The Post-COVID-19 Patient Journey

This article provides strategic analyses and recommendations to assist decision-makers in prioritizing opportunities for improving the post-pandemic patient journey.

Addressed are changes that will likely become part of the “new” healthcare experience expected to emerge after the pandemic, including:

• The elevated priority of marketing and data’s role in driving outreach efforts
• Delivering on the scheduling overhaul and how digital, mobile and self-serve options deliver benefits for patients and providers
• The long-overdue realization of offsite, digital registration and the enhanced data quality that comes with it
• An understanding that social determinants of health have deep relevance to community health and an investment in data – and systems that can interpret that data – are accelerating
• More empathetic, accurate, transparent, and error-free collections and reimbursement functions that build trusting relationships between provider and patient and provider and payer
• …and more.

These and other changes underscore how the pandemic has been an event unlike anything previously seen in American healthcare and has become a catalyst for significant adaptation and innovation.

Introduction

COVID-19 changed the patient journey in America. It sped up the transformation that was already underway around the use of data and digital tools to enable better and varied access, engagement, transparency and control.

Providers and payers used telemedicine, touchless engagement and other innovations to make interactions simpler and more satisfying while simultaneously improving outcomes. Also impacted were patients, thrown into a rip current of change and forced to navigate a real-time learning curve. Looking back at 18 months following the first lockdowns, it’s clear the pandemic has been an event unlike anything previously seen in American healthcare.

There’s no question this upheaval influenced the patient journey going forward, so how can providers and payers thrive in this altered state?

There’s an urgent need to assess what worked, what didn’t and what changes were influential at a level beyond the immediate need of responding to COVID-19. What’s here to stay (and what may continue to evolve)? While the big picture is clear — increasingly, healthcare will be delivered on the patient’s terms — the details of what that may mean for the typical healthcare journey can be both nuanced and detailed. There’s absolutely opportunity today for providers and payers to respond with actions that help ensure patients experience the best outcomes, while also looking ahead at ever-newer approaches and technologies, such as artificial intelligence (AI), to ensure an even better and more resilient patient journey, and improved provider operations, going forward.

This article provides strategic analyses and recommendations to assist decision-makers in prioritizing those opportunities.

The changes that impacted every step of the patient journey

The enormity of COVID-19’s impact on society has been so great that what might appear hyperbole may actually be an understatement; the head of research at one global bank called it “… the most defining moment for this generation” and labeled kids who lived through it “Generation C.”

The changes that impacted healthcare were massive and quick, most relevant where people accessed their care, what they needed and expected from that care, and how those interactions and outcomes were enabled by digital technology.

• Rapid modifications to the “system”: The pandemic generated numerous challenges for providers, payers and physician groups ranging from novel diagnostic codes and new sources of information (behavioral, wearable capture) to unprecedented inpatient volume and government intervention impacting costing, billing and reimbursement. One author has characterized these systemic changes as “distributed, digitally enabled and decentralized.”
• A deferred care dilemma: Almost onethird of Americans put off healthcare during the pandemic, with many of them citing financial considerations, as well as fear of contracting the virus. Over half of all seniors cancelled their scheduled doctor visits and treatments. This created a significant challenge to provider resources and income during the pandemic (everything was dedicated to pandemic services) and is expected to impact population health quality significantly in the years ahead as the consequences of deferred care become clearer.
• Managing changed circumstances: On the jobs front, an estimated 40 million Americans were put out of work and, incredibly, just over half of all workers in North America plan to look for new work in 2021.

Insurance coverage will reflect these changes, informed further by the American Rescue Plan and provisions that may be forthcoming in coverage for conditions related to “long COVID-19” (symptoms that last weeks or months after initial infection). It’s also likely that many people have made healthy living a new priority, which will affect the type and frequency of their healthcare needs. This is good news for national health but disruptive to the organizations needing to pivot again from a pandemic to a changed healthcare market. The “new normal” will certainly include a lot of “new.”

Patients, being consumers, are unlikely to give up things that make their lives easier or more productive post-COVID-19. Neither will providers, physicians and payers. Obviously, the healthcare journeys for Generation C, and their elders, will be very different going forward.

Opportunities for better outcomes: transforming the patient journey

Step 1 — Marketing: finding and retaining patients

Knowing the community and keeping service offerings top of mind within that community were generally “business as usual” for healthcare providers, prior to the pandemic. Much of that came from encouraging regular onsite visits (e.g., checkups, tests, vaccinations, health education), which are reliable ways to assess patient conditions and gather diagnostic and related data that inform the patientprovider relationship. Digital transformation appeared sporadically in areas like using text or email notifications for communications, but this progress represented only a fraction of total engagement/marketing outreach.

The pandemic disrupted the marketing and community engagement that helped establish and develop patient relationships, creating immediate “reconnection” needs:

COVID-19 put tens of millions of people out of work and inspired even more to consider post-pandemic job changes, shifting the community profile of demographics, employment type and even insurance coverage.

People changed locations, with Pew Research reporting that roughly one-in-five Americans either relocated or know someone who did. Some areas saw patient populations decrease while others saw increases. The abruptness of these changes will impact regional marketing in the near and long term, and providers should respond with a sense of urgency, knowing there are other providers dealing with the same issues.

70% of patients deferred or canceled treatments during the pandemic and presented healthcare providers with an important question: Where are the patients and what do they need? The recovery period following the pandemic involves much more than just coronavirusrelated ailments. Assessing community health beyond pandemic issues requires generating high visibility within the community. Marketing plays a significant role in that, and third-party data can help fill information gaps that resulted from a dedicated fight against COVID-19.

Post-pandemic marketing opportunities:

• Reengaging with the community. There’s an immediate need to reengage the community beyond virus testing and vaccine distribution (though these remain relevant and require continued vigilance). Marketing and community outreach should communicate the importance of returning to the pre-pandemic healthcare routine. Of particular importance are mental health services and postponed treatments or procedures.
• Third-party data solutions. New sources of data can help explore and understand how the community has changed since March 2020, down to the individual consumer. For instance, what are people’s priorities in the new normal and how have expectations changed? Who has left the community? Who is new? What is the most accurate view of these new residents and what are their communications preferences?
• Enhancements in the patient experience. Changes implemented during the pandemic — digital scheduling and/or registration, telehealth options, and improved patient portals — need to be promoted clearly and often. Explaining how these services can be accessed and used helps rebuild a “normal” healthcare relationship with providers.

Step 2 — Scheduling: giving patients 24/7 digital access

An AARP survey of older adults (50+) before the pandemic found that a majority would prefer to have their healthcare needs managed by a mix of medical professionals and technology. Such a transition to what’s known as an omnichannel approach was already underway, though in healthcare it was often considered a nice-to-have innovation.

The pandemic supercharged the need to give patients more digital options, and scheduling was one of the most critical. A preference for digital engagement was evident during the pandemic across all age groups, illustrated by numerous anecdotal reports from providers on the growth in patient use of selfscheduling tools. During the pandemic, scheduling was challenged in a number of ways:

The need to quickly send staff home, juxtaposed against a rapidly increasing demand for testing, was one of the first reasons that digital scheduling solutions became so popular in 2020. Getting remote personnel established to maintain call center operations wasn’t easy or quick, and that was one of the primary touchpoints where screening questions helped manage the volume of people calling in for testing.

Another issue faced by call centers was mobile testing units and centers, which later became super sites for vaccinations. Many of these were set up in a first-come, firstserved manner until online scheduling was introduced, at which point the site traffic and call center volume was managed much more efficiently.

The game-changer was patient selfscheduling. Once patients could reserve their own times for tests and vaccinations, a significant burden was removed from the call centers and they took a more active role in rerouting patients needing care that wasn’t related to COVID-19. When vaccinations became the primary driver of patient traffic, self-scheduling added more functionality. Due to the inconsistent availability of the vaccine in the early days of distribution, the task of managing the constantly changing time slot availability was overwhelming. Automated messaging (text and email) provided significant relief getting information to patients at scale when vaccination appointments required cancellation and rescheduling — or when a reminder was needed to make sure patients remembered their second shots.

Adapting the scheduling process to accommodate virtual health and the explosion of offsite and on-camera appointments was one of the hallmarks of digital change during the pandemic. There was a need for new templates, a revised flow of scheduling and registration that could be completed online. The continued improvement of both telehealth and the supporting functions around it point to an expanded use case in the future.

Post-pandemic scheduling opportunities:

• Make 24/7 self-scheduling permanent. Digital self-scheduling solutions implemented during the pandemic should be formalized and integrated if they haven’t been already. There should also be a focus on ease-ofuse and expanding digital scheduling to more service offerings. Patient behavior had shifted to expect and prefer online scheduling before the pandemic. This was reinforced by the multiple challenges COVID-19 presented. The digital preference is understandably influenced by demographics, but even older age brackets are showing appreciation for self-scheduling.
• Expand the digital experience beyond self-scheduling. While arguably the most significant impacts to efficiency and productivity are realized via patient selfscheduling, there’s no need to stop there. In fact, there are multiple reasons to expand on self-scheduling capabilities. Integrating multiple specialty services into the scheduling system streamlines referrals and balances patient volume between specialists, giving self-scheduling patients the ability to check appointment availability across providers. And integrating this into the call center scheduling system keeps call center representatives in-the-know and able to better assist those who call in for appointments or with questions. While the patients are obvious beneficiaries of this configuration, physicians will welcome more appointments, scheduled according to their preferences and scheduling rules, with significantly fewer cancellations and higher-quality engagements.
• Better preparation for the next pandemic — or the flu. It’s never too early to think about the next pandemic — or an evolved COVID-19 virus — that will overwhelm the healthcare system again. In fact, the annual flu and cold season can create similar patient volumes in regional hot spots, and often does. The value of digital scheduling, with its prescreening capabilities, real-time availability status and patient outreach functionality, should be a cornerstone to managing any similar event in the future.

Step 3 — Registration: a familiar pain point

Confirming patient identity at registration has been a challenge hiding in plain sight for decades. It’s estimated that nearly 1 in 5 patient hospital records were duplicates before the crisis. This translates to additional costs for providers and payers and poses potentially dangerous impacts to health outcomes, too. Information capture, which often relied on patients to provide accurate health histories, remained a manageable annoyance up to the pandemic. Then, the burst of patient traffic that accompanied COVID-19 testing and vaccinations moved the problem beyond “manageable.”

At least a fifth of all hospitals across the United States reported “critical” shortages of staff and many had faced challenges collecting and sharing data. This means that the accuracy and integration of patient data in many healthcare systems suffered; going forward post-pandemic, this data will need to be cleaned up and reconciled. Now’s the time to address the root causes of duplicate records and incomplete information before the situation gets even worse.

The pandemic forced available staff to work with unfamiliar registration processes. The challenge to identify patients quickly often resulted in the creation of new records. Going forward, accurate patient identification will require robust patient records matching capabilities that reconcile information and flag when two “different” files are really the same person — or vice versa.

The risk of error also increased during the pandemic due to the remote and temporary setting for a number of services, such as testing and vaccinations. It wasn’t uncommon for the patients to be the sole providers of information that was then manually associated with their treatment. This was a setting ripe for misinformation and missing information, leading to incomplete and/or duplicate records.

Post-pandemic registration opportunities:

• Move registration out of the waiting room and into the living room. The pandemic created the need for “contact-less” care and services but, before the pandemic, these were known simply as mobile or remote capabilities. Preregistration via text or the patient portal delivers numerous benefits for patients and healthcare providers, ranging from better authentication and identity management to improved coverage verification, cost estimates and prepay options to — of course — no more need to fill out numerous forms in a waiting room.
• Improving coverage verification and patient financial clearance. Identity management underpins much of the data-intensive tasks that occur at registration. Other resources moving from “nice-to-have” to “operational need” include coverage discovery and financial clearance tools. Developing a full and accurate profile of the patient includes more than a clinical history and the pandemic highlighted how the healthcare system needs to better prepare for events that impact coverage and ability to pay, the most obvious being a national increase in job losses.
• Enabling payments at Point of Sale. Providers are in the position to collect payments from patients at registration. Accompanied by accurate price estimate tools and informed by a financial clearance tool that leverages several data sources, enabling patients to pay their portion of healthcare at registration improves patient trust while simultaneously speeding up provider collections.

Step 4 — Authorization: getting patients the approved care they need

Authorization is traditionally an administrative step that’s often confusing for patients, labor intensive for physicians and other providers, and critical for payers in their efforts to mitigate risk. It’s peopletime intensive, often relying on the knowledge and expertise of staff to navigate the process intricacies.

COVID-19 made this challenge more difficult and complicated and showed that addressing the amount and roles of people and data are central to getting patients the approved care they need.

The limited number of elective surgeries and nonemergency services during the pandemic resulted in fewer administrative staff (who were also often shifted to positions related to the crisis), complicating efforts to process prior authorizations and other documentation. Now that those appointments are being rescheduled, questions must be answered, such as:

• Are they still medically necessary?
• Have patient conditions changed?
• Has coverage remained the same?

There’s evidence that authorization requirements are returning to previous levels, with one report saying that 81% of medical groups saw payer prior authorization requirements go up since 2020. It’s likely these requirements will continue to grow as responsibility for collecting decision-relevant data is shifted from payer to provider, which in turn can improve time-to-pay and reduce nonpayment.

Ensuring a positive and trustworthy patient experience post-COVID-19 will mean doing everything possible to avoid shifting this responsibility for more information onto patients, instead ensuring data system(s) are more robust and capable of accessing and appending that data to their files.

Post-pandemic authorization opportunities:

• Establishing medical necessity. Some payer requirements were changed or suspended during the pandemic and will continue to evolve. Manual data entry limits a provider’s ability to meet those requirements in a timely and reliable fashion. Automation of processes can reduce the burdens on administrative staff and increase the likelihood and speed of reimbursement.
• Providing notice of admission/care. Gathering and submitting accurate patient admission, observation and discharge data will likely be overwhelming in the short term as the healthcare system braces for patients to return to hospitals, group practices and clinics. “Chasing paperwork” is always counterproductive and more so in the months following the pandemic — with no guarantee that there won’t be flare-ups. Staying compliant and optimizing revenue will require a level of automation; the more the better.

Step 5 — Treatment: getting a more holistic picture of your patients

Healthcare is familiar with the capture and analysis of clinical diagnoses, but it’s now commonly accepted that the “continuance of care” and factors that influence that post-clinical experience are as important, or more so, to clinical outcomes. The term “big data” (or “smart data” more recently) recognizes that nonclinical data can be aggregated to provide insights beyond what clinically collected data reveal.

The pandemic further revealed the impact of behavioral and socioeconomic, or social determinants of health (SDOH), and the necessity of adding them to the diagnostic arsenal.

COVID-19 revealed significant correlations between socioeconomic indicators and mortality. Specifically, SDOH helped inform areas at higher risk for contracting COVID-19 because of mobility and socioeconomic factors like overcrowded housing or housing instability.

SDOH were commonly associated with reducing access disparities for certain social economic and at-risk populations. A better understanding of the population and nonclinical barriers to health allowed care providers to build strategies that made care, such as patient screenings, more accessible for vulnerable populations.

Continuity of care was front and center when leveraging SDOH during the pandemic. Financial challenges (e.g., unemployment), lack of reliable transportation and/or limited access to technology can all play a part in why a patient keeps requiring readmission or isn’t “getting better.” These factors, when flagged, give a provider the needed information to discuss solutions with the patient, designed to overcome nonclinical barriers to care.

Post-pandemic treatment opportunities:

• Adding socioeconomic indicators to patient profiles. There’s an immediate need to elevate the amount and detail of socioeconomic information for informing care planning, as this information not only helps inform treatment decisions but also supports care outcome assessments. Care providers need to know not only that a patient has a lifestyle issue that relates to their condition but that they’re situated to embrace a community program (or not). This data is available now but not readily or regularly included in patient files in ways that are integrated and searchable. “Notes” fields in paper or electronic forms aren’t enough.
• Creating more robust care plans. Once behavioral and social determinants of health are identified and included in a patient profile, they provide more and potentially potent channels for treatment, like proactively engaging a social worker or dietician or nutritionist in triage. This data enables holistic treatment instead of just addressing specific ailments.
• Increasing patient agency. The pandemic illustrated patients’ willingness to take more active roles in their health, and this trend is likely to continue. Providers can build on this with SDOH and combat barriers to healthy outcomes like food instability, housing instability, access to medication and more, focusing efforts to understand the environmental factors that may hamper health equity. Doing so isn’t possible unless there’s turnkey data available for such use.

Step 6 — Claims: reducing the time to payment

Time looms large in the healthcare revenue cycle. The longer it takes to notify patients what they’ll owe, inform providers how much they’ll be reimbursed and give payers a clear picture of their payment requirements, the more fragmented and less satisfying the experience for all involved. Payer replies to claims vary and can take a while, depending on state-level regulations. More time is spent once a submission is deemed incomplete or a denial (or partial denial) is issued, effectively resetting the clock on the process, which further leaves every participant unclear as to ultimate costs.

The pandemic made these challenges more pronounced:

COVID-19 revealed the slowness of traditional claims processing, which usually involves multiple and varied steps. Also, patients were typically removed from traditional care during the pandemic, and many changed insurance coverage or moved to a new location — sometimes both — creating claims hurdles that could impact claims efforts for a while.

Claims denials trended up 23% in 2020 (a steady increase since 2016), which is an ominous sign for many hospitals and health systems in dire need of recouping revenue via patient visits that had been postponed by the pandemic. Improving the speed and accuracy of claims will be critical going forward.

Post-pandemic claims opportunities:

• Improving likelihood of approval. The immediate need is to improve the likelihood of claims approval, as well as ensure timely resolutions. The volume and complexity of post-pandemic claims will stress provider profitability. Using data tools that ensure accuracy in areas like billing codes and contract management results in more accurate submissions and can address this challenge head-on now and in the future.
• Making payments more seamless. As noted earlier in this paper, accurate patient identities and histories enable a variety of benefits across the healthcare journey, including making cost and payment responsibility visible to patients and providers. Reliably knowing what claims will be covered, and when, gives providers the confidence to engage with the patient, providing clear direction on what they’ll owe.

Step 7 — Payment: improved payment experiences

Prior to the pandemic, a considerable number of Americans declined healthcare due to the expected cost of care. The concerns were valid as incurred costs caused many bankruptcies. These factors continue to have significant implications for provider and payer success, too, often starting when the patient’s personal and adaptive engagement with healthcare providers shifts abruptly to impersonal and inflexible experiences related to the financial component of that journey.

The pandemic has exacerbated this problem and raised awareness of the disparity between the patient payment experience in healthcare and their experiences as consumers in other aspects of their lives.

As many as half of nonretired adults expect to suffer financially long term. Other industries are poised to respond to these pressures with established flexible payment arrangements, and the data tools exist for them to do so.

Digital payments of all types (credit cards, mobile payment apps, bank transfers) were all up significantly during the pandemic, as consumers elected transactions that could be accomplished remotely or touchless, and this growth will continue.

Effectively, all consumers expect easy access to their data, and this includes awareness of status and affirmation that their data is protected. Providers and payers will need to navigate the potentially conflicting needs of more disclosure and less privacy risk.

Post-pandemic payment opportunities:

• Integrating third-party data. Reducing bad debt calls for more than a few setand-forget tweaks to the revenue cycle management process. From the moment a patient is admitted, a healthcare provider should be able to see the coverage they have (or don’t have). Access to third-party data helps significantly with this and also adds a powerful tool for personalizing the payment experience before engaging the patient. The data helps provide a clearer picture of the patient’s ability to pay in full, or if a flexible payment plan tailored to the patient’s unique financial situation is more appropriate. The data may even point to financial aid (partial or full) as the best option. Leveraging data ultimately improves the patient experience and increases patient loyalty, and that typically leads to increased patient payments, reducing providers’ cost to collect.
• Offering more payment options. More robust and accurate patient profiles will enable more realistic, flexible and effective alternate payment models (APMs). This will also inform payment innovations (such as offering financing options at registration). The providers and payers that are first to implement these will be differentiated in the marketplace.
• Expanding technology used to help administer payments. Unfortunately, writing off patient-owed balances is not uncommon, and the pandemic will likely make it worse, but it could be much more infrequent if technology is used more strategically. Patients returning to a care setting will expect a greater diversity of payment tool options, especially those choosing telehealth. For many, the pandemic tightened the financial belt, so helping patients commit to and enroll in the right payment arrangement, and securely storing those patients’ credit cards on file, is especially important. This reduces a provider’s exposure to bad debt write-offs, improves the bottom line, reduces cost to collect and improves the patient experience. If there’s ever a need to balance bill patients, simple, easy-to-reach statements are effective, and communicating with patients in their preferred notification channel (e.g., text, phone, online portals, chat, paper statements) makes a significant difference, as does being able to process a payment any time, any day of the year.

Conclusion

Healthcare is moving toward a patient-centric model, delivering care when, where and how it best accommodates patients. COVID-19 both energized and challenged this shift, and its impacts were visible at every step of the patient journey.

The post-COVID-19 patient journey will continue to become more customized, flexible and transparent, and it will be increasingly based and reliant upon a digital framework that connects and empowers patients, providers and payers to be active and more integrated partners in its success.

The opportunity now is for providers and payers to respond to these changes, which will address short-term needs such as handling the expected influx of patients returning to their care journeys post-pandemic as well as set a course for long-term improvements in both patient health outcomes and business performance.

COVID-19 changed the patient journey. Healthcare providers and payers will benefit from adapting future strategy to accommodate these changes.