Care Management

Healthcare revenue cycle challenges exist at every stage of the patient journey, beginning with patient access and extending all the way through claims, billing, payment and collections. However, digital tools and analytics can help providers tackle their top healthcare revenue cycle challenges. “The complexity of our reimbursement structures and the complexity of billing mean a variety of aspects impact revenue cycle management,” says Tricia Ibrahim, Director, Product Management, Contract Manager, Hospital at Experian Health. “Technology, regulations, changing contractual obligations and payer policies, people, processes, billing—each of these complexities adds to the challenge.” Revenue cycle management (RCM) issues can also lead to revenue loss if not addressed. Data and analytics, digital tools and automation can help providers manage complexity and adapt to evolving patient needs. Here are seven of the top healthcare revenue cycle challenges and how providers are taking them on: 1. Problems with patient access Consumers accustomed to using mobile apps and online services to shop and do their banking look for seamless digital experiences when they’re choosing a provider, scheduling appointments and managing pre-appointment activities like registration and insurance verification. In a new consumer survey by Experian Health and PYMNTS, 77% of patients who were not currently using digital tools for healthcare said they would be interested in switching to a provider that offered a patient portal. The automated tools that make up your digital front door make a huge difference in how patients engage. Together with accurate estimates and convenient payment options, digitally focused Patient Access Solutions help providers enhance the patient journey and improve registration accuracy. Manual processes require more staff time up-front; human error can lead to claim denials or billing errors later in the cycle. Automating streamlines the process. Offering patient intake software that can be accessed online or via a mobile device provides the flexible and familiar digital experience they expect in today’s world. 2. Poor collections recovery rate As high deductible health plans have patients taking more responsibility for their healthcare costs, patients are finding it more difficult to pay. Bigger bills often translate into a greater potential for confusion, more questions about insurance coverage, and a greater need for financing options. Providers need effective collections strategies to boost revenue and lower bad debt write-offs as more focus shifts to the patient as a payer. A patient-centered payments strategy helps patients better understand their estimated costs, insurance coverage, and payment options. To help patients navigate the financial process successfully and navigate this healthcare revenue cycle challenge, providers will need to support them with: Clear, accurate estimates that show patients how much they’ll owe up-front Payment options that include multiple payment methods, including cards, Apple Pay, and e-checks Navigating payment plans to manage large balances A process that encourages payment before service or at the point of service to reduce collections down the line When providers have to collect, digital tools and analytics can help optimize the collections process by prioritizing accounts that are most likely to pay, automating billing and messaging workflows, and even tracking the effectiveness of outside collections agencies. 3. Billing errors Claim denials are a drag on workflow, sending staff into a repetitive loop of claims submission, denial, correction, and delay—and throwing a wrench into revenue flow. A denied claim typically slows reimbursement by 16 days. Worse, claim denials are on the rise: 69% of healthcare leaders in an MGMA Stat poll reported that denials increased at their organizations in 2021. Replacing manual processes with automated workflows can reduce billing errors and A/R days. Integrated claims management software reviews claims for inaccurate coding before claims are submitted, easing demands on staff time, reducing claims denials, and shortening the time between billing and payment. 4. Underpayments in payer contracts Missed payments and underpayments can add stress and volatility to your revenue cycle. Often, the source of these problems lies in payer contract issues. “Payers often know your book of business better than you do,” says Ibrahim. “When you’re negotiating contracts, you need to be able to go through large amounts of data quickly and efficiently, so you can come to the table armed with information. One of the services we provide is contract analysis to help providers evaluate contract terms in real dollars and cents.” For active contracts, Healthcare Contract Management helps providers track inaccurate payments and hold providers accountable. 5. Changes in healthcare regulatory and compliance standards New regulations are a constant in healthcare. However, this is one of the biggest healthcare revenue cycle challenges that providers need to keep up with. Failing to stay up to date with the ever-evolving compliance landscape can lead to claim denials, payment delays, and administrative and billing backlogs. Healthcare Regulatory Solutions, which includes systems for providing transparent, patient-friendly estimates, can make it easier to make regulatory compliance part of your regular business processes. A free No Surprises Act (NSA) Payer Alerts Portal keeps providers updated on how new NSA regulations are playing out. 6. Lack of data-driven metrics and insights Gaining efficiencies in RCM means using analytics to provide a big-picture view of what’s happening throughout the enterprise. This perspective is not always the default in a busy healthcare practice or hospital. Yet, “Fixing claim after claim on an individual basis isn’t going to get you the efficiency you want,” says Ibrahim. “You need to identify trends to find the biggest opportunities to improve your results.” Comprehensive data and analytics are key for providers that want to pinpoint and address areas of trouble. Here, disparate systems and siloed information can get in the way of creating the single view needed to diagnose the issues that are slowing down claims, billing, and payment. Revenue Cycle Management Analytics integrates client data with non-native standard Electronic Data Interchange sets to reveal opportunities for process improvements. By leveraging the right data, providers can optimize patient access productivity, billing efficiencies, reimbursements, and payer performance. 7. Potential security issues Patient portals engage patients and empower them to schedule their appointments, review test results, or make payments. But as providers digitalize to improve the patient experience and boost the revenue cycle, patient identities and data may be at greater risk. Cases of medical identity theft reported to the Federal Trade Commission rose more than 532% between 2017 and 2021. Medical identity data is particularly valuable to thieves, bringing 20 to 50 times more money than data from financial sources. Securely authenticating patients is critical as a safeguard for both providers and patients. Identity theft damages the patient experience and erodes trust, while dealing with the resource and reputational damage fraud can cause is a major potential liability for providers. Working with vendors that provide extensive Patient Portal Security and digital tools that protect patient identities without causing friction or frustration is essential to keeping patient data safe without alienating the patients in the process. Prevent healthcare revenue cycle challenges with automation Revenue cycle management healthcare challenges are among the great tests facing providers right now. But improvements in digital tools and analytics are helping providers keep revenue flowing while keeping both compliance and the patient experience in focus. Find out more about how Experian Health's Revenue Cycle Management Solutions can help your organization meet the challenges of modern RCM.

Patient experience may not be the first consideration that comes to mind when you're looking to improve revenue cycle management (RCM). However, a positive patient experience can benefit RCM. It can make the complicated process of understanding and managing healthcare finances simpler and more seamless for patients—and facilitate an easy-to-navigate continuum of care that includes RCM. Financial transparency plays a significant role in building trust and confidence between patient and provider. Patients who may find it difficult to understand medical billing and health insurance coverage—and who are paying more out-of-pocket costs thanks to high-deductible health plans—appreciate accurate estimates and a range of convenient payment options. By optimizing back-end claims, billing, payment and collections processes, providers free up staff to provide individualized help to patients who need it. Strategies to bolster patient experience and RCM Patients who have grown accustomed to using digital platforms for everything from online shopping to food delivery, travel, managing finances and entertainment gravitate toward digital tools and expect a high level of functionality. In a Salesforce survey of 15,000 consumers, 68% of respondents said their expectations of companies' digital capabilities increased after COVID-19 drove more of their activity online. Providing a superior digital experience is now synonymous with good service, but healthcare is lagging behind other service sectors. For providers, automation and data analytics can streamline workflows and improve efficiencies. These factors are critical as staff find themselves under increasing pressure to provide accurate patient estimates upfront and to submit claims accurately to reduce denials. How can providers use the patient experience to improve RCM? Here are a few areas of focus to consider: 1. Offer consumer-friendly front-end technology Patients are looking for seamless digital experiences, where they are empowered to search out what they want, choose from a menu of options and pay effortlessly online. In a healthcare setting, they want to find and schedule their own appointments quickly. Providing new and existing patients with 24/7 mobile access to online patient scheduling is critical to early engagement. In fact, a new report from Experian Health and PYMNTS revealed that 61% of patients interested in using patient portals say they would switch to a healthcare provider that has one. Providing patients with an accurate estimate they can review in advance improves transparency and builds trust. This allows patients to ask questions and make decisions about how to pay on their own time and without pressure. Pre-appointment estimates might also offer patients the opportunity to pay conveniently online before their appointments or at the point of service, minimizing the need for post-treatment collections and reducing RCM costs. 2. Simplify and automate in-office technology Automation can boost the experience on both sides of the front desk. Automated processes simplify patient-facing tasks like registration and check-in while making back-office operations like data entry and authorizations more efficient. “When a patient submits photos of their insurance card and identification, software scrapes that information and inputs it into the system,” Serie explains. “This process is more convenient for the patient, faster and more efficient for staff, and reduces the potential for human error.” As healthcare providers continue to experience staffing shortages, automated systems can offer greater workplace flexibility. That's helpful for providers that need to flex their resources, but also for employees who want more options on where and when they work. 3. Provide price transparency and financial information to improve the patient experience In a Policygenius consumer survey, 26% of respondents said they have avoided care or treatment because they were unsure what their insurance covers. Patients might be forgiven for feeling confused and frustrated – healthcare bills are not always patient-centric. In fact, many consumers report a low level of insurance literacy and, unless told, don't know in advance what medical procedures are likely to cost. At the same time, out-of-pocket costs are rising, raising the stakes and increasing the likelihood that medical bills will pose a significant financial challenge. Outlining estimated costs prior to service can help patients understand their expected out-of-pocket payments. Accurate patient payment estimates take away some of the sticker shock and give patients an opportunity to discuss coverage with their insurance companies, choose the right payment methods, or arrange for payment plans before treatment happens. 4. Allow for online bill payments Frictionless payments are now the norm, online and in-app. Experian Health's PatientSimple solution offers healthcare organizations a suite of tools to simplify payment. Using a healthcare-specific algorithm, PatientSimple provides personalized, data-driven insights that help providers deliver the right messaging and payment options, including: Price estimates based on insurance coverage and payer's negotiated rates Guest payment option for patients who don't want to set up an account Online payments and payment plans E-statements, online account access and email payment reminders Qualification for financial assistance A smoother path to payment increases the chances that patients will pay pre-appointment or at the point of service. By offering patients more and better payment options providers can increase up-front revenue and reduce the need for collections. 5. Enable self-service Frictionless payments are just one facet of helping patients help themselves. Enabling the tools that create a “digital front door”—including the ability for patients to register and check-in online, access a virtual waiting room and make “contactless” payments—can boost engagement and give patients greater choice, control and convenience. By mapping a patient journey that flows seamlessly between virtual and in-person interactions, providers can set the stage for receiving payment earlier in the process. This can also help with outreach to patients post-care for follow-up and payment, if necessary. 6. Ensure coding and billing accuracy Clear, accurate patient billing is the goal, but keeping up with changes across multiple payers is an ongoing challenge for healthcare providers. New products, mergers and acquisitions, policy and procedure changes all create the potential for errors, denials, delay and lost revenue. Experian Health's Payer Alerts helps notify providers of payer policy and procedural changes with a daily digest email and an online portal. A simplified estimate process with fewer revisions streamlines the RCM process; it also helps patients avoid confusion, which degrades the patient experience and may cause patients to delay payment. 7. Optimize bill collections Collections can be one of the most difficult parts of healthcare RCM. On the patient side, post-treatment collections feel like a hassle; they may also become a source of significant financial problems. For providers, collections can be costly and time-consuming. Optimizing collections with automation and data analytics can streamline the process and improve outcomes. Experian Health's Collections Optimization Manager uses specialized scoring algorithms to segment and prioritizes accounts based on the likelihood they'll be able to pay. Automated billing and outreach make collections less onerous for staff, while automatic updates keep accounts and communications current. For patients, providing convenient digital payment options takes some of the friction out of the payment experience and removes at least one barrier to bringing an account current. Patient experience and RCM go hand in hand Improving healthcare RCM is certainly not the only reason to work on improving the patient experience. Enhancing the patient journey across the care spectrum can help providers engage new and existing patients, offer the digital tools and seamless experiences they've come to expect, and reduce their anxieties over medical costs. At the same time, using RCM solutions to bolster the patient experience means new efficiencies for staff and, along with this, expanded opportunities for work flexibility and greater success at managing the revenue cycle. Contact Experian Health to learn more about optimizing your patient experience and improving RCM at your organization.

Inflation is giving the cost of healthcare a run for its money. The Consumer Price Index rose by 8.3% year-over-year in August 2022, compared to a rise of just 2.9% in the Health Care Price Index. However, slower price increases do not necessarily mean healthcare will get an easier ride than other businesses. Healthcare contracts are agreed in advance with government and commercial payers, so any effects of inflation could simply be delayed. How should providers factor such economic unpredictability into their revenue cycle management strategies? Healthcare is usually more resistant to wider economic shocks than other service sectors, so rising inflation doesn’t necessarily mean there’s an urgent need to change course. Providers are always working to maintain a healthy revenue cycle and will continue to do so now. That said, the lingering financial effects of the pandemic, staffing shortages and increasing operational costs mean that provider cash flow is sensitive to any added pressure. While there’s currently no sign that patient collections have been significantly affected by inflation yet, patients may assume that health costs will increase too, along with everything else. This might lead them to delay elective care, which could affect providers’ bottom lines. As non-COVID patient traffic slowly returns and state and federal aid ends, rising inflation presents an additional hurdle to providers’ financial health. Providers will need to tighten their patient collections process and safeguard their bottom line. Download the white paper to learn how inflation is impacting healthcare and get strategies to optimize collections and avoid revenue loss. Providers that want to bolster their revenue cycle against the potential impact of inflation should focus on increasing workforce efficiency to manage costs and mitigate the risk of deferred care, to maintain a steady inward cash flow. They’ll also want to be prepared for any potential shift in patient payment reliability that could occur if inflation persists. Automated solutions and self-service digital tools can help to solve these issues. Minimize workforce inefficiency with automation and self-service solutions Questions to consider: How can digital technology and automation improve efficiency and ease pressure on staff? Where can patient self-service solutions help reduce the need for staff input? Inflation is likely to hit providers hardest in relation to payroll expenses. Staffing shortages lead to increased costs as providers raise salaries to attract and retain new staff, pay overtime costs, and hire more temporary workers. Reduced purchasing power will only exacerbate these challenges. Automation and digital tools can help address staffing shortages and keep a lid on payroll costs by increasing efficiency in existing workflows. For example, digital technology can allow patients to take care of many administrative tasks themselves, thus reducing the demand for staff input. Online self-scheduling and registration allow patients to book appointments and fill out pre-service paperwork without taking up valuable staff time. These tools leverage data and automation to pre-fill patient information, which reduces the risk of costly errors and saves time for patients and staff. Further along in the patient journey, automated collections can eliminate much of the manual work that puts pressure on understaffed teams, while increasing the likelihood and speed of payment. Collections Optimization Manager helps increase workforce productivity to make better use of staff time and avoid unnecessary revenue loss. Advanced analytics are used to prioritize accounts by payment probability, which will be increasingly useful should ongoing inflation increase the risk of patient bills going unpaid. Consumer data helps identify the most appropriate communications method for each segment, so the right message can be sent at the right time to boost the chances of collecting a greater percentage of money owed. Automation also helps reduce staff costs to collect, while bumping up the amount of money that comes in the door. As hospital operations become more expensive on the whole, maximizing efficiency in collections is increasingly important. Maximize revenue by removing friction for patients worried about the cost of care Questions to consider: How can providers help patients better understand their bills? How can digital technology make it easier for patients to access and pay for care? The second step is to make sure that dollars keep coming in the door. Managing household bills can be challenging for patients, and there’s no suggestion that the rise in inflation during 2021 has added any new pressure to patients’ ability to pay for healthcare. Experian Health’s clients also continue to see very low levels of delinquency. However, despite pay raises, many consumers are worried that price inflation will overtake any increase in household income, especially as energy and food prices go up. They may decide to cancel or postpone elective care until they’re sure of their financial situation or move their medical bills to the bottom of their priority list. In reality, costs for patients haven’t increased, because of the delayed effect of inflation in healthcare. That’s why it would make more sense for patients to seek elective care sooner rather than later. Given reports of pricing concerns, providers should consider ways to reassure patients about their financial obligations and make sure they don’t miss out on the care they need. Here are some ways that providers can support their patients: Providers can help patients get a better understanding of their medical bills and payment options, by incorporating solutions that offer greater price transparency. Upfront patient estimates delivered directly to their mobile device, with links to appropriate payment plans and payment methods, can help them plan with confidence. This will help to reassure patients that prices have not increased drastically due to inflation, so they are dissuaded from deferring care. Finding missing or forgotten insurance coverage is another strategy to give patients certainty around how their bills will be covered. A tool such as Coverage Discovery can run repeated and automated checks for previously unknown government and commercial coverage, using multiple data sources. Self-service patient access and patient payment tools can help to reduce friction during scheduling, registration and billing, so patients see fewer reasons to postpone care. Liz Serie, Senior Director of Product Management at Experian Health, says, “Automation and patient self-service features can help address the risk of patients choosing to put off visiting their doctor or getting a procedure they need. Many patient access and patient payment activities that would normally require staff attention can be easily pivoted to an innovative patient-facing experience. This will reduce friction for patients and help providers manage staffing shortages and cost pressures.” “Automation and patient self-service features can help address the risk of patients choosing to put off visiting their doctor or getting a procedure they need. Many patient access and patient payment activities that would normally require staff attention can be easily pivoted to an innovative patient-facing experience. This will reduce friction for patients and help providers manage staffing shortages and cost pressures.” - Liz Serie, Senior Director of Product Management Find out more about how Experian Health’s digital tools and solutions can help healthcare organizations create a financial safety net and protect their revenue cycle against the possible impact of inflation.

In the decade since the Affordable Care Act sparked the transition toward value-based care and pay-for-performance care models, clinical services have been transformed by advances in diagnostics, medical devices and digital technology. However, despite a commitment to improving care quality and patient experiences, the healthcare industry still struggles to influence the factors that have the greatest impact on patient outcomes – the social determinants of health (SDOH). It’s now well-established that clinical factors have a relatively small impact on a person’s health-related quality of life. As little as 20% of the factors that influence health outcomes are attributable to clinical care. The remaining 80% includes social, economic and environmental factors – such as access to safe and clean housing, healthy food, education and transportation. Healthcare providers cannot be expected to solve these challenges alone. That said, providers will benefit from developing plans and investing in systems that foster awareness of the social determinants of health that impact their communities. This will help enable the delivery of the proactive and coordinated services patients need to live healthier lives. The pandemic intensified many of the socio-economic barriers patients face when accessing care, medication, housing and food. It forced sudden changes to the way care was delivered, making it harder for healthcare organizations to sustain high-quality services. When overwhelmed hospitals just needed to get through the day, value-based care took a hit. To support underserved communities, healthcare organizations need reliable insights into their patients’ evolving life circumstances and socio-economic challenges. SDOH data can help providers identify the right strategies to serve their patient population in the most effective way. SDOH should be at the heart of patient-centric services. Healthcare organizations that prioritize the use of SDOH data are strengthening their ability to deliver value-based care. How has the pandemic affected SDOH and value-based care? Value-based care and pay-for-performance models were gaining traction just before the pandemic, and many providers were agile enough to respond quickly to the pandemic with telehealth and other remote services. But against a tsunami of COVID-19 cases, tests and vaccination programs, reimbursement models based on quality measures such as effectiveness, efficiency and timeliness proved fragile in the midst of an emergency. As is often the case, the worst effects of the pandemic were felt most acutely by marginalized and economically vulnerable groups. For example, groups with less stable employment were less likely to have access to sick leave or remote working opportunities, putting them at greater risk of catching the virus. Many community programs were put on hold, with consequences for the individuals who relied on them for food, support, and company. Insights on the social determinants of health can help providers segment vulnerable populations that need extra assistance to take control of their health. Once these populations are identified at the patient level with insights driving one’s unique SDOH risks, providers can develop strategies to ensure the right help is given at the right time. They can offer targeted outreach to ensure patients are able to adhere to care plans and access health checks, even take their medication as prescribed. This can reduce the risk of readmission, minimize hospitalizations, and keep healthcare costs down for both patients and providers. To supplement reliance on expensive and time-consuming patient surveys (that often leave out the “why” of a patient’s circumstances), Experian Health’s SDOH solutions combine analytical expertise, machine learning and proprietary data to generate actionable recommendations on the best way to address barriers to care, medication, housing and food. Combine SDOH and consumer data to personalize patient outreach The key to successful value-based and pay-for-performance care models is treating the patient, not just the disease. Data on SDOH allows providers to offer a more personalized healthcare experience, which is even more powerful when combined with consumer data. ConsumerView pools data on patient interests, psychographics, behavioral insights and broader lifestyle insights to give providers a 360-degree view of their patients. With this data, providers can offer relevant and timely advice to help patients overcome potential obstacles to attending appointments and complying with their care plan, such as information about transportation or childcare. It can be used to personalize healthcare communications too. Rather than blasting patients with one-size-fits-all healthcare information, communications can be tailored to patients’ preferred time and format, so they’re most likely to engage with the message. Making value-based care a reality starts with knowing who your patients are and what’s stopping them from getting the care they need. Find out how Experian Health’s Social Determinants of Health turn-key solutions can give your organization the insights needed to develop resilient and responsive models of care. With these tools, your organization can lay the groundwork to improve patient outcomes, regardless of the challenges that lie ahead.

The recent discovery of the Omicron variant has placed the world on high alert. As COVID-19 continues to transform and evolve, erupting as “new” pandemics within the existing pandemic,  it is becoming clear that digitally-enabled clinical care and access to that care are some of the world’s tools to mitigate its spread. Should infection rates rise, providers can anticipate fluctuations in patient volumes, which may trigger a return to the scheduling complexities seen earlier in the pandemic. Streamlining patient access with digital scheduling to minimize wait times, free up hospital beds, and ensure efficient intake workflows is going to be crucial. New variants could also exacerbate existing healthcare staffing shortages, which is a major concern for providers whose capacity is already at a “tipping point.” With a winter flu season “twindemic” looming on the horizon, and more people traveling over the holidays, this challenge may only get tougher. One route through this uncertainty is to continue the digital pivot seen in the early days of the pandemic. Here, we look at how flexible self-scheduling tools and other digital services can continue to help providers maintain operational efficiency as they navigate the implications of this new coronavirus strain. Uncertainty about Omicron – and future variants –  could trigger patient scheduling complexities The new variant could trigger a rise in patient numbers, as seen with the Delta variant. In parallel, some providers and states may follow New York’s lead to try to manage non-urgent care and postpone certain elective treatments. Patients, too, may decide to hold off on booking appointments if they’re worried about contracting the virus while visiting their doctor. This means that the scheduling (and rescheduling) challenges seen throughout the pandemic could resurface. Providers should be ready to offer easy and convenient self-scheduling options. Digital patient scheduling platforms allow patients to book essential care and reschedule deferred appointments from the comfort of their own home, using whatever channel suits them best. Not only will this ease pressure on busy staff and reduce the number of people sitting side-by-side in doctors’ waiting rooms, but it’s also a quicker and more reliable way for patients to plan their care. Providers can augment these operational efficiencies with digital scheduling and registration tools. Registration Accelerator can reduce the burden on patient access teams by allowing patients to create user profiles and fill out pre-treatment information from home. Double down on convenient vaccination scheduling New variant outbreaks also add a layer of urgency and complexity to the ongoing vaccination program. Boosting the country’s vaccination rates is a crucial defense against existing strains of COVID-19. Patient-friendly digital scheduling tools can make it as easy as possible for people to arrange an appointment, thus helping to bump up vaccination rates. Of course, if more people are encouraged to seek vaccinations and boosters, the scheduling process could get even more complicated. Again, digital self-scheduling tools can ease the pressure, by using real-time databases and automation to ensure that patients book appointments within the requisite vaccination window. Automation can also be used to deliver personalized patient outreach reminders, nudging patients to schedule their vaccine appointment if they haven’t made one already. Comprehensive consumer data can help identify the most appropriate messages and channels for different patients, to make it as easy as possible for them to plan and book their appointment. The federal response to new outbreaks has included provisions for vaccine outreach campaigns and education initiatives. Providers should consider how their own outreach campaigns are performing, as well as ensure that their scheduling platforms are ready to meet the increase in demand that’s likely to follow. Automation and digital scheduling tools could help alleviate staffing shortages Behind the scenes, providers are still wrangling with ongoing staffing shortages. According to an analysis of US Bureau of Labor Statistics data, hospital employment declined by nearly 100,000 between February 2020 and September 2021, amounting to a financial cost of around $24 billion. New variants could make this worse. If more staff are infected, healthcare organizations may find it more difficult to handle the increase in patient volume. Automating manual tasks can free up capacity by helping to manage the growing demand for services and reduce call volumes. These automated tools and systems are designed to be user-friendly for busy staff, and for patients looking for a stress-free patient access experience. With streamlined self-scheduling options and more efficient staff workflows, providers can feel more prepared in the face of uncertainty. Contact Experian Health to find out more about how digital scheduling tools can help your organization prepare as the Omicron situation unfolds.

Healthcare providers could be losing up to $265 billion each year on avoidable administration costs. A recent investigation by the Washington Post and McKinsey & Company found expensive inefficiencies in several areas of healthcare expenditure, with financial transactions such as prior authorizations among the main culprits. How can healthcare organizations adjust to streamlining prior authorizations? Prior authorizations (or pre-authorizations) are intended to provide financial certainty to patients and providers, by confirming in advance that a payer will cover the cost of a particular test or treatment. However, securing pre-approval isn’t always a tidy process. The criteria are complicated and frequently change. In April this year, the American Medical Association reported that 85% of physicians found the burden associated with prior authorizations to be very high. The consequences are severe – hold-ups and errors can lead to delayed care, poorer outcomes for patients, and more unnecessary costs for providers. Securing pre-authorizations has always been challenging, but as with many healthcare operations, the COVID-19 pandemic exacerbated the problem. Experian Health’s State of Patient Access 2.0 survey revealed that more than half of providers find it difficult to keep track of changing pre-authorization requirements. Two-thirds expect to encounter roadblocks when seeking authorizations for rescheduled elective procedures. In fact, prior authorizations have overtaken patient payments as the biggest area of concern when it comes to collections and reimbursements. In our "Interview with the Expert,” Ellie Henry, Experian Health’s VP of Implementation, discusses the challenges around pre-authorizations and offers some immediate actions healthcare providers can take in response. Watch the interview below: Why are providers increasingly concerned about pre-authorizations? Pre-authorizations have been a hot topic for a while, but Experian Health’s State of Patient Access surveys, taken six months apart in November 2020 and June 2021, show a significant increase in provider concerns. Is this purely down to the “pandemic effect,” or is there more to it? Henry suggests that while the pandemic has been the main driver of recent authorization challenges, manual processes and changing payer rules have played a major role, too: “Hospitals had to restructure operations during the pandemic, which led to a lot of care being rescheduled. But it wasn’t always clear if existing authorizations would apply to that rescheduled care, which led to more reworking. Payers were continuing to adjust their rules, and understaffed organizations had to do more with less, which made it even harder to function effectively.” Many states also released their own pre-authorization requirements. For example, in September 2021, New York released an executive order to suspend prior authorizations for 30 days. While this may have been intended to ease pressure on staff and accelerate patient care, it also raised numerous questions. Providers had to determine if preapproval was needed for care that was planned during these 30 days or deferred until later and whether these changes overruled national payers’ requirements. How should providers address current pre-authorizations challenges? Henry says that providers can mitigate these challenges and focus on streamlining prior authorizations by dedicating limited resources to the most important problems first. This means using technology and automation to alleviate pressures on staff: “Providers need to streamline hand-offs and eliminate accounts that don’t need to be touched. With the right automation and technology, you can eliminate manual work and optimize workflows to manage demand. No matter how good you are, there’s always room to improve.” The growing administrative burden, exacerbated by increasing patient volumes, is an uncomfortable equation for healthcare organizations with reduced workforces. The traditional methods for managing patient accounts and checking for changes in payer policies are no longer sufficient. Instead, providers should look to automated prior authorization solutions that can ease the strain and ensure that more accounts are processed faster and more accurately. These should encompass both back-end automation and patient-facing digital tools that support self-service and reduce call volumes. What new opportunities lie ahead for streamlining prior authorizations? In the longer term, patient volumes will continue to increase as rescheduled care ramps up, and as patients begin to think about healthcare “maintenance” again. Providers have several options available to them to manage the pre-authorizations that will follow suit. Henry suggests that a good starting point is to invest in the right technology: “Technology can reduce manual tasks and keep the process manageable. The more tasks you can streamline and automatically update within your system, the better. Reach out to technology vendors and ask if their tools can help to make the process more efficient.” With prior authorization software, payer rules can be automatically updated so staff always know they’re looking at the latest information and don’t need to input data by hand. For example, Experian Health’s SmartAgent feature can sign the user into the appropriate payer website and auto-fill relevant patient information, saving time and reducing the risk of error. Dynamic work queues can help staff navigate the process with confidence and reconcile all the relevant data points within each patient’s specific situation. Henry also recommends doing knowledge-based checks to determine whether a patient’s planned procedure needs pre-authorization. Having records and supporting documentation in place can help handle rework and prevent errors from occurring in the first place. Engaging with payers to build stronger relationships is another strategy to support smoother authorizations. Again, reliable solutions and digital tools can simplify each of these tasks. Watch the full interview and download the State of Patient Access 2.0 white paper to find out more about how automation and digital tools can ease the burden and help with streamlining prior authorizations. By streamlining prior authorizations, providers can reduce unnecessary costs and deliver faster, high-quality care to patients.

Mass relocations during the pandemic caused seismic shifts in healthcare markets. With millions of Americans moving and reshuffling to be closer to family or take advantage of remote working opportunities, healthcare providers have extra work on their hands to ensure their patient base holds steady. Some attrition is inevitable; however, as more patients relocate, providers may see more patient churn than usual. Unfortunately, this means more dollars in lost revenue. On top of this, consumers have changing expectations and more choices when it comes to healthcare, which means even more patients coming and going. Providers must find new ways to differentiate themselves in an increasingly competitive market for patient recruitment and retention. In June 2021, our State of Patient Access 2.0 survey revealed that attracting and retaining patients was a top revenue recovery strategy for providers hoping to make up for the shortfall caused by the pandemic. An Interview with the Expert, featuring Mindy Pankoke, Sr. Product Manager of Patient Identity and Care Management at Experian Health, sheds some light on the opportunities that lie ahead for patient recruitment and retention. Pankoke also explains how consumer data can help providers deliver an outstanding patient engagement experience. Watch the interview below:   How have patient recruitment and retention been affected by the pandemic? The pandemic changed how patients live and work. Many have relocated, while others have overhauled their lifestyles to find a better work-life balance and/or to pay closer attention to their health. Pankoke explains that these changes not only push patient recruitment up the priority list, but also require providers to take a bird’s eye view of their evolving markets in order to develop a better understanding of who their patients are. She says, “Waves of employment, unemployment and remote working mean patients’ locations and lifestyles have changed. As the dust settles, we’re starting to see how the market has shifted. It continues to be highly competitive, with multiple health systems fighting for the same patient base, so it’s important to know who’s new to your market, who might have moved out, and how COVID-19 may have impacted their lives. You can use that data to better engage with them and offer the most relevant communications.” How can data help providers with patient recruitment and retention? Understanding patients’ needs and preferences call for fresh and accurate consumer data. But which specific data points are most useful when it comes to patient engagement and recruitment? Pankoke suggests three areas to focus on: “Accurate contact information will make or break your patient recruitment strategy. Providers need to be able to reach the patient they’re intending to contact. Then, you can enhance demographic data by making sure you’re speaking to patients in their preferred language. Finally, marketing data can offer non-clinical insights about patients’ lifestyles so you can reach out and engage them more effectively.” Pankoke says it’s important to consider how the content and format of marketing communications might resonate with different patients. For example, a 50-year-old diabetic patient who has a job and lives in a multi-generational household will have a completely different lifestyle to that of a 50-year-old diabetic patient who is retired and lives alone. Consumer data can help providers see the full picture of a patient’s life, so they can offer the most helpful, sensitive and personalized information. Using data to “meet patients where they are” One way to stand out from the competition is to demonstrate an understanding of what patients need right now. Data on the social determinants of health (SDOH) can be used to enrich patient records, by providing insights into the non-clinical aspects of care and lifestyle factors that can affect a patient’s access to services. This is especially important given that socially and economically vulnerable groups were among those hardest hit by the pandemic. In our survey, 23% of providers said they were planning to or already implementing SDOH programs, up from 13% six months earlier. With SDOH data at their fingertips, providers can tailor their communications, so patients are supported to access the services they need at that moment in time. Reliable consumer data also helps providers communicate that information in the most appropriate way, to improve engagement, outreach and access. Pankoke suggests that some patients may prefer to learn about healthcare services through TV advertising, while others may prefer a leaflet or brochure through their door. Knowing your patients’ level of comfort with technology also means you can make better decisions about who to direct to patient portals or telehealth services. Get in front of patients before they start looking In today’s consumer-driven and competitive healthcare market, every touchpoint matters. Communications that are consistent, relevant and personalized are key to attracting and retaining patients. With the right data and digital tools, providers can anticipate patients’ needs, address obstacles and reach out to help patients stay on track with their healthcare journey. They can offer convenient and flexible options to register, schedule and pay for services – using a format that best suits each patient. In some cases, this means knowing what the patient needs before the patient knows it themselves. It’s a lot easier to get in front of patients with useful healthcare information before they start looking. Consumer data gives providers a head start so they can integrate SDOH and other patient information in patient recruitment and retention strategies that are proactive, rather than reactive. Watch the full interview with Mindy and download our State of Patient Access Survey 2.0, to find out how your healthcare organization can incorporate consumer data to communicate the right message in the right format to attract and retain loyal consumers.

This is the fifth in a series of blog posts that will highlight how the patient journey has evolved since the onset of COVID-19. This series will take you through the changes that impacted every step of the patient journey and provide strategic recommendations to move forward. In this post, explore the fifth step—treatment, and how social determinants of health can help your organization get a more holistic picture of your patients. To read the full white paper, download it here. How does a virus that does not discriminate produce such different healthcare outcomes across population groups? COVID-19 exposed population care challenges within the healthcare system. For example, data from the Centers for Disease Control and Prevention (CDC) consistently shows that American Indian and Alaska Native (AIAN), Black, and Hispanic people have a higher risk of COVID-19 infection, hospitalization, and death than their white counterparts. The AIAN community is 3.4 times more likely to be hospitalized due to the virus. An analysis shows that health disparities like these result in approximately $93 billion in excess medical costs and $42 billion in lost productivity per year. These differences in the health status of various population groups are socially influenced, unequal in distribution, and, most crucially, often avoidable. Arming clinicians with patient-level “Social determinants of health” insights can help When it comes to health outcomes and patient engagement, health providers can look beyond the immediate medical needs of a patient to understand non-medical factors that commonly act as barriers to accessing good healthcare and inhibit successful treatment. These can be things that influence a patient's social networks, socioeconomic situation, cultural and environmental conditions, as well as how they live from a health perspective. They are collectively known as social determinates of health (SDOH), and they account for up to 80 percent of health outcomes. Examples of social determinants of health include: Access to nutritious foods and opportunities for physical activity Access to transportation Education, job opportunities, and income Housing stability Language barriers and poor literacy skills Pollution and [lack of] access to clean water Racism, discrimination, and violence For example, a patient that suffers from a language barrier may have problems booking an appointment and understanding the steps for proper care. This can result in inconsistent treatment and poor treatment outcomes. A patient’s income can also play a part. Some patients may lose their jobs, move homes, lose access to cars, and more – resulting in food insecurity, housing instability loss of access to care and medication. According to a Gallup survey, 25% of patients defer treatment because it’s perceived to be unaffordable. It’s vital for healthcare providers to create a plan that includes touchpoints that screen for SDOH updates. Providers will need to actively educate their patients about alternative payment plans and other financial aid programs, to show their patients that care is accessible through a variety of resources. The benefits of addressing SDOH using digital solutions: to reduce health inequity and improve patient engagement Research found that integrating SDOH data into patients’ electronic health records and care plan considerations offered the potential for improved care and health. Adding this useful data allowed for a better understanding of patients’ social influences, as well as better collaboration between healthcare providers and community services – enabling patients to be treated and engaged from a holistic standpoint. When providers take SDOH into account and adjust patient engagement in care planning  accordingly, can alleviate: Readmissions Unnecessary emergency department visits Poor care quality ratings When employing an SDOH solution, providers can use data to develop new strategies that can target vulnerable populations. For example, SDOH research during the pandemic, conducted by the National Center for Biotechnology Information, revealed that school closures increased food insecurity for children, which led to greater rates of malnutrition. This led to lower immune system responses and increased the risk of infectious disease transmissions When trying to increase COVID-19 vaccination rates among populations living in low-income areas, healthcare providers can utilize SDOH data to develop ways to make care more accessible. Social determinants of health insights on access to care, medication, housing, and food barriers can also proactively identify patients with health inequity. Understanding differentiating drivers of individual SDOH profiles can help healthcare programs meet patients’ unique needs – ones that are hindering an equal playing field for their own health. Social determinants of health can help providers discover new opportunities Healthcare providers can also use this data to devise strategies to communicate more effectively with their patients, especially via the patient’s preferred channels. Technology and communication barriers that are typically overlooked should be examined as a part of SDOH. For example, a patient that prefers direct mail over email may ignore communications that they’re not receptive to. Meeting a patient where they are and through the channels they prefer is crucial to making a connection. Once they understand a patient's SDOH, providers can connect patients to relevant outreach or community programs that assist in removing some of the barriers to a patient's optimum care.  For example, if a hospital learns that their patient base has higher food insecurity, as opposed to access to care risk, they can work to prioritize partnerships with a local food bank or meal delivery programs. This allows providers to proactively help their patients make it easier to comply with their care plans when otherwise, a meal on the table would’ve taken priority over a wellness check. combining SDOH solutions with patient scheduling software, providers can automate proactive outreach for more and frequent follow-ups to encourage patient engagement. By utilizing social determinants of health (SDOH) insights, every patient visit becomes an opportunity to verify and address the non-medical factors that may be affecting the patient’s health and make better use of your organization’s community network. SDOH can help providers build robust patient profiles to display information that wouldn’t be visible in the clinical data. With Experian Health’s SDOH solution, providers can create robust profiles that can determine a patient’s readmission SDOH risk, and provide factors that are driving these risks. This solution can also provide recommended strategies that care team members can use to align appropriate resources and be proactive about their health outcomes. The healthcare system is designed to help patients during illness or injury.  However, delivering care equity is best achieved by also accounting for the non-clinical conditions that influence health. By looking at a patient holistically and combining clinical data with SDOH, providers can identify the unique challenges patients face and then tailor care to a patients’ individual needs. As providers adapt to life in the shadow of COVID-19 and move beyond crisis mode, it’s more crucial than ever to enrich patient identity management with SDOH, and close the gaps in care when the virus subsides. Missed the other blogs in the series? Check them out: 4 data driven healthcare marketing strategies to re-engage patients after COVID-19 How 24/7 self-scheduling can improve the post-pandemic patient experience COVID-19 highlights an acute need for digital patient intake solutions Automated prior authorization: getting patients the approved care they need

COVID-19 transformed the patient journey, and it's clear when we evaluate every step. Data and technology gave patients the convenience, flexibility, and control to get care on their terms, and these changes will be here to stay. From marketing to scheduling to payments and more - providers and payers have ample opportunities to respond to these changes and will need to adapt their future strategies accordingly. Self-scheduling, mobile registrations, and automated authorizations are a few examples of tools and technologies that are more than likely to remain prominent in healthcare. What other changes are here to stay? In this new infographic, we take a dive into each of the 7 steps to see how data and technology has impacted the patient journey, and provide strategic recommendations on how providers and payers can adjust post-pandemic: The use of data and digital tools opened up new doors for greater patient access, engagement, transparency, and control. The post-COVID-19 patient journey is going to continue to evolve - payers and providers will need to adapt to keep up with the changes, to ensure that patients experience the best outcomes. To get a deep dive into all of the changes to the patient journey, download our white paper.