The Future of Healthcare with David Shelton of PatientMatters

I think we also need to examine ways to improve operational efficiencies that control the administrative expenses such as connecting with the patient at the earliest point of contact regarding their care, payment expectations, the patient relationship and cutting costs around follow-ups. Asa part of my interview series with leaders in healthcare, I had the […]

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I think we also need to examine ways to improve operational efficiencies that control the administrative expenses such as connecting with the patient at the earliest point of contact regarding their care, payment expectations, the patient relationship and cutting costs around follow-ups.

Asa part of my interview series with leaders in healthcare, I had the pleasure to interview David Shelton. David serves as Chief Executive Officer for PatientMatters, a patient access and advocacy solutions provider helping hospitals and health systems offer patients highly-personalized financial solutions. He has served in senior healthcare management for more than 15 years, with experience in operations, technology development, and manufacturing. His expertise includes delivering business growth, streamlining operational management, and generating profitability for PatientMatters and its healthcare clients.

Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?

Iwas working with a top patient advocacy organization called Medical Advocacy Services for Healthcare (or MASH) program and Sheila Schweitzer, our founder, was doing a lot of work in the healthcare industry. She recognized that the financial relationship between the patient and healthcare provider was changing. Deductibles were changing, copays were changing and the patient financial responsibility was growing, which meant healthcare providers needed to adjust their ways of addressing patient financial outcomes. So Sheila acquired our company, along with some other technology solutions, and established PatientMatters. We were one of the first organizations to help both the healthcare provider and the patient reach the same goal: finding ways to work together to meet payment obligations.

Can you share the most interesting story that happened to you since you began leading your company?

At PatientMatters, we work with patients to find the best healthcare payment option, whether it’s a unique payment plan that fits the individual or helping a patient in need connect to a government or charity payer source. We have a call center in Houston, Texas, and one time I was down there doing some work when one of our call center representatives received a call from an individual who had just come out of a hospital. The individual had been to this particular hospital in the past and we had worked with him on a payment plan. While he knew he was going to have a bill, his statement had not dropped yet, but he was calling us because he wanted to be put back on the same payment plan that he had before because he recognized how the hospital had worked with him to find a payment plan that would help him meet his obligations. It reinforced in me that if you will work with your patient population to help them understand their bill and how it relates to them and you will work with them to find a payment plan that fits for them — they will quickly adapt and look for ways to engage with you over the long-term.

What makes your company stand out? Can you share a story?

We help healthcare providers improve their performance with both operational efficiencies and with financial improvements, we tackle both of those at the same time. We see hospitals that we are working with have dramatic improvements especially on the front end that spill over to time savings on the registration piece and reduce overall no-shows for the hospital. One particular hospital is in New York that we have partnered with for three years, we have seen their numbers not only spike in the appropriate directions, but they have sustained and continued to improve. This reinforces to us that when you apply the technology and operational efficiencies and improvements your patients adjust, and if your hospital staff will make adjustments operationally and adhere to the process you have, you will continue to see improvements over long periods of time — it is not just a one hit wonder.

Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?

The pain point we are addressing specifically is the patient financial impact and how it affects the hospital or healthcare provider. We are engaging with patients on the front-end even before the services have been provided which is a key point for us. Understanding the patient’s out-of-pocket expenses and their financial current state helps us lay out a path that fits their personal residual income opportunity. We are disrupting the status quo in the sense that we are talking to patients before the service has happened to say “Hey, here is how much money you will owe — how do you want to pay it?” We are already getting patients to commit to payment plans before services are rendered. It is a pretty novel approach and stresses the engagement we have with the patient. The impact we are having on the healthcare provider is improving their operational patient through-put that improves the overall patient experience such as through a reduction of registration times, reduction of no-shows, and improving pricing transparency that eliminates surprise billing that the patient may incur.

What are your “5 Things I Wish Someone Told Me Before I Started” and why. (Please share a story or example for each.)

I have three meaningful things that I wish someone told me before I started that I think are worth sharing:

  1. Healthcare is not easy. Healthcare doesn’t operate like a traditional business — when there are people’s lives that are being impacted you can’t always apply traditional business practices or models to the equation, you have to find innovative ways to help the patient. If someone can’t pay their bill, you don’t deny services. If a patient is struggling with a financial obligation you still have a responsibility to that individual to provide the care they need and find a way to work through it.
  2. Technology alone is not a cure-all. Just because you have a technology platform that may have all the bells and whistles, it does not fix all the challenges a healthcare provider has. Any technology application also requires an operational change to benefit from the improvement. So just because you have technology that is really innovative, if you are have not operationally equipped your staff to adjust the workflow or look at the patient flow differently while utilizing the technology, you will never see the real benefit that is available to you.
  3. Patients really do want to pay their bills, and healthcare providers really do want to work with them to find a solution. My experience has been that hospitals want to find a way to work with the individual and both parties want to solve the issue, but sometimes they just need the tools to find a connection that satisfies both parties.

Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?

This study touched on a few different areas, but there were two areas that really resonated with me based on my experience and the work PatientMatters does as an organization.

  1. Administrative efficiency. There have been a lot of studies done on this, but about a quarter of all healthcare costs have been associated with administrative overhead. So, it is taking a lot of staff to go through the office pieces that are necessary in providing healthcare. We spend a lot of time and effort working on technology solutions that improve the staffing performance, that give them a better efficiency within the clinical staff to maximize the hospital facilities and equipment. We spend a lot of time working to improve technology models that provide more accurate patient estimations and that create pricing transparency for the patients and improve overall patient satisfaction. Administrative efficiency is an area that healthcare struggles with because it takes a lot of people — and we are looking for ways to lighten that load. Coupled with that are the operational efficiencies that shorten registration times for the patient. When you shorten those registration times, you are using less staff or are able to maximize staff performance. You are doing things that result in more hospital payments and less staff follow-up.
  2. Access overall for the patient. When you look at patient access, it is in line with the study because there are a lot of challenges for patients living in rural areas with overall access to healthcare. We have seen patients who are confused about their healthcare costs and they delay or even avoid seeking care. That confusion can be both with how their own insurance works such as deductibles, copays they elected with an employer or through the exchange, that now don’t make sense as they come across a need to apply that insurance or find a way to work through that to cover their healthcare experience. So a lot of times patient access is not only your ability to get to a facility but recognizing when you get there how you behave, how you understand your insurance and out-of-pocket expenses and how those things are communicated to you that challenges US healthcare.

You are a “healthcare insider”. Can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

In order to improve the overall US healthcare system, there needs to be a better understanding of the patient and their ability to pay. More employers are offering a healthcare coverage solution that saves the employees upfront costs but may not have a broad enough coverage plan in a time of need. The patient/employee has made a choice to perhaps select an inexpensive healthcare solution that when it is time to put it to use they can’t make it cover all the expenses that they have. Better communication from the hospital side is needed at the initial encounter with the patient, creating payment plans that fit the patent’s ability to pay.

I think we also need to examine ways to improve operational efficiencies that control the administrative expenses such as connecting with the patient at the earliest point of contact regarding their care, payment expectations, the patient relationship and cutting costs around follow-ups.

Another necessary change is utilizing patient friendly technology solutions like patient estimation tools, as the ability to build pay algorithms can address your patients pricing and reveal your pricing to the patient so there is no surprise. Price transparency is currently an important issue. You need to be able to properly communicate with a confused patient, and that confusion is often wrapped around personal decisions they have already made. You need to be able to help talk them through the financial experience.

Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities and leaders do to help?

I am looking at this from three different perspectives, the first being a government perspective. One of the challenges that the US has with high pricing is the ability for the government to negotiate with drug manufacturers on drug pricing. Medicare part B prohibits Medicare from being able to negotiate with drug manufacturers and if they were allowed to do it, it’s estimated that the savings would be more than $100 billion over a ten year period. So I think that is one area that can be adjusted.

The second perspective is corporations. I think there are opportunities to improve communication efforts with employees since the employer in our country is the number one provider of insurance. A lot of times I think those individual employees don’t understand what they are buying and are making dollar only decisions. If they had a better understanding of how their employer’s insurance policy works and the benefits being provided they might elect to pay more to adjust more for a health savings plan or something like that, knowing the challenges their family might be facing. The employer is probably the best to do that.

I do also think there is a responsibility for individuals to educate themselves on their insurance plan and the benefits that are available. Even for the uninsured to be able to reach out to their providers. The individual needs to be proactive in being able to address that.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

In terms of podcasts, I enjoy HFMA Voices in Healthcare Finance and HealthcareNOW Radio. From a blog perspective, one I have started following is by Sramana Mitra and her One Million by One Million work — she identifies a lot of niche solutions in the healthcare arena with emphasis on IT solutions. She provides some cutting edge information that goes out to different vendors on how they can better position their organization to provide the maximum amount of opportunities to the healthcare provider. We also do a lot of reading in different e-magazines and healthcare publications that include MedCity News, Healthcare Business Today and RCM Answers, those are some that we follow on a regular basis.

How can our readers follow you on social media?

Twitter: @patmatters

LinkedIn: PatientMatters

Thank you so much for these insights! This was so inspiring!

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