Patient access staff at The MetroHealth System, Cleveland, use the CARE approach (Connect, Apologize, Resolve the issue, Express gratitude) to address patient concerns. The goal is to make an emotional connection with patients, says Donna Graham, senior director of revenue cycle.
“We not only capture the facts provided, but also use emotional intelligence to comprehend the feelings, emotions, and patients’ perception,” she says.
Here are examples of how patient access staff use the CARE model:
• A patient with secondary insurance says he is not feeling well and is concerned about what he owes, and he angrily states that it needs correction now.
Connect: Mr. XXXX, my name is xxxxxx. I understand that it might be difficult to discuss the bill at this time, when you are not feeling well.
Apologize: In reviewing your account, I want to apologize that only your primary insurance was captured.
Resolve the issue: I understand that your services were allowed by your primary insurance, with a portion going to your deductible. I identified, from prior services, your secondary insurance is XXX. I would like to take few moments to validate the Aetna information so we may ensure we bill correctly so your insurance pays appropriately. (Verify data.) The claim will go out today. It will take approximately 30 days for payment. We will flag your account to ensure payment or follow up. We will also pend the statement for this balance for service date xx/xx/xx. If you should receive one, it might be a timing issue. Please do not send payment. Our representative will contact you by (date) with an update to your account. In the meantime, you may call xxx/xxx-xxxx or email xxxxxx if you have any questions.
Express gratitude: Are there any other concerns that I may help you with? Thank you for your time and for allowing me to assist you.
• A woman with no insurance is waiting to be seen in Express Care with a cold, and she was sent to financial counseling without an escort as the department’s protocol requires.
Connect: Ms. XXXX, my name is xxxxxx. I want to reassure you that you will not be delayed in seeing the physician. I will receive a call as soon as your provider is available to see you and escort you back to Dr. XX’s office.
Apology: I am sorry that you needed to come to my office without an escort. I am here as your advocate to discuss with you how we may determine financial plans that would meet your personal needs to remove financial barriers for care — not only today, but also for future visits. It will take about 15 minutes of your time.
Resolve the issue: Here is a brochure of our patient financial communication information, which also reflects all of our sites that you may schedule appointments for. Based on your address, these are in your location for convenience. You may choose any locations, however. When scheduling future appointments, please let the scheduler know if there are any changes regarding your demographics or registration. Is there anything else that I may help you with?
Express gratitude: I appreciate your time, Ms. XXXX. I will now take you back to your physician’s office and let them know at the front desk you are here.
