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Episode 31: Christopher Wolfington and Pete Nielsen Talk Patient Financial Responsibility
25 Plays23 hours ago
In this episode, Chris Wolfington and Pete Nielsen have an off-the-cuff conversation about patient financial responsibility and how it affects the industry.
Chris Wolfington is the founder and chief revenue & strategy officer of FinPay. He has more than 31 years of experience in technology, healthcare, payments, consumer, and financial services companies.
Chris is determined to utilize his talents to positively impact these industries. With a keen sense of leadership, he has used his passion, energy, and capital to lead numerous businesses in the areas of payments and financial services, including three public companies.
Our other guest is Pete Nielsen, who long-time listeners may remember from episode 2 of the podcast. Pete Nielsen is the President and Chief Executive Officer for the California Consortium of Addiction Programs and Professionals (CCAPP), CCAPP Credentialing, CCAPP Education Institute and the National Behavioral Health Association of Providers (NBHAP), and the Publisher of Counselor Magazine.
He has worked in the substance use disorders field for 20 years. In addition to association management, he brings to the table experience as an interventionist, family recovery specialist, counselor, administrator, and educator, with positions including campus director, academic dean, and instructor.
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Transcript
Introduction to 'Destination Change' and guest speakers
00:00:03
Speaker
Welcome to Destination Change, a podcast where we talk recovery, treatment, and more. I'm your host, Angie Fieber-Sutton, with the National Behavioral Health Association providers, and I use she, her pronouns. My guests today are Chris Wilfington and Pete Nielsen.
00:00:16
Speaker
Chris is the founder and chief revenue and strategy officer of FinPay. He has more than 31 years of experience in technology, healthcare, care payments, consumer, and financial services companies. He is determined to utilize his talents to positively impact these industries.
00:00:29
Speaker
With a keen sense of leadership, Chris has used his passion, energy, and capital to lead numerous businesses in the areas of payment and financial services, including three public companies. Our other guest is Pete Nielsen, who longtime listeners might remember from episode two of this podcast.
00:00:45
Speaker
Pete is the president and chief executive officer for the California Consortium of Vision Programs and Professionals, CCAP, CCAP Credentialing, CCAP Education Institute, and the National Behavioral Health Association providers, NBHAP.
00:00:57
Speaker
He has worked in the substance use disorder field for 20 years. In addition to associate management, he brings stable experience as an interventionist, family recovery specialist, counselor, administrator, and educator, with positions including campus director, academic dean, and instructor.
00:01:11
Speaker
Take it away, Pete. All
The uniqueness and challenges of FinPay
00:01:13
Speaker
right. Thank you, Angie. And I got to set the stage here because, you know, I'm in an office environment. I have a tie, i have a colored shirt, you know, ah and then we have Chris who looks like, you know, he just got hired for the militia and has this black hat and black sweater on. So, you know, it's jack you just can't see it, Pete. It's a jacket. And this has an Eagles filled up the Eagles logo on it, which by the way, for those that don't know, we did win the Superbowl. And I say we, cause I live, I'm from Philly.
00:01:44
Speaker
Well, you know, it's interesting. It's funny. Some people say to me, right, FIMPAY is the only electronic financial records technology in the market. You guys have Monopoly. Isn't that great?
00:01:57
Speaker
And I say, well, it sounds great, but it's actually not great because nobody's used electronic financial records at a level where that it's as common as an EMR.
00:02:10
Speaker
And today, if a treatment facility wanted to start and not have an yeah EMR and tell their clinicians, oh, you're going to use paper and spreadsheets to manage their charts and get claims paid, everybody would think that place is nuts, right?
00:02:24
Speaker
But there was a day right before CMS mandated electronic medical records that where people use paper and spreadsheets for charts and to submit claims. And so back then clinicians would be like, I'm not using some computer. I'm, my notes are great. My system's great. And there was a learning curve too, but today no one would you be left at if you suggested don't use electronic medical records.
00:02:54
Speaker
So with the same is true with electronic financial records. So think of it this way, Pete, and i and I try to explain this, but when you have a monopoly or you're first to market, the challenge is this.
Importance of tracking patient financial responsibilities
00:03:08
Speaker
I say to somebody, 20% of your revenue is owed directly by the patient.
00:03:15
Speaker
Right. So rates are coming down. We all know that the out of network model sort of under attack, but more and more of the rate that you're entitled to kant is owed by the patient in the form of deductibles, co-pays and coinsurance.
00:03:28
Speaker
And people are managing that with paper and spreadsheets, but they just don't know any better. ah So part of the difficult thing about being the only electronic financial record system in the market is trying to explain to people, this is really important. Like if you want to track that portfolio, that portion of your revenue, that's 20% of all the dollars you're owed and how you track that across multiple departments and how you collect that money and how you make sure you're compliant with Because as you know, ECRA, since 2018, the Elimination of Kickbacks and Recovery Act says it's a criminal offense not to collect that money.
00:04:07
Speaker
And payers are being more aggressive with audits. And if you show up in an audit, Pete, imagine... with the associations and the organizations you're involved in. Could you imagine showing up to a payer audit with paper and spreadsheets to substantiate that you're innocent of inducement, right? That you when you show someone, oh, here's my good faith estimate.
00:04:28
Speaker
It's on like a piece of paper. Maybe I did an Excel spreadsheet, right? Like like you're not going to win that. But because there are no subject matter experts that work for the organizations that I speak with,
00:04:41
Speaker
Like the CEO can't know everything. So normally, if if a billing company came in and talked to the CEO and said, hey, i'm go to I want to sell you my billing services, the first thing he would do is go to a CFO and say, hey, this billing service is here.
00:04:57
Speaker
How's our billing service doing? Should we talk to these guys to, right? He would rely on his expert to tell him, is this a service that we should consider changing? Well, you go in and you say, who's your patient financial management, vice president or director of patient financial management.
00:05:13
Speaker
He looks around and goes, am I supposed to have one of those? but like i don't have one of those. Or they go, Hey, admissions guy. Or admissions woman who has enough things to worry about.
00:05:24
Speaker
I'm going to throw that on your plate. Or, hey, revenue cycle manager, I know I beat you over the head to get the claims paid efficiently and at a high percentage, but I'm going to throw patient responsibility and patient financial management on your plate.
00:05:40
Speaker
And now that person's going, look, I'm stretched thin as it is getting these claims paid, and now you want me to deal with the patients on what they owe? So my challenge isn't the need for automating this part of the business.
00:05:54
Speaker
It's no one's ever managed it or automated it. Does that make any sense? Right. No. and And this is where you come into when you're an innovator versus an imitator. You come in
Innovators vs. imitators in market education
00:06:05
Speaker
and... Whoa, whoa, whoa. Say that a again. Say that again.
00:06:07
Speaker
I like that. Yeah, you're an innovator instead of an imitator. So when you're an innovator, you have that burden of educating the public, educating the consumer thank your product, you know, this is what it is. So anytime you're cutting edge, that is the burden of responsibility.
00:06:25
Speaker
The problem is... is at some time you will get the and and imitators and they will feed off your coattails. So, know, this is the problem that I always have when I innovate is that it's great, except people don't understand the product, the service, what you're trying to do. And you spend a lot of time on that education. And then when, when you start to educate the public or but consumer,
00:06:52
Speaker
then the imitators come along and then they can ride the coattails. And, you know, so it's, it's, that's always the hardest thing when you're and innovator and, and, you know, doing something like this,
00:07:06
Speaker
where people don't really understand. And especially since, you know, Acura about patient responsibility. I mean, we have a toolkit and we have, you know, patient responsibility.
00:07:18
Speaker
And you think that would be the number one seller, but people don't think of that as a first, um a first thought, you know. um but And here here's my metaphor. I always use for that.
00:07:31
Speaker
So if somebody owns a Toyota, And they walk into a Honda dealership and the Honda salesman starts talking to them about the value of a Honda, how much it costs, the features of the car, the different colors it comes in.
00:07:48
Speaker
Immediately that person in their brain, whatever they're hearing from that person, the Honda comparing it against what but Toyota, which is what they currently drive. In other words, there's a bucket in their brain that they associate with cars and their personal experiences.
00:08:05
Speaker
So anything they're hearing from the Honda person is always being measured against those prior experiences. What's interesting to your point, I think, in this case, we're talking about patient financial management.
Strategies for managing financial and compliance risks
00:08:17
Speaker
And just as it as I define that, Pete, I define patient financial management as the strategy, the policies, the workflows, and the technology that is used to manage the the economic and compliance risks associated with patient financial responsibility.
00:08:38
Speaker
And patient financial responsibility takes the form of private pay patients that just pay cash or insured patients that have deductibles, co-pays and co-insurance, sober living, rents, right? Anything where a human being, a consumer slash patient has to reach into their own pocket and pay all are a portion of the services. So I just, just, because I'm going to use those acronyms a lot.
00:09:02
Speaker
I say PFR a lot for patient financial responsibility. So just as you and I are just chatting away here, so people know the the context. But when you go in and you talk to someone about patient financial management, their brain is like searching for a bucket, right, of experience that they have.
00:09:20
Speaker
And normally what people will say to me, oh, you're a payments company. Well, we do payments, but we're not a payments company. Oh, you're a billing company. No, we don't have anything to do with the claims. It's all about the patient. Oh, you're collection company.
00:09:33
Speaker
No, collection companies are what happens, what you're doing now when... the claim adjudicated and it's now 120 days after treatment and you're trying to chase the patient around for the money they owe you. That's the challenge that we always have. and what I think is interesting is most people in this industry, in the business, they just think of patient responsibility as that thing that used to go, don't tell anybody, but just come on in I'll let you in Don't worry about that money you owe me because I just want to get the insurance claim paid.
00:10:05
Speaker
And 10 years ago, Pete, I'd be a hypocrite if I didn't admit that was that was that made sense, right? You had a huge out-of-network models out in the marketplace.
00:10:16
Speaker
People were making enough money off the insurance and they always in their head were going, well, the guy down the street's not collecting that money, so I don't want to lose the admission by talking about money, so I'm just going to ignore it.
00:10:28
Speaker
And that was well and dandy, but two things happened. One is you and I just discussed, that girl was passed. right So now it's criminal offense, not civil, criminal, not to collect that money.
00:10:40
Speaker
Second thing that happened was high deductible health plans hit the market at a very accelerated basis. And so when that 10 years ago, the patient owed maybe 2% of the bill.
00:10:53
Speaker
Now they owe 20 to 23% of the bill, right? I've seen some as high as over 25%.
Impact of financial stress on treatment outcomes
00:11:00
Speaker
So think about it this context. How many businesses, Pete, do you know of? They can have 20% of their revenue never get paid and still build a sustainable, viable business, especially in network.
00:11:14
Speaker
I'll argue you can't. And then the other, there's other supplementary things that people don't think about. I'd love to get your opinion on this. There's a ripple effect that this part of the business impacts.
00:11:26
Speaker
So let me give you an example. I'll give you a three right off the top that I think are huge. One is, i would say 95% of the market, their patient financial management strategy is the following.
00:11:39
Speaker
Run a VOB, maybe even do a live VOB that your billing service or your billing staff does. Just store that somewhere in the EMR. Let's wait till the patient discharges.
00:11:52
Speaker
And after the claims are adjudicated, we'll send them three statements because we think falsely, by the way, that three statements makes me compliant with that credit. It does not statements do not count as a regular and customary collection effort in and of themselves.
00:12:08
Speaker
So now think about what I've just done. i don't think anybody on this listening to this or you people would argue that the relapse rate in the United States is over 50%. Would you agree with that statement?
00:12:22
Speaker
I'm not going to disagree with it. You are going to disagree? No, i'm I'm not going to disagree because i I don't know if we... Let's go with that. Let's go 50%. Let's call it 50 just to make my point.
00:12:34
Speaker
Yeah. So flight have 100 patients go through my facility and my patient financial management strategy is to send them a bill for thousands of dollars that's going to arrive 60 to 90 days after they discharge from treatment.
00:12:53
Speaker
that no one helped them with, no one told them was coming, knowing that one of the leading causes of relapse is financial stress. So the fact that a treatment facility would have a patient financial management strategy that literally triggers what is commonly accepted as one of the top three causes of relapse, financial stress, seems absurd to me.
00:13:21
Speaker
And then I'll add to that. one hundred When that's your strategy, 100% of your patient's last experience with your treatment facility is financial, not clinical.
00:13:38
Speaker
That strategy I just articulated, that means the care is first and the bill is second.
00:13:46
Speaker
right And so if that's your strategy and patients get unannounced multi-thousand dollar bills in the mail shortly after treatment, well, think about what that means to your alumni strategy.
00:14:03
Speaker
When that 50% of that population relapses, I don't know where they're going. I only know where they're not going. When that alumni population has a family member or friend that needs treatment, I don't know where they're going to refer that family member friend.
00:14:19
Speaker
I only know where they're not going to refer that family member friend. So if the financial experience is allowed to be that horrible, just because people don't know how to manage it any other way,
00:14:37
Speaker
Think of that ripple effect. I'm not getting paid when I'm owed. I'm possibly triggering a relapse for the very person I was paid to help protect and to get well. And three, I've killed any chance that that alumni is going to be a brand ambassador and refer me to family members and friends.
00:14:57
Speaker
And if they relapse, they're sure as heck not coming back to me. But I think, i and I think that, you know, one of the issues that we have in treatment is we don't, we don't look at payment as a clinical issue.
00:15:10
Speaker
And, you know, everything that you're saying is really puts it in the realm of a clinical issue, you know, ah for, for individuals and, and thinking about that, that's a part of their care.
00:15:22
Speaker
And from another perspective that, you know, for, you know, helping somebody regain their lives and change their lives,
Benefits of early financial discussions
00:15:29
Speaker
taking responsibility You know, and being able to improve their life, part of that is financial, you know, know and and being responsible.
00:15:40
Speaker
And I'll give you a great example, a further step on that or to to to support that. So one of the misplaced sort of fears or apprehensions I'll hear from somebody. So let let let me give you some data first.
00:15:54
Speaker
And I can show this. i have a chart for this. um If anyone follows up with me, I'll get it to them. So FinPay as a company, we've managed about $500 million or more, so over a half a billion dollars of this risk for over 100 treatment facilities representing 220,000 patients.
00:16:17
Speaker
and here's the data If you talk to a patient prior to admission and have a fair, accurate, honest conversation about costs, they'll pay you 76% of what they owe.
00:16:31
Speaker
If you wait till they're in treatment to have that financial conversation. you'll only get 50% of what you're owed. If you wait till they discharge, you'll get 35%. And if you wait till the claim is adjudicated, you'll get less than 20. That is the math on $500 million dollars worth of data and 200,000 patients worth of data. Now here's what else was interesting, Pete, we learned.
00:16:57
Speaker
The patient satisfaction score, when someone was the financial conversation had up front, and I'm going explain what doing it right means, like having it fair and honest and transparent.
00:17:08
Speaker
Because it's not just, oh, you owe me the money, are you going to pay me? That's not what I mean. But when it's done right, and i'll explain what that means in a second. The patient satisfaction score across that population, 200,000 plus patients was 97.2.
00:17:24
Speaker
So let me compare the first two things I just shared with you. What's the collection rates and versus what's the patient satisfaction score? So the average collection rate of behavioral health on patient financial responsibility is only 13 to 15%.
00:17:37
Speaker
Across the entire market, our clients get 70. The patient satisfaction score, people using our automation tools, 97.2. It's less than 5%. it's less than five percent across the whole market.
00:17:53
Speaker
Now, here's a data point that I wasn't expecting. Unfortunately, i can't tell you why this is, but inpatient patients stayed 3.05 days longer when they were engaged around cost upfront.
00:18:12
Speaker
My theory is that if I go into treatment the day I walk through the front doors and my fears and anxiety concerns around cost are already in the rear view mirror because I've already handled it.
00:18:23
Speaker
Why would I leave early? So getting back to your clinical connection, right? Like nobody thinks to connect. a dollar somebody owes to what, how it would impact their clinical outcomes. Well, I think everybody listening to this would agree that a higher dose of treatment produces better outcomes. So if someone doesn't leave early, they have a better chance at more sustainable recovery.
Financial details in informed consent
00:18:45
Speaker
Secondly, if somebody doesn't have any fear, anxieties or concerns, about cost, now they have skin in the game. Now they they they have a responsibility factor. Now they're not going to get triggered by financial stress well when an unannounced bill shows up.
00:19:01
Speaker
All of these things affect clinical outcomes. And if anyone listening to this believes in social determinants of care impact clinical outcomes, well, then this is even more relevant, if that makes sense.
00:19:17
Speaker
you know it does. and And I think that when you bring somebody up to your facility, you're supposed to have informed consent. Informed consent includes all the stuff clinical, but also financial.
00:19:29
Speaker
So they know the full package. And and to your point of skin in the game, when I used to run facilities, i used to run treatment, I don't know if you knew that, used to run treatment facilities. And I'll tell you, the ones that would come in And they were indigent and they didn't pay any money. And they came in, they would come in and they were just behind the Kentucky fried chicken, you know, eating garbage scraps. And, you know, two days earlier, they would come in five days later and critiquing the food, critiquing the pillows are too soft. They were sleeping on bricks and concrete. And then, you know, and and I think and then.
00:20:06
Speaker
They would be more likely to AMA. Why? I believe that and to to your point, that once somebody has skin in the game, meaning that that they have something invested, they put something in.
00:20:19
Speaker
It doesn't have to be a lot. It has to be. I'll tell you, I was going to say, even if it's 10 bucks, it's something in there and it's tangible. And and here's the thing. You know, when people are in their addiction, everything's very tangible.
00:20:31
Speaker
You know, money and and and finances are very tangible. And they're thinking, you know what, if I blow out of this, that's money that's gone. I don't want to lose that money.
00:20:44
Speaker
And people do have that thought process. I've had conversation with lots of clients. I'm like, why'd you stay? And because, well, I knew one I'd be disappointed in my family, but the other is that I already paid for it. And that money would, what am I going to do with it? I would rather, you know, see what this has to offer, even though I'm not,
00:21:03
Speaker
so totally bought into this whole recovery thing, but i will finish this because it's going to cost me, you know, if I don't. And I think that having that responsibility and skin in the game really changes the dynamic. And I think clinically you're less likely to have clients to have negative perceptions and feelings about the organization that helps save their life if you know they ah they feel secure and that financial ah picture. And ah how do you trust somebody?
00:21:36
Speaker
Well, hold on, Chris. How do you trust somebody if if you feel like they're taking advantage of financially? You don't. How do you trust the clinicians? How do you trust any of that? If everything's up front and you got all the that the money and that the finances and they treat it seriously and they're not just a wink and a nod and and letting it go by, you trust that institution even more.
00:21:58
Speaker
And, and what's the number one thing as a match in the match studies back in the seventies or eighties, it said that therapeutic alliance that I think aligns them with the the clinician and the agency with that therapeutic alliance, because they can trust what they say, they feel secure and that, you know, and when we do weekend and odd stuff and, and, and not take it seriously and kind of say, Oh yeah, yeah, well we'll, we'll, we'll, we'll take care of it.
00:22:25
Speaker
It feels like it it is when they're out there using that that whole mentality and that there's nothing changed in that. when you When the facility acts responsible, helps the individual to act responsible. Yeah, they feel like they're getting over on you because no one asked them. They know they owe money. You know they owe money.
00:22:42
Speaker
let Let me ask you a question because I want to sort of talk to you about what I call the right type of financial engagement versus the wrong type. What do you say to the treatment agency Facility owner, or probably more relevant, the director of admissions at, you know, ABC treatment.
00:23:03
Speaker
If they say, you can't talk about it money, you'll lose the admission. Or you can't talk about money up front because the guy down the street, he's letting him in without having to pay anything.
00:23:16
Speaker
So I'm going to lose my admission to that person if I even bring up money. Now, I have an opinion on this that I'll share in a second, but I'm curious, what would you say in 2025, not the guy from 10 years ago, because he'd probably be right 10 years ago.
00:23:31
Speaker
What do you say in 2025 to the admissions director that thinks that? I think that they need to disclose that. And I even think that they're wronged by not. And, and you know what, that's the same as saying, and you know, we're not going to, we're not going to do any difficult feelings or, or any chat, anything challenging in treatment.
00:23:52
Speaker
We're going to make sure that, that, that they don't have any care in the world. And you know what the problem is, is they're setting them up for failure, you know, because they're not, you know, they're they're really doing benign treatment. So when you say, oh well, let's let's let's let the slider was not talk about it.
00:24:10
Speaker
Or I think that's irresponsible in my book. And, you know, letting people know what to expect up front. Same thing in treatment. It's not all going to be comfortable. It's not all going to be roses.
00:24:22
Speaker
And it could be painful and difficult getting through the process. Same thing with with with finances. I think that the agency owes the client to let them know the costs up front because other than that, it would be bad treatment.
00:24:41
Speaker
And i I'm not even saying just bad financial. I'm saying bad treatment. If they don't discuss what the impact or what the finance up front, they're misleading and lying to the client.
00:24:51
Speaker
And that's not a good relationship to start. It's a horrible way to start. And I would agree. Not only do I think it's irresponsible, but as we discussed in the beginning, since 2018, it's criminal.
00:25:03
Speaker
Yeah. To not collect that money. But so, here but here's why I asked the question. So you have ulterior motives. thats to Yeah. Yeah. Well, well, no, just, I want to make, I want to delineate between.
00:25:16
Speaker
We're just talking blandly, right? We're saying talk about. Right. but We're not. drilling down into what does that really mean? So let me give you the scenario that's the wrong way, right?
00:25:29
Speaker
Hey, Pete, I just ran a verification your benefits with your Aetna policy and you have a thousand dollars remaining on your deductible. How do you want to pay that today?
00:25:41
Speaker
Well, that's the wrong way to have the conversation. Number one is you haven't earned the right to ask for money yet. Right. So you don't ask for something you haven't earned too. There's more than just the deductible. There's the coinsurance. So in essence, if I just try to collect the deductible, cause that's the only quantifiable number I have.
00:25:59
Speaker
I'm misleading the
Conducting transparent financial conversations
00:26:00
Speaker
patient. Cause if I paid that thousand dollars when I was told, what do I think? I think I'm done. Right. I think I paid you everything I owed you. And then when a bill shows up for 2,500 bucks in the mail because of the co-insurance, I think you lied to me.
00:26:13
Speaker
I think you bait and switched me. And now I've hurt my brand. So let me roll. If you don't mind, Pete, I want to role play with you a little bit because in our software, We have this scripting and it's dynamic scripting. In other words, we look at the data from the CRM that we got and it tells me a lot. tells me if you're an in-network or out-of-network patient.
00:26:33
Speaker
It tells me if I'm talking to you pre-admission, during care or after. It tells me how much you owe if you've used our estimator tool. And people that owe a lot of money need to be talked to slightly different than people have a smaller dollar amount.
00:26:46
Speaker
And the scripts are dynamic and unique to the different, what we call risk classes. And each risk class is separated by what we call the different situations. So I'm going to pretend, Pete, that you're an in-network patient.
00:27:00
Speaker
And i'm going to share with you a little bit how we train people and they push a script button in our software and the right script that's relevant to the exact type of patient shows up. And it might sound something like this.
00:27:13
Speaker
Hi, Pete. My name's Chris. I'm the patient engagement specialist here at ABC Treatment. umm ah Before we get going, Pete, I just want to let you you know that you should be really proud of yourself for making that phone call to ABC because it really is your first step in your journey to recovery. You should be very proud of yourself for that.
00:27:31
Speaker
So right away, it's not about money, I'm just trying to help you. And by the way, ah um and I'm the dedicated person at ABC Treatment that talks about money. The admissions person is now off the phone waiting for the next call.
00:27:44
Speaker
but So then I say, Pete, I wanna tell you, it's a really good thing that you called ABC Treatment because we genuinely care about your financial health, not just your physical health. And every one of our patients gets free access to an engagement specialist like myself to help you navigate your costs for treatment.
00:28:00
Speaker
And the reason we do that, Pete, is most people don't understand that ABC treatment does not determine what you owe. 100% of what you owe for your treatment is determined by your Aetna policy.
00:28:13
Speaker
Did you even know that, Pete? And most patients say, no, I didn't know that. And I say, well, most people don't know that, Pete, and my job is here to help you navigate the policy that you picked and the policy that you have.
00:28:25
Speaker
Does that make sense? Yeah. Yes. And my goal today, Pete, is to not only answer all your questions and make sure you're we fully transparent with you about cost for treatment. I'm even going to help you get into a payment program today that you feel really confident and comfortable that you and your family can afford and won't have a negative impact on your family budget.
00:28:44
Speaker
Does that sound like a good job a good idea, Pete? Yeah. Okay. And another thing, Pete, that I found that's pretty consistent amongst all the patients I speak with, they all, the people that have a good support network, and you might tell me your mom, your brother, your sister, your friend, whoever, and every name every name you say, Pete, I'm writing that name down.
00:29:05
Speaker
Now, the next thing in the script, I won't go through the whole thing, but I might say to you later, a couple of minutes, you know, Pete, a lot of people get frustrated with healthcare costs because it's hard to understand. And they don't understand the billing and claims process and all the mail that's going to show up.
00:29:19
Speaker
You get mail from your insurance company, you get mail from us. Do you mind, Pete, if I take a couple seconds and explain some of that to you so you don't get frustrated? Everybody says yes. When we monitor the cause, they're like, sure.
00:29:31
Speaker
So like we explain what the scripting explains what an EOB is, explains the difference between that in the statement, explains that it can take 30, 60, 90 days for all this paperwork to catch up. And then I say, Pete, does that all make sense to you? Like, I don't want you to get overwhelmed when all this mail shows up. Do you understand how the billing claims process works? You say, yeah.
00:29:51
Speaker
And I said, another good idea, Pete, for me to cover with you is, you know, there's some things you can do to save money in your treatment. Do you mind if I share some of those ideas with you? And what do you say? Sure.
00:30:03
Speaker
And I'll explain to you what an FSA is and an HRA, right? um And an HSA. And I'll explain to them and say, hey, depending upon your employment, you may want to go to your HR department, find out if you're eligible for any of these programs because you could save a lot of money and pay for your treatment on a pre-tax basis.
00:30:22
Speaker
And then I'll get into, hey, Pete, I see have an Aetna policy. lot of people find these policies confusing. Do you mind if I take a couple of minutes and explain how your specific health plan works and how that how Aetna determines what you owe?
00:30:36
Speaker
Notice what I said, how Aetna determines what you owe. Right. Now I'm paraphrasing some of this stuff, Pete. Right. But what have I not done? I'm a couple of minutes into our conversation.
00:30:48
Speaker
And what have I not done? and i in money I have not asked you for a dime. What I've been doing is helping you, helping you, helping you. Pete, learn how to save money? Sure.
00:31:00
Speaker
Pete, you want to explain the billing and claims process so you don't get frustrated? Sure. You want me to explain how Aetna determined what you owe? Sure. I'm a helper. I'm a helper. I'm a navigator. Now I say to you, Pete, it's a good thing.
00:31:11
Speaker
Last thing I want to cover with you is at ABC Recovery, we want you focusing on getting well, not on affordability. And we have several great payment program options for you to help make treatment as affordable as possible.
00:31:24
Speaker
And then I would go in and I would explain, and the software lays out on the screen exactly based on the business rules of the people that own ABC treatment, exactly what payment programs that are available to them based on their situational risk.
00:31:38
Speaker
Now, I know that was paraphrasing and I know I was cutting that short, but that's a whole different level of engagement than just saying, Pete, you owe me three grand. How going pay that today?
00:31:49
Speaker
Here's what I look at that person. This is, this is what I look at. So for me, in my life, it's better to pay with cash than credit. In a sense, it's better to be upfront and honest rather than tell people what they want and and and to to appease people and then later pay the price with interest because you know you you you didn't really you weren't upfront and honest with them.
00:32:14
Speaker
And that's how i look at this is is you're really... paying with cash, so to speak. I'm no pun intended really, but yeah're you're you're really paying with that because then you you don't have to, somebody understands what they owe.
00:32:28
Speaker
They understand, you know, who's paying with the whole responsibility. You know, how many times that would all get messed up in treatment. this These conversations of this stuff getting messed up happens all the time.
00:32:42
Speaker
And people leave. There's AMAs because of that, because there's a misconception of who's paying. Or here's the other thing, is what's the great excuse?
00:32:54
Speaker
to to leave treatment is saying, well, they lied to me. They didn't tell me everything up front. So forget this place. I'm going to go to those A&A meetings and I'll be fine. you know Yeah, and they get and then they get the bad reviews. This place only cares about money, blah, blah, blah.
00:33:09
Speaker
and And here's, it's funny. it um um It's interesting that you went down that path because I agree with you. From my perception, what we just did is created a software that automates and takes all of the guesswork out of how to, the best way to engage. So I don't know if I ever showed you, Pete, it's actually really cool.
00:33:28
Speaker
We built this estimator tool that integrates with our client's CRM and I can grab their VOB and automatically create an estimate that'll say,
Automating transparency with FinPay software
00:33:37
Speaker
this is the revenue you'll generate if you approve this admission.
00:33:40
Speaker
Here's the percentage of the money that the patient owes. Here's the actual dollar amount. And here's the breakdown of what portion of that was deductible, copay, coinsurance. so And then, so when they're talking to the patient, not only can you do a better job of engaging, you're using really accurate information.
00:33:57
Speaker
And so the patient feels even better that, hey, these guys know what they're talking about and they're being really clear. And when someone gets into a payment program, you literally push a button in the software, electronically sends out the documentation. So you're compliant with ECRA and you're compliant with consumer protection laws.
00:34:13
Speaker
And all the patient has to do is click an approve button on their cell phone and all your compliance documents are signed. So what we just did, because I'm passionately believe in what you just said.
00:34:25
Speaker
If technology can make your employee do a better job of having an engaging, transparent, fair financial conversation that not only secures the admission, but extends the value of your brand because no one else is doing it that way.
00:34:47
Speaker
And if you're worried about them calling the guy down the street, trust me, when you do that type of conversation, they called the guy down the street and the guy down the street is doing the bait and switch and ducking the entire financial conversation.
00:34:58
Speaker
People aren't stupid, right? Like we talk about car salesmen, right? The bait and switch, everyone has like, or the insurance salesman, right? Like treatment has the same way. There are bad actors in this industry, sure.
00:35:11
Speaker
But the people that do it right, The clinical outcomes are better. The financial outcomes are better. The compliance outcomes are better. Right. And then you have a more sustainable business.
00:35:22
Speaker
And I'm just a big believer. Yes, I'm a little biased. Right. Because like, i yeah, but I really believe it. But, yeah know, halfway through you talking, I just had a big smile on my face.
00:35:33
Speaker
And I'm like, oh, I just figured out Finn Pay's tagline. I just, I'm like, boom, there, I got your tagline. You're going to, you know, I need royalties for this tagline. Okay.
00:35:46
Speaker
Anti-patient brokering software. Boom. There you go. Drop in the bucket, you know, because everything that you said really, really, gets to the bad actors in the industry of, you know, this this this real unscrupulous, you know, hidden, and nobody really knows what's going with these patient brokers. And basically, you create you have a transparent system so that everybody knows. How do you know that somebody isn't going to a patient brokering organization?
00:36:18
Speaker
I'll tell you, having transparent financial information is the anti-patient brokering inside of an agency. How do I know? If you're truly patient and brokering, there's no way you're going to do that, right? No, absolutely not.
00:36:33
Speaker
you You don't want to be transparent. you i never thought i never thought of it that way. That's an interesting... That's why you keep me around, Chris. This is you keep me around. I keep you around because your bubbly personality. That's I keep you around. Well, hey, so i want I want to transition on us and kind of, you know, how we got into this, because I think you tell the story because I've heard it three times now.
Innovative ideas from conference discussions
00:36:56
Speaker
Best, you know, so I'm going to set us up. So we're at this networking thing and I've known Chris for years, just just walking by. And and and and we've had a couple of conversations, but nothing really strong and engaging.
00:37:11
Speaker
We yeah were just conference. Yeah, it was a conference. Yeah, and and we just seen each other at different conferences and stuff. But, you know, so I'm trying to find a place to eat and there's not a lot of places. And so I happen to eat at this table and it's right next to Chris entertaining some people at this nice little fire. And and I'll let you take it away from there because just smoked my cigar and I was relaxing. Well, no, what made it funny, Pete, was as I'm talking to the people I was chatting with,
00:37:41
Speaker
I noticed that you're your back was to me, but I noticed it was you. And a couple of times I was seeing if I was get your attention to say hello. But because I'm engaged in the conversation, i don't go there, right? Unless it was, you know, you present the option.
00:37:56
Speaker
So we're talking about all sorts of stuff. i love the i love conferences because I get to meet some really insightful people. like i i My attitude in life is always, you're always learning. The day you stop learning, you know, you're dead.
00:38:09
Speaker
So I'm always interested in ideas and thoughts people have. So I'm in this great conversation, which clearly it was great because at one point you couldn't help yourself. You were done eating. Pete stands up.
00:38:20
Speaker
Now I have to understand his chair is to my, his back is to me, but I could literally, my arm was twice as long. I could have tapped him on the shoulder. That's how close he is. Well, Pete literally just stands up, flips his chair back. So now it's facing me, sits down and goes, oh, hi, Chris. Mind if I join you?
00:38:41
Speaker
And I'm like, and I said, hello. And you're like, well, you've met me before. I go, Pete, that's why I'm saying hello.
00:38:51
Speaker
And then he got bobbed in the whole conversation. And then you and this kind of spurred this. You were telling me about some of the stuff you were doing, some of the podcasts and some of the great things your organization does out in California.
00:39:05
Speaker
And you and I embarked on an hour and a half conversation, Pete, that I was telling people when I got back in office. I could have gone on for another two hours with you. I mean, you and I got into some really cool, I think, industry-leading discussions and thinking discussions.
00:39:24
Speaker
And it went like this. It just flowed. And when you were talking about getting on a podcast, it's like, well, I have someone else do the podcast. like, Pete, you and I need to have these conversations. He and I just, it was like smooth. I mean, it just rolled.
00:39:38
Speaker
And I love the conversation. Just like this is going. I just, it's fun. I'm having a good time. thing but I'm looking. An hour has almost gone by, and it seems like we've been on here for five minutes. what and and And this is why I was engaged in the conversation is because nobody's talking about the fate patient responsibility.
00:39:57
Speaker
We have a toolkit. You have software. But really, the conversation is much deeper than all of this. More more more deeper than than than any of this is that what I think is really would fix some of our problems in the industry that we have.
00:40:14
Speaker
you know, whereas patient brokering being one of them, ah you know, ah AMAs being another, distrust of treatment facilities, that there's clinical and business and all rolled up into this issue that we're talking about. And and that's what really intrigued me because you were right. you When you were talking and I was listening, i was like, he's absolutely right.
00:40:38
Speaker
You know, and I've never really heard you discuss in detail about all of this. And so, you know, when I was listening, I'm like, yeah, I mean, you know, there needs to be an honest discussion about ah patient responsibility that is not shortened and is not treated as a checkbox.
00:40:58
Speaker
it's it's actually part of the full care for the for the client treatment. And that's what I heard. What you were saying, that's what I was hearing was, wow, this would benefit the the client. I wasn't really looking from the angle of the facility and in the business practices.
00:41:13
Speaker
I was really looking at This is really sound practice, you know, for facilities to be responsible in in you know, and then and then I also thought, wow, if facilities do this, that that they could actually increase the amount of money they make legitimately, honestly.
00:41:33
Speaker
wow that that This is a game changer, not knowing, you know, just just take out the software, just doing this practice. They could increase the amount of money they're making. They could increase patient satisfaction.
00:41:47
Speaker
And I'm like, and it it's it it's just baffles me that one, nobody's talking about it. and that's That's the weirdest thing, Pete. Nobody it's look greater to me talks about it. I go to kind i want to hear a crazy, crazy statistic.
00:42:04
Speaker
Crazy. This is insane to me. 20% of the revenues owed by the patient go to any conference the United States in the last seven years. And there's zero zero conversation about...
00:42:20
Speaker
best practices. What are the consequences of doing it right? What are the consequences of doing it wrong? What are they just open dialogue? Everyone puts their in the sand and pretends it doesn't exist. And I'll go a step further. Something you just said strategy is important, but if your strategy is I'm using paper and spreadsheets to manage this, that is not a strategy. That's a destiny for failure.
00:42:42
Speaker
If your strategy is Hey, Mary or Joe in the admissions office, tell the guy they owe you $2,000 and ask him how he's going to pay for it. If that's your strategy, you're going to lose.
00:42:52
Speaker
Right. Right. Or if your strategy is what most people do, put your head in the sand, send them three statements, hope I never get an audit because that's not compliant. And maybe I'll cross my fingers and somebody will pay me.
00:43:04
Speaker
But all of these things, Pete, is why the the national collection rate on the And substance abuse and behavioral health is 13 to 15%. That's absurd.
00:43:16
Speaker
And so there is a right way ah to your point. There is a way you can get your cake and eat it too, which means you have fair, honest conversations that build up your brand, that add credibility to your brand, where you get paid, where patient satisfaction scores are literally through the roof. Better.
00:43:34
Speaker
Our clients want to hear crazy. The financial experience satisfaction scores for most of our clients are higher than the clinical scores. Think about that. I have a testimonial.
00:43:45
Speaker
I show it every time I talk to a customer. And I kid you not, this was the this is a note that the patient wrote to us. This was the greatest financial transaction I've ever done. I'm extremely, I'm extremely happy. So think about what she said, paying for my drug and alcohol treatment before I even got there was the best financial transaction I've ever done.
00:44:07
Speaker
I'm extremely happy. We get the, I call them love letters and we get the average client gets anywhere between five and 10 of these a month. Some of the bigger clients, maybe 15 or 20.
00:44:19
Speaker
Where patients are literally writing or family members writing notes because they're so shocked at how great the financial experience was because normally it sucks. Right.
00:44:30
Speaker
That they feel compelled to write a note about it. Who the hell would ever think that? And that's what I loved. That's the part I love. They should be common practice. They should not just be ah rarity, but it should become practice and, and facilities should do this just as kind of practice.
00:44:48
Speaker
And, ah you know, put your software, you know, ah aside from that, they should be doing the practice. yeah Software is good, but the practice is is key and they're not doing that. And the nice thing that I can say, and I'll do a little plug for your software is it's plug and play and it makes it easier for the facility.
00:45:07
Speaker
And it's really a training tool for their staff. So you you really get a lot with it. And I only know just just from having you know engaging conversations. But I am going to start to, because I know time for us to kind of wrap it up and I'm going to kind of change the conversation a little bit, kind of move us into it to into, and I'm just curious if, you know, you have all these other opportunities in the world to So your person in in long-term recovery, why are you doing this?
Chris's journey from recovery to FinPay's creation
00:45:41
Speaker
Why why are you not, you know, killing it on Wall Street or have 14 other companies? Why are you doing this, Chris? So FinPay is my seventh startup.
00:45:54
Speaker
So I just turned 60, Pete. I'm showing my age. And this is the seventh startup. And I say startup. I mean, literally from my basement, right? Like kind of thing. And are you're going to laugh at this. Yeah. So.
00:46:06
Speaker
I get sober. I go into this place called G and G holistic down in Florida. Uh, it's not in business anymore. They sold it. The people that bought it closed it down or whatever.
00:46:16
Speaker
ah two great guys owned it. Uh, Jerry Goldfarb and John Giordano. I, I, I throw them a shot. That's nice. G and G. Yeah. They saved my life. Right.
00:46:27
Speaker
And I'm very grateful for that. But I had means. My story was a little different. I actually had successful companies and I was making a lot of money. it just goes to show you money doesn't solve problems because like I was... ah stop and nurses like I was spiritually and emotionally bankrupt at the time, but but I'm a business guy and I always and intrigued by how businesses work. So I'm literally in treatment and I'm noticing that some people that came after me have already left before me. And I remember I got to know the owners pretty well.
00:46:59
Speaker
And I said, ah you know, what's going on? Why did Mary leave? Why did Steve leave? And they were sitting out, well, they couldn't afford to stay. And, you know, we have some people we scholarship, but we can't scholarship everybody or we wouldn't have a business.
00:47:13
Speaker
So going on, it so happens to be at that time, I had a company that did payments in the casino industry. And part of that was we lent money to gamblers called Marker's. And we did a lot of that.
00:47:25
Speaker
And my bad debt on that was really low. So I went to Jerry and John after I got our treatment. I said, guys, two things happened. For those of us that have gone through recovery and you do it successfully, you follow the steps, you have a sponsor, you do all those right things and you get that happy happy and joyous free thing that the big book talks about.
00:47:46
Speaker
It really is true. It's happy, joyous, and free. And it's it's a new kind of high and it's a new type of intoxicating. Mine manifested itself in a very bizarre way. I was so excited about being sober that I, in the in one year out of treatment, I scholarshiped eight different people, six of which, Pete, I didn't even know who they were.
00:48:09
Speaker
And I quickly learned, yeah, this is not a good model. Writing checks to send strangers to treatment, that's not going to last long. I'm going to run out of money. And so then I went to Jerry and John and I said, hey, I got this business that lends money to gamblers. We use technology to do that.
00:48:25
Speaker
I said, ah what if I lent your patients money? What if I made a way to, just like cars, right? When's the last time you saw a car commercial that showed the price of the car? No, they show the monthly payment.
00:48:37
Speaker
So I said to him, I'd like to work with you guys. I'd like to get more people in treatment. Meanwhile, this is like a side thing from my core business. And then i have a strong faith. I believe God didn't want me in that other business.
00:48:50
Speaker
And I ran into some healthcare scenarios for, with family members, one of which was family member that needed treatment. One of the eight people I paid for. And I just realized, wow, this is huge. And I started doing research, Pete. Want to hear some crazy numbers?
Addressing healthcare payment gaps
00:49:05
Speaker
Last year, there were $490 billion dollars in co-pays, co-insurance, and deductibles, and only 19% of it ever got paid. That's the entire healthcare industry.
00:49:17
Speaker
And in behavioral health, it's $50 billion, and only 13% of it gets paid. So I'm like, that's insane. And then i remember, cause I go, and go to a lot of meetings. You hear talking about people about financial stress and then you'd hear people bitching about like, oh my God, I couldn't afford treatment.
00:49:33
Speaker
And I'm like, know this is going to sound corny, but I was like, I can solve this problem. I literally had to, I go, I literally can solve this problem. It was recovery centers of America, which at the same time I was starting FinPay, they were a brand new business and they were growing so fast.
00:49:51
Speaker
that as I was learning with FinPay little nuances to make things right, the way it is today to really bite button up the software and how to talk to patients about money and how to do an estimate through technology and how to, you know, have visible, all the things that make our system great. In my opinion, it was only really possible because early customers like recovery unplugged and recovery centers of America, give a shout out.
00:50:18
Speaker
We're like, they drank the Kool-Aid. They said what you said, Pete. We want to be great at this. We don't want to be good at it. We want to be great at it. We want a patient to look at us in high esteem, whether they're looking through a clinical lens or a financial lens, because both of them impact their recovery.
00:50:35
Speaker
And so the the management at Recovery Centers of America, the ownership and management at Recovery Unplugged were like, no, there's only, it was like you, Pete. was like, I was here to me. ah ah This guy, Rob Harrison is great. I'm going to become great friends with him.
00:50:50
Speaker
He said to me, Chris, there's there's there there's only one right way to do it. You do it upfront, you do it transparently, right? You have a dedicated person talking about money. So they're a pro at it.
00:51:02
Speaker
It's not a part-time job for somebody. And he's like, and your software just helps to automate it, make it really easy. And when you have early customers like that, that taught me as much as I taught them, mean, I can't tell you how many times I'd be in conversations with both of the management of those two businesses and would be these great collaborative exchanges. And our company is great today because of our customers.
00:51:25
Speaker
like giving us that kind of really valued feedback. And that's why I tell everybody in in the company today, if you think we're there, like that's the scariest thing in the world. I never want anyone in our company to think we've arrived because we're always learning. And that's sort of how I got here.
00:51:42
Speaker
Well, and we're wrapping up because I think it's time and could go on for hours. We can definitely call you when we're done. We can keep chatting, you know, and talk about this stuff. So, you know, so I think it's really great, you know, to have this conversation.
00:51:59
Speaker
We didn't know where would lead. We just knew that we needed to have a conversation where other people can listen to us to have the conversation because i really feel passionate about it. And obviously Chris feels passionate about it, you know, um and and bring awareness to this issue, you know, more that than anything, more than the my organization or more than Chris's organization.
00:52:21
Speaker
If we can get more facilities to do this, We can increase the satisfaction by patients and we can increase, you know, um the business practices and help get rid of, you know, some of the scandalous actors. I really, truly believe that having good practices, business practices
Role of transparency in patient satisfaction and reputation
00:52:41
Speaker
can do that. And, you know, i was smiling on the inside when you're talking, Chris, because I'm dealing with a lot of, you know, anti-treatment legislation on a daily basis.
00:52:51
Speaker
And I was just like, you know, somebody can hear what is what what what we're talking about that's not from this industry that that believes that there's bad actors and people trying shim-sham and okie-dokie people, you know, listen to this conversation where we're talking about being open and transparent.
00:53:13
Speaker
We're talking about being that anti-facient brokering. you know, philosophy and really looking at, you know, doing that. I think that people would change some of their minds on treatment because unfortunately they have way too much experience with some of these shim sham artists and, you know specifically in certain areas of California, there's some of them that pop up, you know, ah quite frequently. and And we have to push legislation to get rid of those, you know, about it. And if you want payers to pay you,
00:53:45
Speaker
a better rate so you can afford to provide a better clinical experience for the patient. Well, it takes leadership from these organizations, of my opinion, to create an environment where the payer community looks upon the treatment provider market and says, this is a credible, like well-oiled, disciplined, you know, industry And therefore I'm okay investing as a payer into these higher rates. Cause I think it's going to get better outcomes for the patient who in the payer's eyes is a member.
00:54:21
Speaker
They use the term member all the time. And so, and the, the, the thing is though, Pete, it takes one, one leader followed by another leader, followed by another leader that recognize that the best practices when followed clinically and financially make everything in the industry better.
00:54:41
Speaker
Yep. It just does. And before we ruin it, Chris, we're going to let Angie take us home on this, you know, it that so, and you know, Angie, go Angie.
00:54:51
Speaker
Well, first of all, ah for the, those of us in the audience who may want to contact both, either of you ah let us know where people can find you. So Pete, you go to really important person.com. No, I'm kidding.
00:55:03
Speaker
Yeah. Yeah. I'll give you mine. So our company is finpay.com. That's F as in Frank, I-N-P-A-Y.com.
00:55:14
Speaker
Obviously put the www in front of it. My personal email is actually even easier. It's my two initials, C-W-W. ah Chris Wolfington. So CW at thin pay.com.
00:55:28
Speaker
And I welcome any questions, comments, ah good, bad, or ugly or indifferent. I actually love these kinds of discussions, Pete. So anyone in your audience that just wants to have a conversation like this, I, I love it. So I eat, breathe and sleep this stuff.
00:55:42
Speaker
And for me you know, you can find me at Pete at CCAPP.us and check out the website. So ah thank you, Angie.
00:55:54
Speaker
You're also at Pete at nbhap.org. No way. See what I mean? he has so many more impressive letters after his name. And we have a, but we also, Pete, i don't know if you've ever said it. We have a blog that we put out on a monthly basis covering all sorts of topics. As I said, there's ripple effects. So we cover all of that.
00:56:12
Speaker
um If you go on to FinPay's LinkedIn page, you can see those are onto our website. You can also access them. Hey, you've been listening to Destination Change. Our guests today were Chris Wilfington and Pete Nielsen.
00:56:23
Speaker
Thank you for being here. Our theme song was Sun Nation by Kitsa and used via a Creative Commons license by the Free Music Archive. Please consider rating and review reviewing the podcast on Apple Podcasts so we can get more listeners.
00:56:35
Speaker
In the meantime, you can always see more about the podcast, including show notes and where else to listen, on our website, www.nbhap.org.
00:56:44
Speaker
have questions for the podcast, please email us at info at nbhap.org. Thanks for listening.