Price Transparency

A consumer-first healthcare revolution has been simmering for years. Despite efforts to create more human-friendly services, the industry still lags behind other consumer-centric sectors. Patients want healthcare to be simple, convenient and on-demand, but a persistent lack of coordination, accessibility and affordability leaves many struggling to navigate the healthcare landscape with ease. Is this about to change? Has COVID-19 flipped the switch? The pandemic has prompted people to engage with their own care in a way the industry hasn’t seen before, with a surge in telehealth and virtual care. Infection-control forced much of the patient journey online, while providers were pushed to find new ways to communicate quickly and clearly. Now, those with an eye on the road to post COVID-19 financial recovery are optimizing these digital strategies to meet new consumer expectations and improve patient loyalty. Embracing digital technology and automation throughout the entire patient journey will be key to patient acquisition and retention. Where should providers focus first? 4 consumer-led strategies to keep patients loyal 1. Prioritize convenience across the entire consumer experience Eighty percent of patients would switch providers for convenience factors alone – ranking ‘convenient, easy access’ ahead of insurance coverage and quality of care. Creating a digital experience that gives patients the flexibility and simplicity they desire should be priority number one in any patient loyalty plan. Providers can start by reviewing their digital platforms. Encourage patients to use their patient portal to access information, book appointments and manage their healthcare when appropriate. Telehealth and virtual care solutions can be future-proofed with reliable identity protection, so patients can safely access care from home and not worry about cumbersome log-in procedures. 2. Make patient access…accessible The patient experience shouldn’t begin with time-consuming forms, long waits and error-prone manual intake processes. Rather, providers can make it easy for patients to complete as many tasks as possible BEFORE they set foot in the office by automating patient access. Online patient scheduling lets patients book, cancel and change appointments online – which 77% of patients say is very important. It has the potential to reduce delays and no-shows, and can minimize the administrative burden for provider staff. While patients remain concerned about the risk of infection during COVID-19, providers can ease their concerns by reducing face-to-face contact with online pre-registration. 3. Respond to affordability and pricing pain points One Experian Health study found that the top pain points in the consumer journey center on the financial experience, from shopping for health insurance to understanding medical bills. Patients may be unsure what their insurance covers, whether their deductible has been met and whether they can afford the out-of-pocket costs. By providing clear, upfront pricing information about coverage and financial responsibility, providers can protect their patients from unnecessary surprises and reduce the risk of missed payments. Self-service patient payment tools can simplify the payment process too: patients can settle their bills anytime, anywhere, and get advice on financial assistance and best-fit payment plans. 4. Personalize the patient experience from end to end A one-size-fits-all approach doesn’t cut it anymore. Patients are looking for communications and services tailored to their individual needs. That used to be both technically and logistically impossible, but not anymore. Providers today can use comprehensive data and analytics to personalize the entire healthcare journey, from customer relationship management to patient collections. By combining automation, self-service tools and accurate insights into the patient’s circumstances, providers can help consumers make better decisions about their care and how to pay for it. To ensure data reliability and integrity, providers should consider partnering with a trusted data vendor, who can translate robust, multi-source consumer and financial data into a competitive consumer experience. There is no question that COVID-19 has changed the way we do healthcare, but the industry is perfectly posed to harness the change in consumer behavior and shift towards greater patient engagement. By bringing together a myriad of digital tools, providers can create a healthcare experience that’s convenient, compassionate and in line with consumer expectations. Interested in learning more about how we can help your organization welcome new patients through its digital door, and boost loyalty among existing patients?

Few of us would buy a new car or TV without checking the price tag first. Why should our healthcare be any different? Yet this is exactly what many patients are forced to do when they need medical tests or treatment. Following the breadcrumbs on a provider’s website is a time-consuming and confusing way for patients to piece together a price estimate. Even with a rough idea of the cost of care, variations in health plan pricing often bump up the final bill. The lack of transparency is stressful for patients and costly for providers, who end up chasing slow payments and losing revenue to bad debt. But could things be about to change? Many providers have been proactive in offering transparent pricing, and thanks to recent regulatory changes, this could soon be an industry-wide requirement. The CMS Price Transparency Final Rule mandates that by 1 January 2021, hospitals should publish consumer-friendly pricing information on certain ‘shoppable’ services, to help patients understand and plan their bills ahead of time. The proposed Health PRICE Transparency Act would similarly compel providers to publish real cash prices alongside rates negotiated with insurers. As households, businesses and public bodies grapple with the economic impact of COVID-19, any additional clarity around pricing that could help make a dent in healthcare-related debt is to be welcomed. Liz Serie, Director of Product Management and Patient Experience at Experian Health, says that regardless of changes to the regulatory landscape, pricing transparency is here to stay: “It’s great for the patient because they have visibility, transparency and clarity about what they owe. They can prepare financially before their visit, so they can focus on what matters most – healing. Providers are excited about price transparency tools because they let patients pick and plan payment options, reducing the total cost to collect. And with more reliable billing data, it’s a win from a decision-making perspective too.” Transparency is becoming the norm in other aspects of healthcare consumer experience, and billing should be no different. 4 steps to fast and simple patient-friendly pricing 1. Remove the guesswork with accurate, upfront pricing estimates No one wants to play detective with their deductibles. Giving patients pricing information upfront puts them in control of their payments, improving their engagement and increasing the likelihood of faster collections – a top priority for providers today as they continue to feel the effects of COVID-19 on the bottom line. A Patient Estimates tool can generate accurate, easy-to-understand estimates based on known treatment costs, payer rates and real-time benefits data. Estimates and secure payment options can be sent straight to the patient’s mobile device, improving the patient financial experience with a single text message. 2. Give patients 24/7 control through their online portal With COVID-19 pushing even more of our lives online, a 24/7 patient portal is a must for providers that want to stay competitive. Yale New Haven Health (YNHH) used PatientSimple to give patients a mobile-friendly, self-service portal through which they can generate price estimates, choose payment plans, and monitor payment information. Sharlene Seidman, Executive Director Corporate Business Services at YNHH says patients have welcomed online access: “ROI is not just tangible dollars in additional revenue, it’s patient satisfaction and improving the financial experience.” 3. Minimize delayed payments with quicker insurance checks Millions of Americans have experienced sudden job losses or changes to their insurance status in the wake of the pandemic, causing confusion about their current coverage. Payment delays and denied claims are an inevitable side-effect. Providers can help by offering fast, automated insurance eligibility verification, so patients can confirm coverage at the point of service and take the next steps with confidence. 4. Move to mobile for a more convenient patient experience Imagine if your patients could have all the information they need about their healthcare account, right there in their pocket. Patient Payment Solutions offer real-time pricing estimates based on provider pricing, payer rates and benefit information, so patients can review their bill at a time and place that suits them. There’s also the option to offer secure and contactless payment methods, so they can settle their bill at the click of a button. Estimates suggest that the average family of four could save up to $11,000 a year if they had the option to choose care on the basis of more transparent pricing. Savings on this scale mean that demand for clear information about out-of-pocket expenses is going to soar, whatever happens with price transparency regulations. Learn how Experian Health can help your organization support patients and improve collections through more transparent pricing.

The regulatory requirements for price transparency are in full effect. The Centers for Medicare and Medicaid Services (CMS) is moving forward with the OPPS Price Transparency Final Rule (CMS-1717-F2), which states that hospitals must provide transparency that will help consumers understand medical costs and make informed decisions. At this point, it is recommended that hospitals begin to form a strategy for price transparency. The concept behind price transparency is simple: provide transparency that will help consumers understand medical costs and make informed decisions. Experian Heath's commitment is simple: provide solutions that benefit the patient and the provider, that improve collections and patient satisfaction. Discover how Experian Health can help you succeed with price transparency.

With so many complexities surrounding deductibles, premiums, copays and more, consumers sometimes struggle to understand the financial components of their health plans and are often unaware of the out of pocket for their healthcare needs. Recognizing that confusion about healthcare costs can make it difficult for consumers to ask the right questions, define priorities and take a more active role in their healthcare, Silver Cross Hospital made a point to educate and provide its patient base with health care estimates prior to service being rendered. With the Self-Service Patient Estimates tool from Experian Health, patients of Silver Cross Hospital now have a consumer-friendly, easy-to-use and accessible path to obtain out of pocket cost estimates. The Self-Service Patient Estimates tool works both with the hospital’s electronic medical record (EMR) and as a standalone tool for the community to use when needed. Integrating with Silver Cross Hospital’s EMR, the solution calculates estimates based on the hospital’s charge master pricing information and payer contracted rates and utilizes each patient’s individual eligibility and benefits information to create specific out of pocket costs. The tool also allows for detailed and accurate estimate creation using historical claims data to determine the typical procedures and related charges to generate average out of pocket cost estimates by health plan. Accessible via the hospital’s website, the tool acts as a digital front door in the patient exploratory process. Patients can obtain an out-of-pocket estimate any time of day or night, and as part of the process are then connected to the next place of service, whether that be to schedule an appointment, ask additional questions or obtain more information. Since implementing Patient Estimates, Silver Cross Hospital has: Increased point of service (POS) collections by bringing more awareness and education of out of pocket costs to patients upfront Reduced inbound calls and queries to the organization regarding cost estimates Integrated the solution into scheduling and pre-registration workflows within the EMR Reduced time spent training staff on other systems or workflows Learn more about Patient Estimates and how we can help create accurate estimates of authorized services for patients before, or at the point-of-service. “Patient Estimates acts a great digital front door for Silver Cross Hospital, facilitating that first step in the patient exploratory process.” – Miguel Vigo IV, Administrator Director Revenue Cycle, Silver Cross Hospital

Medical expenses are often a source of anxiety for many patients, whether they are unsure about the amount owed or how they’ll ultimately pay for it. Unfortunately, intimidating collections processes don’t help, and a crisis like COVID-19 only exacerbates this stress. A more compassionate billing approach could help patients better navigate their financial obligations and also build long-term loyalty—a necessity for providers today looking to retain patient volume during a time of crisis. Consumers overwhelmingly want to understand the cost of healthcare services, prior to services being performed. Effective price transparency involves offering patients clear, accessible, and easy-to-understand estimates of their financial responsibility for services before they are performed. Give patients clarity from the start with precise pricing estimates and up-front info about what they’ll have to pay can reduce sticker shock, help them plan and create an overall better patient financial experience. By empowering your patients with financial expectations, their feeling of control increases, improving their engagement and the likelihood that you will collect payments faster and more efficiently. Just as you don’t provide identical medical treatment to every patient, processing all patient accounts the same way doesn’t make sense. Every patient is different. Using comprehensive data and advanced analytics, providers can better understand an individual's propensity to pay and make the payment process a positive one by assessing and assigning each patient to the appropriate financial pathway based on their unique financial situation. Medical bills are often the most direct contact providers have with patients after a service is rendered. Unfortunately, money is often a sensitive topic for patients and statements are often overwhelming and difficult for patients to read. Tailoring communications at each stage can convey compassion and increase patient satisfaction. Customizing patient statements gives providers the ability to simplify and customize bills quickly and easily, turning an often confusing process into one that adds value. Including relevant, personalized messages and educational updates can turn billing statements into a useful resource, all with the potential to drive revenue. In addition to offering personalized payment options, providers can also find out whether a patient prefers to discuss billing by phone or email. Minimizing friction at the point of payment is crucial to fostering compassionate collections. Providers should offer flexible options that include in-person, telephone, mobile and online patient portals, so they can pay in a way that’s most convenient for them. This also frees up staff to help those patients who may need a little extra help understanding their statement. Want to learn more? Check out Experian Health’s Collections Optimization Manager which helps providers segment patients based on an individual’s propensity to pay and payment preferences, informing a compassionate patient engagement strategy and improving collections.

For many patients, unanticipated healthcare bills are up there with car breakdowns and untimely home repairs. No one likes a surprise bill. But when your washing machine is on its last legs, you probably do a bit of shopping around to find the best price for a replacement. Are patients doing the same when it comes to their healthcare provider? This is the idea behind recent industry and legislative moves to improve price transparency in healthcare. Recognizing that surprise billing leaves patients feeling stressed out and anxious, lawmakers are working to find a solution that would end ‘balance billing’, where patients are billed the difference between what providers charge and what insurers will pay. These bills often come as a shock, firstly, because the patient didn’t expect the bill in the first place and secondly, because the complexities associated with healthcare expenses create opacity around the actual cost of care. How transparent pricing builds a better patient experience In theory, an end to balance billing in favor of more transparent pricing should improve the patient financial experience. The hope is it leads to more competition and therefore better choice and quality overall. CMS Administrator, Seema Varma, says: "We want to empower consumers and patients to shop around for their health care and pick the provider that works best for them." However, some believe patients don’t yet think of healthcare providers in the same way as other consumer goods. Larry Levitt, Executive Vice President of Health Policy at the Kaiser Family Foundation says: “Most patients don’t think of healthcare as something you can shop around for, and there’s not much incentive when you don’t foot most of the bill directly.” Still, many healthcare organizations are on board. Giving patients greater clarity through more accurate pricing estimates and proactive communication about who pays what should reduce sticker shock, creating a better patient experience. Patient collections are likely to be a smoother and more cost-effective process, while consumer loyalty will be reinforced. All in, transparent pricing is an increasingly useful strategy to improve revenue alongside patient satisfaction. So, how should providers be using transparent pricing to improve the patient experience? How to use transparent pricing to build a better patient experience 1. Provide proactive pricing info to patients Don’t leave your patients to be surprised. Let them know upfront what the cost of treatment is going to be, including their coverage status, so they can plan ahead with confidence instead of heading into treatment with no clue as to what their final bill will be. Digital platforms can help you make this a seamless experience. A text-to-mobile solution such as Patient Financial Advisor gives patients a personalized and simple-to-read cost estimate prior to their healthcare visit and secure links to their bills so they don’t have to chase your collections team for updates. 2. Create a personalized payment experience Transparent pricing isn’t just about providing accurate estimates pre-service. It’s about seeing each patient as an individual with different circumstances, needs and preferences. A price transparency tool can reveal valuable insights about a patient’s specific situation and propensity to pay. With that, you can tailor the information you give them, the way you communicate and any payment plans you might want to recommend. For example, let’s say a patient is due to have an MRI, which will cost $650 with their high deductible health plan. For many, that’s a lot of money. Imagine how much less stressful the experience could be if you’re able to text them in advance to let them know what they owe and give them flexible payment options to manage the cost. 3. Make it easy for patients to pay One simple way to improve collections is to make the payment process as accessible and frictionless as possible. Patients have come to expect a similar consumer experience to what they’d get with online banking, booking travel or online grocery shopping. With the data-driven technology available today, it’s entirely possible for providers to deliver this. Self-service dashboards and tools are a way for patients to see what various procedures might cost and pay their bills whenever is most convenient. These can let patients apply for charity care, update their insurance details and even schedule appointments, giving them greater financial confidence and control over the process. Find out more about how to set up personalized and compassionate pricing estimates and payment options.

For many patients, the unknown cost of unexpected care is a source of anxiety: two-thirds of Americans are “very worried” or “somewhat worried” about being able to cover unexpected medical bills. No wonder, when around 56% say they wouldn’t be able to afford an unexpected bill over $1,000. In cases where insurance doesn’t cover the entirety of the bill, responsibility for paying the balance falls to the patient. The lack of price transparency leads to confusion and stress for patients, and unnecessary administrative costs for providers, who are left to chase payments from growing numbers of self-pay patients. Moving towards more transparent pricing Traditionally, patient billing has been calculated at the end of the revenue cycle, after insurance adjustments have been made. In recent months, a push for meaningful price transparency is emerging as a result of consumer demands about the cost of care, pressure from governing bodies, and bipartisan support for a legislative solution to surprise billing. In response, healthcare organizations are increasingly looking to move patient billing to the front of the revenue cycle, to give consumers greater clarity about what to expect when their bill arrives. Estimating patient liability is far from simple. It calls on front office staff to make complicated calculations based on insurance benefits, charges, contractual adjustments and provider discounts. If staff are doing this manually, they may find themselves using outdated pricing lists that don’t include current insurance information, rates and discounts. So how should providers ensure their front office staff have the right tools in place to give accurate, personalized estimates for each patient? Data-driven technology can help reduce surprise billing Data-driven technology that automates, simplifies, and unifies the revenue cycle can ensure timely communication on billing between healthcare providers and insurers. This means your front-office team can base estimates on accurate, up-to-date information. To reduce the risk of errors creeping in, price transparency and collection practices should be standardized across the enterprise. A pricing transparency tool eliminates the need for manually updated price lists and removes the guesswork that often leads to mistakes. It can also include reporting features that let you track potential and actual collections, so you have greater insight into the opportunities for revenue cycle optimization. Helping patients navigate the cost of care As patients bear more out of pocket payment responsibility, they expect a better consumer experience. Creating an optimal patient collections strategy and frictionless experience is ever more important. Full transparency calls for accurate and up to date pricing to be available to patients before they receive care, along with a detailed breakdown of what their insurer will cover. When they know what the difference is, they’ll know upfront how much they’re likely to need to pay. Additionally, clear and proactive communication around the billing process can help eliminate the shock factor, improve the patient collections process, and create a better patient financial experience all round. You could provide a text-to-mobile experience that delivers a text message with a secure link to the patient’s estimated bill. Or you might integrate a price transparency tool into your patient portal or mobile app, that lets patients see a personalized cost breakdown based on real-time pricing and benefit information, alongside methods for secure payment. A price transparency tool can also help you gather insights into a patient’s financial situation and propensity to pay, so you can optimize your collection strategies from the start and get them onto the right program. El Camino Hospital in California set an organizational objective to improve price transparency. Terri Manifesto, Senior Director (Revenue Cycle) says: “We decided to do a soft launch of a patient estimator tool, and the very next day, even without advertising it yet, our patients found the tool on the website and started using it. The feedback was excellent. We’re providing a lot more estimates than we could before because it’s 24/7 and patients can use it on their mobile device, their laptop or their desktop. Some advice I’d give other hospitals is to think of the patient when you’re deciding what to do to best communicate your prices. What would the patient want?” Working with a partner such as Experian Health lets you combine industry-leading technical expertise and payment tools with your own knowledge of your patients, so you can create the best payment experience for your consumers. Using data-driven technology, you can work to eliminate the pain of surprise bills and promote price transparency, resulting in greater revenue opportunities and customer loyalty.

Experian Health announced it has acquired MyHealthDirect, a SaaS-based company specializing in digital coordination solutions in scheduling. We interviewed Jason Considine, Experian Health general manager of patient engagement and collections, to learn more about the acquisition, as well as opportunities arising in healthcare due to the rise in consumerism. What led to Experian’s interest in MyHealthDirect and the ultimate acquisition? We’ve had a relationship with MyHealthDirect for several years. Experian Health has been reselling the MyHealthDirect solution since 2017, and we’ve long recognized that their platform’s digital care coordination capabilities would be a great match with our existing solutions. MyHealthDirect's platform links patients with the right providers, offering online scheduling tools and referral coordination to ensure more timely access to care for patients. These solutions have proven to increase appointment and referral rates, improve call center efficiency, reduce no-shows and enhance the overall patient experience. By coupling this technology with our Experian data, we can ensure patients are getting the care they need in the management of chronic diseases and wellness programs. This acquisition evolves our core revenue cycle management capabilities and helps us make gains in the patient engagement space with all-new innovative offerings. You referenced “digital care coordination.” What does this mean and how does it apply to healthcare? Digital care coordination, as it applies to the MyHealthDirect suite, is comprised of self-scheduling, call center, referral coordination and automated outreach solutions, making it easier for people to access healthcare. By combining these scheduling solutions with Experian’s existing digital patient engagement solutions, we can deliver a seamless consumer-centered experience – from serving up an estimate, to streamlining the registration process, to providing consumers with the ability to pay their healthcare bills via multiple channels. Today’s healthcare consumer expects a turnkey, personalized, on-demand experience. When you think about the best engagements we all enjoy in retail, financial services, travel and entertainment, the expectation is that the healthcare experience should be no different. We need to arm consumers with the ability to streamline their healthcare and make it easier for them to access care. Why is the scheduling component so key in the overall patient journey today? Scheduling is the one of the very first steps of the care journey and booking an appointment has traditionally been a poor experience. Common frustrations include not being able to reach the provider, finding out that no appointments are available, or being forced into a time-consuming three-way call between the health plan and provider. Without fast and easy access, patients may not be able to get the care they need. When healthcare plans use technology to better connect patients to needed care, quality scores for patient experience rise and efficiencies are gained. Can you give us an example on how more automated approach to scheduling could lead to better health outcomes for the consumer? Sure. Take for instance an individual who is living with diabetes. It is important for this person to have regular check-ins with their provider to monitor their condition and adjust care plans accordingly. If this person is challenged to see their provider, or doesn’t have regular appointments booked, they could run the risk of becoming an unhealthy diabetic, being faced with additional health challenges. By tapping into digital appointment scheduling, a provider or payer could create an automated outreach plan to make the scheduling hassle-free. Appointments could be streamlined and scheduled directly on the phone via IVR or text, and appointment reminders can be delivered. How do you see providers responding to the rise in healthcare consumerism? It’s no secret that healthcare costs are rising, and consumers are increasingly bearing more of those costs. Providers, therefore, are telling us they need to deliver a better experience. They are asking for digital technologies to gain rich insights into consumer behavior and then adjusting their care delivery plans accordingly. They recognize that consumers have a choice on where to take their healthcare business, so they need to compete. In the case of scheduling, MyHealthDirect conducted some research and revealed 66% of patients would switch providers for more convenient access. In that same study, 77% of patients think the ability to book, change or cancel appointments online is important. My point? Those providers and payers investing in on-demand tools to interface with their consumers will win, simplifying many of the administrative tasks associated with healthcare. — Learn more about scheduling solutions.

The President, members of Congress and consumer advocates are all demanding price transparency within the healthcare universe.  The major push of late is President Trump’s executive order that will be issued in June 2019; while critics hope this initiative will fade, the topic has been on the industry radar for many, many years. How did we get to today’s scenario? We have a robust perspective on this subject at Experian Health because we’ve been working with healthcare organizations offering various solutions that inform consumers about the costs of their care for more than 10 years. We brought to market the first iteration of our current Patient Estimates product back in 2008, responding, in part, to the growing issue of medical debt and inherent risk to providers not getting full payment for services. The challenges presented by medical debt are well documented, but the important point to focus on is that as long as Americans continue to lack the ability to pay for their care and health organizations struggle with collections, the push towards price transparency will continue. Perhaps this is much needed progress? Since 1957, nearly 75% of Americans have consistently reported being insured but unable to pay their medical bills, according to a study by the Centers for Disease Control. Now, more than 50 years later, many legislators hope mandated price transparency will alleviate the surprise factor of medical costs and spur a more competitive environment. In 2008, helping patients understand their costs was intended to improve providers’ collections success. The term ‘price transparency,’ with additional connotations (e.g. better experience for the patient, improved efficiencies), popped up about the same time as the introduction of very high deductible health plans. The phrase started gaining traction following passage of the Affordable Care Act, and as patients were responsible for more of their medical costs. Add in the rise of consumerism within healthcare and Americans’ digital lifestyles, and it’s no surprise there are calls for pricing to be as easy to understand as they are in the retail space. We harness the power of data and analytics to fulfill these needs in the marketplace. The healthcare industry was ripe for change more than a decade ago, as evidenced by the desire of organizations to leverage what we could offer. While there is continued debate on the transparency topic, the good news is today’s data-driven technology can create a patient financial experience that is friendly, understandable and accessible, delivering the good-faith estimates many consumers, legislators and the industry-at-large wish to see. Consumerism drives price transparency expectations Ultimately, the financial aspect to care is a key component to consumers’ satisfaction with a provider. This realization began to bubble to the surface over the last several years. In fact, Experian Health conducted research last year to understand consumer pain points during the healthcare journey. Consequently, it was no surprise when the study revealed consumers’ biggest frustrations and challenges – above clinical areas – is dealing with the financial aspects of healthcare: 90 percent of respondents ranked worrying about paying their medical bills as a very important to extremely important pain point. 30 percent acknowledged the challenges of determining what financial support options (e.g., payment plans, government grants, and hospital charity care programs) are available 90 percent reported significantly underestimating the costs associated with major medical procedures (e.g., knee replacement) The takeaway from this study is clear: consumers want a streamlined payment process that builds confidence and provides peace of mind. We know that healthcare providers want to increase the efficiency and success of their collections efforts. Ultimately, everyone benefits from clarity around pricing. So whether government-mandated or not, there is no denying that price transparency, in some form, is here to stay and a transformation in the industry is taking hold. Experian Health is leading the way to innovations that will help healthcare organizations thrive in this new era. By leveraging our expertise in data and analytics and our understanding of healthcare costs, we can help patients successfully navigate their financial obligations from primary care appointments through subsequent diagnostic procedures and surgeries. The potential is there for everyone to benefit from an evolved, modern system. Related Articles: How Blessing Health System personalized estimates to improve patient satisfaction