HIStalk Interviews Scott MacKenzie, CEO, Passport Health Communications

Scott MacKenzie is CEO of Passport Health Communications of Franklin, TN.

Tell me about yourself and about the company.

I’ve been CEO of Passport since 2009. I worked originally with Electronic Data Systems as a programmer in healthcare. I’ve worked with Cerner, NDC Health, and McKesson. I came to Passport in 2009, so I have a lengthy background in healthcare, always in healthcare technology.

At Passport, our focus is on patient access and payment certainty. With patient access, our focus is on the front end, or the onboarding part of the process when the patient is entering the healthcare system, be it the hospital or the physician’s office. Understanding the demographics, understanding their benefits, making them aware of their responsibility, and trying collect if possible.

Also, looking at the order and understanding if you need to run medical necessity, if you need to make them aware of advance beneficiary notification, if you need to run pre-certification. It’s really a focus on the front end of trying to get everything as clean as possible to avoid denials, avoid rework on the back end, and to make the patient aware of their responsibilities so there’s no confusion later on.

Around payment certainty, obviously getting that patient payment where appropriate and also payment certainty in terms of using that information to drop a clean claim if it’s covered by a third party. 

That’s our focus. We’ve been around since 1996 in that market. We’ve got almost 2,000 hospitals and over 6,000 physician organizations that work with us.

Several companies offer a similar roster of services. What interests your customers about Passport instead of one of your competitors?

I think the biggest difference with Passport is we have worked to be the experts at what we do. This is what we do. For example, we look at the content going to the payers and coming back from the payers. We have teams of people that actually study that. We normalize that information and put it in the right format for the provider so they know what to do.

If you look at the flagship product at Passport, One Source, it began with taking that payer response and putting it on a Web site where the provider could look at it. It would be the response regardless of which payer you are dealing with. If you’re dealing with Blue Cross Blue Shield, Aetna, Cigna, Medicaid, or Medicare, it all shows the same way with the same fields.

As you know, there are standards, but is still a lot of variation in terms of how the payers respond within those standards. We spend a lot of time normalizing that information, normalizing those responses, and really getting the provider what they need to make the right decision relative to the patient’s benefits and the patient’s responsibilities. We specialize in understanding and analyzing this information.

We can also understand and analyze it and put it into an HIS system. We co-exist with the HIS system that the provider has chosen and put that information in there so they don’t have to do a lot of rules or a lot of rewriting to try to re-codify that information based on one payer’s response being different from another payer, for example.

We’ve also written a Software as a Service package that covers the whole workflow of patient access and also the back-end revenue cycle tied to that. We’re really focused on making it exception-driven, trying to drive the workflow to get the best results and to hold the staff accountable in terms of checking the right things, making sure that it’s a quality registration, and it’s a quality claim as well. Having that software available is something that differentiates us from what  you might think of as traditional clearinghouse.

Do you often find patients mis-categorized as self-pay, or those who produce an insurance card but really don’t have coverage?

We check the demographics. If they’ve given information around their name, birth date, and address and it doesn’t all check out, we can say, “This does not look like the same person as what’s been presented.”

There’s a significant number of folks where the initial coverage they present is not correct, but we are able to find the correct coverage, maybe secondary coverage or maybe alternative coverage. There’s also a number of self-pays where we run through a coverage determination process and we find coverage. Perhaps the birth date was put in incorrectly or the name was misspelled. We’ll go through algorithms where we try to find common spellings of different names.

There are also situations where for some insurers, you’ll get a higher hit rate if you don’t send certain information. For example, don’t send the middle initial if it will give you a response that the patient isn’t found or isn’t covered.

Where are hospitals with the ability to quote prices and accept patient payments at the point of service?

I think it’s still relatively small, but I think that’s one of the highest growth areas.  It’s being driven by the fact that it’s revenue leakage. Once that person leaves, your collectability drops. What I’ve read is about a 50% write-off rate plus up to 20% cost to collect. There’s a significant haircut once that person leaves the office.

It’s also driven by the fact that people are responsible for a higher portion of their payment. You see these high-deductible health plans, you see employers shifting more to the employee. It used to be no big deal if we wrote off part of that. Now, it’s significant. We’re seeing a lot of activity. Most of the for-profits are doing it. I think most of the non-profits are looking at it and are in the process of implementing or at least considering it. I’m guessing 20% of the market does more than just the co-pay. But it’s a very high-growth area for us and a very high-growth area in the market as well in terms of estimating the additional payment and collecting it.

Do you think the lack of penetration of point-of-sale pricing is because of technical reasons, or is it that people struggle with the idea of paying upfront for routine healthcare services?

I think it’s the second piece. Healthcare has been an entitlement for a long time. You have a lot of non-profits that have come to exist to provide healthcare. It’s very difficult for them to have those hard conversations in terms of the patient’s responsibility.

I also think a lot of people feel they’re entitled to healthcare, that it’s different than getting your car fixed. I understand in the emergency room that care has to be given, but if it’s an elective surgery or an elective process, it’s totally appropriate to have to pay for that. Personally, I like knowing what my responsibility is because I usually get the bill. I’ll wait until the third or fourth bill to find out what the actual collection amount is. Knowing that upfront allows people to plan as well.

But like you say, it’s like in any other industry for more and more people to be accountable for their cost of care. Also, for them to understand the price of what they’re doing. It’s one of the levers that we can use to drive down the cost by people being smart consumers, so I think it’s good for the system as well.

Do see any possibility that that will move even closer to the patient, where instead of getting a bill after their treatments, the provider says something like, “I’m going to give you this shot, but here’s what it costs” and maybe the patient says, “Well, no, it’s not worth that.”

I do. I know there are some companies that are out there trying to do it.

The problem right now is that a lot of providers are uncomfortable giving their lowest price. Maybe they’ve guaranteed certain insurers certain prices. There are a lot of concerns around pricing transparency.

I do see a lot of movement in the market in terms of companies that want to do that. I think more and more consumers are interested in that. A lot of our clients use our payment estimation product for people who call in. There are people who are medical shoppers. Our employees, for example, can choose a high-deductible health plan where if you spend intelligently, you can keep the money left over in your healthcare account. That’s your money. That causes people’s behavior to be different, where people do ask, “How much is this going to cost?” The provider needs to be able to respond. 

I do think that will become more common. It’s still a small portion, so I don’t want to over-represent it, but I do think it’s a growing portion of the population who wants to understand the cost of that care before it’s provided. More and more providers want to be able to give that to them. I read an article that Walmart is looking at becoming more active in the provider community. That will be interesting to see how they change it as well.

Hospital charges are mostly funny money. They often don’t even know what something costs – they just made up some charge years ago and increment it every year by some percentage increase. Would Passport ever be involved in hospital charging?

We don’t do anything in terms of helping them to create a charge, but we pull their historical information so that they can understand what they’ve charged historically for that procedure. Then they can load rules in terms of, “Here’s how much I would charge a self-pay patient for that.” We help them give an estimate for a call-in, walk-in, or if they’re doing another procedure and the patient wants to know what it’s going to cost. It actually prints it out on a PDF. The hospital can hand this to the consumer and they can ask them for payment right then and there if they’d like to.

We definitely do that today. That’s generally driven by norms in the market, as opposed to, as you said, building up a cost-based structure. It’s more based on market norms in terms of what they’ve been charging for that similar procedure based on their third-party agreements and based on other self-pays. That’s definitely something that we support.

I think probably everything’s been said about version 5010 that ever needed to be said but do you have anything interesting to add to that whole debate?

No. We’ve got a number of payers live now, but there’s a huge amount that still are not. It’s going to be interesting to see how all of this occurs.

A lot of work has gone into it. At this point, we’re past the point of investment. We’re really at the implementation stage. We see a lot more activity happening right now. More providers are testing and more payers are coming out with it. It’s a huge amount of work. There’s so many things going on with 5010 and ICD-10 and the Affordable Care Act. Hopefully they’ll result in benefits down the road.

If Accountable Care Organizations take off like everybody seems to think, what will the effect will be on your business?

The biggest thing will be that at the point of eligibility or at the point of accessing the health system, it’s not only going to be, “Are you covered?” but “Are you covered here?” and, “Are you covered here, and under what pricing mechanism?” 

Depending on how this all finally rolls out, you may find that when you go to a particular provider, the answer is “Yes, you can have services here, but here’s the differential on terms of the payment that will be made for this.” I think it’s going to add an additional dynamic to the eligibility process:  “You’re covered, you’re covered for this procedure, but you may or may not be covered at this location.”

I think there will also be more dynamics in not just getting you in for that procedure, but setting up the logistics for that procedure for follow-up.  Such as, “We’re going to do this knee replacement, but while you’re here, we need to set up your physical therapy and make sure we follow up with those appointments so we provide the standard of care that we’re committed to as part of the ACO.”

The onboarding process will become more rigorous. That’s an opportunity for Passport. It’s going to make our transaction more important.

Everybody’s jumping into the ACO waters because the government says it’s a good idea and they’re afraid someone else will do it first. Is the IT support available to let them be successful?

I think it’s going to have to evolve. For things that people are committing to or looking at, there are capabilities in systems, but those capabilities have to be turned on or implemented.

There will be cultural changes that have to take place totally separate from the technology. There’s been such a wave of new technologies over the past few years that I think the footprint’s in place, but a lot of people who’ve turned on this technology just got it on. They’re going to have to do additional things in implementing it and in terms of what they track to support the ACO.

A lot of the technology that’s out there didn’t originally consider this concept of a commitment across a spectrum of care. I think there’s probably some upgrades to some of the systems that will have to occur, with additional investment or additional tweaking. But we’re a lot better prepared than we were five years ago.

Any final thoughts?

Healthcare has always been dynamic. If  you look at what’s going on now with ICD-10, 5010, and the Affordable Care Act, there’s a lot of transitions occurring. Those challenges are opportunities for technology to help.

My goal, and I think the goal of all technology suppliers, is how can we make our technologies support these changes and have the least impact to providers? That’s going to be the challenge we’ll all face in the next few years. Is technology going to support the ACO movement? I think it’s the responsibility of the technology suppliers to invest in their technologies, to upgrade their systems to support these things. The changes aren’t going to stop. Having flexible technologies and having people who are engaged in making that technology stay current with the changes will be important.

I also think that engaging the patient is going to become more and more important in terms of standards of care, the patient being accountable for care in terms of coordination. I hope you’ll see a lot more around patient engagement and people taking more of an active role in their care. That’s another way we can improve people’s health and reduce cost to the system.