Having worked with healthcare payers and providers for many years, I’ve seen how the healthcare industry lags significantly behind other sectors in digital transformation, especially when it comes to managing documents and patient communications. While industries such as banking, retail, and even telecommunications have swiftly adopted digital-first, customer-centric strategies, healthcare remains entrenched in fragmented systems, manual processes, and paper-based workflows.
This lag not only impacts operational efficiency but also has profound consequences for patient trust, satisfaction, as well as how and when they pay.
That is not to say there is no hope. In speaking to healthcare payers and providers, there is a real appetite to improve patient communications, however putting the patient first in every interaction requires real work beyond just adopting and integrating new technologies.
So, what should the healthcare sector be thinking about when it comes to communicating with patients? In this blog, I focus on the Explanation of Benefits (EOB) as an example of a document that can change the face of the patient experience.
First, let’s define the market.
Payers and Providers in Healthcare
In the healthcare ecosystem, two key players need to be understood: payers and providers.
- Payers are the ones that finance healthcare services, including insurance companies and government programs like Medicare and Medicaid.
- Providers are the healthcare entities that deliver direct services to patients—hospitals, clinics, physicians, nurses, and others. They diagnose, treat, and manage patients’ health and manage billing, reporting, and compliance.
Both payers and providers heavily rely on a constant flow of documents and data to communicate, process claims, and provide care. Yet, the industry’s archaic methods for handling these documents often result in inefficiencies, errors, and confusion.
Healthcare’s Digital Transformation Lag
The healthcare market is notoriously behind in adopting digital tools and transforming patient communications. This is evident in the disjointed nature of critical communications such as authorizations, EOBs, bills, and open enrollment documents. These touchpoints are crucial in guiding patients through their healthcare journey, yet they often come across as confusing, fragmented, lacking empathy and personalization.
EOBs: A Case Study in the Complexity of Healthcare Documents
The EOB serves as a prime example of healthcare’s document challenge. An EOB is intended to break down a patient’s healthcare costs, services received, and insurance coverage. However, these documents are often full of jargon, unclear explanations, and disjointed information.
The process of integrating patient data with financial data across multiple touchpoints in the patient journey only adds to the complexity. Moreover, the timing of EOB delivery can further confuse patients, arriving long after the service has been rendered and making it difficult for patients to reconcile their bills.
I am not alone in saying that in healthcare, clarity and timeliness should be paramount. Yet, traditional EOBs, often delivered in static PDF or paper formats, fail to meet these needs. These outdated methods of communication can lead to misinterpretation, frustration, and a lack of transparency in the healthcare experience.
Transforming EOBs with AI and Data-Driven Approaches
To address these challenges, healthcare organizations must shift their mindset around EOBs and other patient communications. It’s no longer sufficient to take static documents and convert them into digital formats like PDFs or even HTML5. Instead, the industry needs to fundamentally rethink how these communications are delivered.
By leveraging AI and data-driven approaches, EOBs and other healthcare documents can be transformed into interactive, patient-centric experiences. AI can be used to personalize content, ensuring that patients receive relevant and easy-to-understand information based on their specific needs. Moreover, dynamic digital formats enable real-time updates based on a patient’s action or even reaction to a document.
This shift from document-centric to experience-centric communications will enhance patient understanding and satisfaction, ultimately reducing the confusion and emotional distress that often accompanies healthcare documentation.
The Road Ahead
The healthcare industry cannot afford to remain complacent when it comes to digital transformation. As patients increasingly demand more transparent, personalized, and accessible communications, payers and providers must embrace digital-first solutions. By revolutionizing documents and focusing on improving the patient experience, healthcare organizations can improve patient engagement and satisfaction.
