Peter Longo is chief revenue officer at Sirono of Berkeley, California.
Tell me a little about yourself and Sirono.
Sure. I’m the chief revenue officer for Sirono. I got into healthcare back in the McKesson days. A lot of people don’t realize McKesson wasn’t strong in the hospital business. They were hiring people to get stronger in that business. That’s where I got started. I’ve always been involved I leading and building sales teams for healthcare. That’s how I got involved with Sirono as they wanted to build and grow their sales and marketing team for this product.
Sirono is dead set on fixing the problem of everyone saying, "I hate how my hospital bills me." We built software from the ground up that focuses on treating the patient more like the customer and interacting them with their bill so they get accurate information. We do that with services and processes that treats them as a customer and not like a tiny little insurance company which hospitals treat patients like today.
Why can’t hospitals do that on their own as they bill and collect from patients?
Hospitals generally get their money from insurance and government. They’ve built massive technology and processes around billing with insurance companies. We’ve all seen that bill that gets to our house that says, "This is not a bill, don’t pay" even though it says “bill” on top. It’s kind of stupid, but it derived from them working with insurance companies. They try to take that same insurance company mentality and treat me as a patient and bill me like I’m an insurance company, send it to me three times hoping that I pay.
As hospitals try to do it on their own, they’re not taking a step back and starting from scratch and saying, "Let’s treat this person as a customer, not as a tiny insurance company.” That’s why hospitals struggle with it. They don’t have the tools and technology to do that today.
How did ACA affect the problem?
It’s getting worse. Obamacare is not perfect by any means, but it’s helped our industry a lot to look at change. If you look at the early information from Obamacare, it’s starting to show a big trend in high-deductible plans. Different levels of plans have different levels of deductibles. The data is already showing that most participants are choosing high-deductible plans. To be in those means more cash out of pocket to pay for care. Every time I go to have an event or an episode, I’m going to be paying more out of cash. I might not have that cash readily available. They just even showed a report that in California that the Obamacare premiums are going to rise 13 percent next year. That’s a lot of money. That’s a lot of cash that’s entering into the system.
Hospitals are used to doing a finite number of insurance companies and billing them. Now with Obamacare, they’re expanding how many people a hospital has to collect from. It’s a capacity issue as well with hospitals to try to do it. Obamacare is making more cash payment and more people that have to try to collect from.
It is really a train wreck that’s coming in the next two years of so much more cash coming into the system and hospitals figuring out how to work with it because of the higher deductibles and the increase out of pocket for Obamacare patients.
Should we expect to see government intervention around patient payments?
What we really think we’re going to start seeing is a little more regulation around it. There is a rule that came out called 501R, for instance, where hospitals are being asked to document more appropriately how they offer charity care to their community and show that they do it equally amongst their community and not just to anyone who asks for it.
The other thing is that hospitals have a tendency to if you have a payment, let’s say $1,000 a hospital, they’ll let you do a payment plan and they don’t charge interest. In the old days, when the cash out of pocket of a payment wasn’t a large number, a couple hundred dollars, a payment plan was not a big deal. Now with high deductibles and more patient responsibility, those numbers are getting to be $10,000, $20,000, $50,000. Hospitals are still giving them no-interest loans which are payment plans. The government is going to start regulating that. We’ve already seen many committees in the Senate looking at this trying to figure out. These are small business loans you’re giving hospital. We think it is going to become more regulated on how they collect the money and how they treat these loans that they’re giving their patients.
How does this affect patient satisfaction?
That’s something I’m extremely passionate about. I love that hospitals are focusing on patient satisfaction. The other day, I went to my university hospital. I literally walked in the door and they all greeted me and said, "Welcome." All the staff, almost like I was going in the Gap, when you go into these retail stores and they all say hi and welcome. It was the exact same experience. I’m thinking, "The hospital is looking at the other businesses and learning from them. How do they treat customers? Let’s start doing that as well."
What’s different is they’re not doing patient satisfaction on the billing side. I called at 4:15 to ask about a bill to the university hospital and I got a message that they’re closed. They close at 4:00 and they’re closed on weekends. What patient satisfaction is that in helping me with my bill and never being available to take my call? I do think that we’re seeing hospitals improve on patient satisfaction on the clinical side. We just need them to start doing it on the financial side as well.
The government sponsored a contest to try to make better-looking patient bills. How is Sirono solving this problem?
That’s great. I was excited when so many people emailed me about that competition to make a better bill. Making the bill pretty and understandable is not going to solve the whole problem. It is a step in the right direction. The way Sirono approached it is we partnered with Salesforce, the leader in CRM, customer relationship management software for every industry. Why doesn’t healthcare learn from them? We partnered with them and built our platform on top of Salesforce. Every interaction with the patient is a good interaction. The bill does look a lot better with Sirono. They’re able to pay on a portal. We can consolidate all their information, whether it be my wife, my kids, everyone in one place on our platform. To see them try to make a bill prettier is not going to solve it. We have to reinvent how we treat a patient and treat them as a customer. Salesforce has helped us step in that direction in partnering with them to bring that into healthcare.
What do you envision the financial experience will look like three years from now?
I see it as I look at a lot of this as myself. I’m going to get a call from a hospital who’s going to know, have everything about me, right in front of them. They’re going to have my deductible, what I owe. They’re going to see everything if my wife went or my kids went to the hospital because I’m the guarantor. All my information in one place. They’re going to understand how I want it interacted. I want to pay on a portal. They’re going to also understand whether I can do a payment plan. Am I good to be put on a payment plan? They’re going to understand everything about me in one place. Then I’m going to say, "My doctors are great. My billing experience is great as well." That’s what I want to happen in a couple of years.
Today, unfortunately, what we get is we get great medical care, and then we get the hospital to send us a bill that basically just says screw you. They neglect us in the end after they’re provided incredible nurses, doctors and care for us. Then they leave a bad taste in our mouth by messing up how they bill us.
Do you have any final thoughts?
The reason Sirono is doing so well and getting so much momentum is really about the people. My advice to anyone else in healthcare and technology is to make sure you have the right people, the right experience. Healthcare is hard. It’s not easy. It needs a change, but if you have the right people, that’s a foundation where you can +create a better environment. At Sirono, that’s what we’re trying to do is create a better billing experience for customer for the hospital.