Krause said Epic’s challenge now involves expanding such communication capabilities over more channels, such as chat services.

“I think that that’s very helpful to people right now, because they are feeling disconnected somewhat from their doctor, where they don’t get to see [providers] face to face as much anymore,” Krause said.

That greater ability to connect digitally with providers is already changing how healthcare is provided, he said. And things will likely keep shifting as patients get habituated to reaching out across digital channels to get the exact care they need exactly when they need it instead of all care occurring at a doctor’s office.

Making Medical Billing Transparent

But Krause said that in addition to the industry changing how it provides care, Epic is seeing real momentum toward changing how healthcare is billed — making massive billing “surprises” no longer a standard part of the experience.

Many patients have had some variation of the “surprise bill” experience. That’s where one gets several mailings from a provider with a long list of numbers, one of which might actually be the amount that a patient owes out of pocket. Or not.

Even worse, Krause said that getting a price estimate before a procedure take place has historically been hard. He said that’s not because providers didn’t want to help patients plan, but because they themselves had no idea about what a procedure would cost — and no easy way to find out.

“I don’t think you’d find any healthcare provider who would say, ‘I don’t want to let patients know what they have to pay,’” Krause said. “It’s just that they didn’t have good data and tools in the old days to come up with that ahead of time.”

But Epic has built tools to let physicians quickly look up and offer cost estimates on various procedures. The company calculates prices by using historical and insurance data.

Krause said that since many U.S. consumers are paying ever-increasing shares of costs out of pocket, it’s reasonable for them to understand those costs in advance and begin developing a payment plan. He said Epic designed its software both to provide such transparency and create an easy path for health systems to set up payment plans ahead of time.

“It’s mutually beneficial that patients have a better understanding of what they have to pay, and have some options to make those payments that are convenient and mobile,” Krause said. “We also want to make sure that health systems continue to make their bottom lines, so that they can stay afloat and provide really good care,” he added.

“What we have seen in recent months is the digitization makes it possible to pursue both of those beneficial ends at the same time for both parties.”