Care Management

It’s a puzzle many healthcare providers are still working to solve: when over 80% of health outcomes are influenced by non-medical factors, how can health systems help their patients achieve better outcomes? From affording time off work so they can attend an appointment, to accessing healthy food, childcare or transport, your patients’ ability to engage with and benefit from health services can be heavily influenced by a host of social and economic dynamics Understanding these social determinants of health (SDOH) gives you a more complete picture of your patients’ health and life circumstances. You can anticipate their needs, coordinate their care more effectively, and ultimately give them a better healthcare experience. What’s more, harnessing the right data on SDOH leads to smarter investment and operational decisions, yielding advantages for your health system as a whole. That’s why many providers are starting to use non-medical consumer data in their care management planning. Here we look at some of the top use cases for SDOH data. 5 top use cases for data on social determinants of health     Reduce missed appointments No-shows cost providers an average of $200 each (plus a lot of wasted physician time). Often these are down to lack of access to transportation or childcare. SDOH data can help you anticipate where these challenges might occur, so you can offer additional services like a free shuttle bus or crèche. You’ll make the experience a little easier for the patient, and potentially prevent an unchecked health issue from becoming something more serious.     Save costs from preventable health events Unfortunately, life circumstances can lead to many people using health services in a way that could be avoided. Missed appointments or difficulty following a care plan can lead to escalating medical issues, entailing more treatment and readmissions. Patients might also fall back on emergency services because they can’t easily access appropriate alternatives. SDOH data helps you understand the circumstances that might lead to this kind of patient behavior. For example, if you can spot patients who may be likely to dial 911 because they have no other way to get to the health services they need, you can offer alternatives that avoid an unnecessary visit to the ED. This could help you save up to $2000 per Emergency Department visit and around $10,000 for each hospital stay (which often can’t be fully reimbursed if the patient ends up being readmitted).     Increase care plan compliance A patient’s living situation can often determine whether or not they’ll be able to stick to their care plan. For example, specific dietary advice can be a real challenge for a diabetic patient if they have a limited food budget, lack of time to shop and prepare food, or a plain lack of options of where to buy it. An SDOH needs assessment can flag this in advance so clinicians can help patients find a plan that will work for them. Similarly, pharmacies might use consumer data to help minimize abandoned prescriptions or situations where a patient fails to follow dosage directions, which is estimated to cost the industry $290 billion per year.     Save administrative and clinical time Analyzing consumer data can help your operations run more efficiently, which benefits your patients through well-coordinated care, timely information sharing and prompt referrals. Many providers are taking advantage of automated solutions for leveraging SDOH data, saving massive amounts of administrative time for care managers by pre-populating patient data and automating SDOH needs assessments. Consumer insights solutions like Experian Health’s ConsumerView analytics can optimize operational efficiencies and ensure your care managers use their time well.     Investing in relevant community health programs One of the most impactful use cases for SDOH data is to gain a richer understanding of your member base, so you can invest in the most relevant community health programs. For example, a 2018 pilot project by Atrium Health in North Carolina screened for food insecurity in older patients who may have been at risk of readmission. Emergency food services were provided where needed, and as a result, readmissions dropped by 60%. Your purchasing power can also be a force for change. The Cleveland Clinic outsourced its laundry service to Evergreen Cooperative Laundry, a local collaborative working to combat poverty. Ralph Turner, executive director of patient support services at the Cleveland Clinic says: “Establishing the foundation for people to stabilize their incomes and become part owners in a business… in itself generates health and wellbeing in our community.” Leveraging consumer data to improve patient outcomes These examples show some of the varied ways screening for social determinants of health can open the door to understanding your patients and creating truly person-centered care services. Who knows what opportunities are hidden in the SDOH data for your patient population? Are there gaps in your data? Could you combine different data sets for a fuller picture? What exactly is your consumer data telling you, and how do you turn it into meaningful management decisions? At Experian Health, we have comprehensive data assets and analytics platforms to help you answer these questions and more, and leverage consumer data most effectively.

What if you could flag patients who are at risk of readmission? What if you could anticipate missed appointments or know ahead of time that someone is going to face challenges with their care plan? This knowledge could help you improve patient outcomes, streamline staff workflows and improve your bottom line. So how can you get this non-medical information and use it to improve treatment outcomes? A person’s circumstances can help us understand potential challenges in access to care to predict their behaviors More than 80% of health outcomes are unrelated to medical care. Instead, they are attributable to outside social and economic forces, such as housing, education, unemployment, low income, transportation, access to green space, loneliness, inequality and other non-medical factors. These social determinants of health (SDOH) are the living and working conditions that come together in just the right combination to either promote or a limit a person’s health and wellbeing. As a healthcare professional, you’re no doubt aware that people struggling with financial or life circumstances have a more difficult time focusing on their health and subsequently face more urgent hardships. And it isn’t just the patients who suffer. It has a negative impact on the entire healthcare ecosystem. Why providers should care about social determinants of health When patients struggle to access healthcare services, they’re less likely to follow treatment plans or adhere to follow-up visits. They’re more likely to need to come back with more serious conditions that could have been detected earlier, had they felt equipped to follow the care plan. Not only is this worrying for the patient, but it also leads to excessive service utilization that is costly for providers. Missed appointments are estimated to cost the US healthcare system a massive $150 billion, while each unused 60-minute slot costs an average of $200. And that’s not to mention the opportunity cost of equipment and rooms sitting idle, and all those wasted hours of billable physician time. The shift to value-based care puts more pressure on providers to improve outcomes. But how can they do that when those outcomes are partially determined by factors beyond their control? Considering that 68% of patients have at least one social determinant challenge, the only sensible move is to bring solving for SDOH to the forefront of care planning. “No patient wants to skip appointments and dial 911 as their only reliable means to get the care they need,” said Karly Rowe, Experian Health vice president of product management. “We want to level the playing field by helping providers identify and solve for these socio-economic challenges that make it hard for some patients to get the care they need. SDOH has the ability to improve outcomes, lower costs and increase patient satisfaction, removing the socio-economic obstacles hindering healthcare.” An example of providers and payers collaborating to solve for social determinants of health is the Aligning for Health coalition, which in 2016 referred 33,000 patients to community initiatives. Andy Friedell, a senior vice president at Maxim Healthcare Services said of the program: “We are prioritizing community-based care and social determinant solutions for our patients and clients. In fact, we have effectively used these tools to help reduce readmissions by over 65% for high-risk patients.” How can social determinant data improve outcomes? Let’s look at two examples of how healthcare providers might analyze social determinants to help improve care management. 1. Reducing appointment no-shows For many patients, a lack of transportation is the main barrier to compliance. How do they get to an appointment or procedure if they don’t have a car, don’t live in an area well served by public transport, and can’t afford a cab? Looking at vehicle registration data and public transport services in the area would be one way for a provider to gauge access to care. But does that give the full story? Even if they can find transport, are they juggling two jobs? Do they need childcare? By synthesizing data on transportation, family arrangements, average incomes, and more, providers can anticipate the propensity of someone being unable to access care, and offer solutions such as a free hospital bus service or crèche facility. 2. Preventing escalated health conditions Understanding social determinants is not about identifying unhealthy behavior. For example, a provider might see poor health and point to poor diet. But a patient’s poor diet may not simply result from poor choices. A provider who’s aware of the potential impact of social determinants might consider the propensity of food insecurity – maybe the patient doesn’t have access to healthy food? However, putting the patient at the center and truly understanding social determinants means thinking beyond the ‘food desert’ explanation. Even where healthy food is available, the ability to eat it might be limited by lack of time to cook it, or money to buy it. The provider must adjust their lens and understand how a stressful work schedule, chaotic household and readily available cheap food converge to make it virtually impossible for the patient to even think about putting their health first with a healthy meal. As a result, a patient who could have been identified early on with symptoms indicating the onset of diabetes, for example, instead has their diagnosis delayed because they can’t get to an appointment, while their condition worsens due to their unhealthy diet. Instead of offering dietary advice or signposting to a wholesome supermarket, the provider might choose to work with a registered dietician nutritionist, direct patients to community resources, participate in community partnerships, or even engage with local planning departments and commercial developers. When you understand what drives your patients and recognize the real barriers preventing them from prioritizing or accessing healthcare, you can proactively identify opportunities to solve them. 3. Using the right data to understand and solve for social determinants of health Better care management and improved health outcomes start with understanding the whole patient and the social determinants impacting their life, and then turning those insights into actions. For providers to be proactive, preventative and patient-friendly, they need to know the patient’s socioeconomic background before they enter the room. They must have an idea of what that conversation should look like before they even say hello, and know which SDOH-related programs might be relevant to this patient. Analytics platforms can help leverage wider consumer data sets to spot patterns that affect operational efficiencies so providers can offer more patient-centered care. Of course, if you’re using consumer data, you must have confidence both in its accuracy and in your ability to safeguard consumer privacy. Both can be achieved if you work with a data management partner who can collect data from consumers at scale, with solutions that check all the privacy boxes necessary to allow this data to be used in a healthcare setting. So if you weren’t already thinking about what social determinants of health mean for your organization, perhaps think about what you could do now to incorporate a solution that tells you what patients need, provides the right amount of context to understand what external factors might be causing or affecting that need, and then solve for it at the point of care. — The solution exists to help you. You could have the power to identify and solve for social determinants at your fingertips.

In a recent healthcare information technology survey, more than 40 percent of chief information officers identified patient matching as healthcare’s top IT concern. And though a quarter of the respondents admitted it wasn’t a current priority for their organizations, they did say that it very much should be. There’s no shortage of reasons why, but the most pressing is the need to reduce medical errors, which account for over 250,000 deaths in the United States every single year. Case in point: Seventeen percent of CIOs acknowledged that errors in matching data with the right medical identities have led directly to adverse outcomes for patients. The numbers speak for themselves: Healthcare organizations must find more effective ways to manage the data within their networks. That begins with building a robust medical database that not only hoses data, but also knows how to match it with the proper patients. How robust EMPIs streamline workflows An enterprise master patient index (EMPI) is a database that can help you clean up your data and eliminate duplicate and inaccurate records. It uses algorithms to match exact data elements among disparate records, as well as elements that fall within an acceptable range of possible compatibility. Using technology that can apply an algorithm of probabilistic and referential matching methodologies will allow healthcare organizations to expand beyond the limitations of conventional single methodology matching, as both probabilistic and referential matching techniques provide a higher degree of likeliness. The system assigns these data points to unique identities that follow patients throughout the organization. Any new data generated within the network is also attached to this identity, meaning physicians, specialists, pharmacists, and other members of the patient’s care team can access and update it as needed. EMPI support tools and unique patient identities are building blocks toward creating a healthcare ecosystem that’s truly interoperable. According to an April 2018 survey by Black Book, hospitals with an EMPI report “consistently correct patient identification at an overall average 93 percent of registrations and 85 percent of externally shared records among non-networked providers.” Unfortunately, not all healthcare systems possess the IT infrastructure to support these programs. And as long as some organizations fail to integrate similar platforms, providers won’t reap the benefits of industry-wide interoperability — and patients will continue to suffer. Whether it’s a frustrating billing mix-up, privacy breach, or a detrimental (or even fatal) misdiagnosis, many errors can be successfully prevented with an EMPI. Filling in the holes The goal of such a system should be to standardize data entry and access within each healthcare organization, as well as across the entire industry. Such a network could protect, govern, and match unique patient identities across every discipline and every aspect of their care continuum. But in order for the system to achieve these goals, you need to be sure you’re feeding it relevant, recent patient information. To ensure you have enough patient data to build an EMPI that accurately matches profiles, ask yourself these questions: 1. What kind of medical care have my patients received before this visit? When patients enter a new hospital, they’re given a brand-new identity, or patient number, that’s only relevant to that healthcare system. The identity you assign them within your own organization doesn’t provide any insight about what they’ve experienced before their current visit — and that’s the crux of the matter. When patient information is siloed within a specific system, you have no view of the patient’s medical history. But when it’s shared across systems and fed into a more dynamic and interoperable data management system, patients will ultimately receive better care. 2. Who are my patients when they’re not “patients”? It’s important to understand who patients are when they’re not in the hospital. Yes, they’re husbands and wives, mothers and fathers, brothers and sisters. But some could be physically fit, while others haven’t seen the inside of a gym in years. Some might get regular checkups, but others cannot afford to see a physician regularly. All of these traits factor into your patients’ identities. With a comprehensive EMPI, you can tie them together to understand the environmental and socioeconomic factors that influence your patients’ health. You can then identify what social determinants of health need to be addressed or could potentially influence the efficacy of certain treatments. 3. Can we identify patients without a picture ID? Biometrics such as fingerprints and iris scans are more secure forms of identification than a photo ID. They’ll not only make it easier to identify patients, but will also offer heightened security against fraud. That being said, even biometric identification isn’t 100 percent secure unless it’s part of a database, such as the EMPI, that accurately matches patient identities with relevant medical data. Accepting that the healthcare industry needs better data management and patient-matching strategies is the first step to realizing those goals. EMPIs have shown organizations the value in universal patient identities. Now, they simply need comprehensive databases that are robust enough to keep patient identities consistent across the entire healthcare ecosystem.

Manually cold-calling patients to remind them of upcoming appointments or of bills nearing a due date has never been an effective engagement strategy. On the contrary, such reactive tactics reduce engagement quality and can harm revenue cycles. It's important to remember that real connection empowers patients to be proactive in their care and improve their own outcomes, which encourages them to keep up with future appointments and medical payments. For modern healthcare organizations, maintaining this level of high engagement requires more than the automatic actions they’ve grown used to. Instead, the overall healthcare world needs more robust patient engagement to push forward and stay relevant with patients. Without this change, organizations are more likely to encounter skipped appointments, preventable readmissions, missed payments, revenue loss on several fronts, and poor patient outcomes. Fortunately, Experian Health offers a range of solutions that make it easy to engage patients in their care, improve patient outcomes, and create more profitable revenue cycle management (RCM) throughout an entire organization. Using patient engagement technology to improve care As previously mentioned in an Experian Health blog, patient portal technology — among others — is rewiring the technological landscape and capabilities in the physician and patient relationship. Portals are used for secure messaging by 41 percent of family practice physicians, and 35 percent of physicians also use them for patient education. This type of patient engagement technology culminates in our Patient Self-Service portal, which pools together data from our Patient Estimates, Patient Statements, and Coverage Discovery tools. The portal gives patients a single point of access to request estimates, pay bills, check financial assistance eligibility, and receive advice from doctors, nurses, and specialists. The above are just a few results from elevated, proactive patient engagement. Another perk is the portal’s unique ability to automatically populate patient-specific and payer-specific information into each estimate for optimal accuracy. This feature gives patients peace of mind by knowing what their exact out-of-pocket expenses amount to. When they receive a bill that matches the estimates they’ve been budgeting for, patients are more likely to adhere to payment obligations and return to a healthcare organization for future medical needs. This also makes it easier for an organization to collect payment at point of service and throughout the rest of the patient’s care continuum. Risk stratification for more successful revenue recovery For the first time in history, there is a growing convergence of powerful, internet-connected personal devices and massive amounts of analytical, social, financial, and behavioral data tied to individual patients. Experian Health’s timely patient engagement tools allow providers to tap into this convergence to revolutionize how they engage with patients at all points throughout their care. For example, by analyzing patient-specific financial information, this engagement technology can help providers identify when patients may benefit from financial assistance, especially for upcoming treatments. In turn, the provider can send the patient information about how to request for this type of assistance through an interactive portal with accurate estimates. To help reduce readmission rates for non-critical concerns, Experian Health’s tools can also help identify when patients may need unique, targeted engagement. For instance, patients with heart conditions can benefit from information regarding diet and lifestyle changes that improve cardiovascular health. These tools help providers determine the best type of content to send and the appropriate medium to send it through, such as email, text, or app notifications, according to the patient’s specific preferences. By working together with healthcare providers, Experian Health’s solutions combine highly personalized self-service with accurate price transparency and patient-risk stratification to proactively engage with patients. You, too, can be at the forefront of improving patient outcomes and RCM strategy effectiveness by understanding the changing healthcare environment. Utilizing tools, such as a patient portal and others, can position your organization to increase patient engagement and benefit from being a forward-facing healthcare provider.

As healthcare in the United States shifts toward a more value-based model, reducing readmission rates has become one of the biggest challenges healthcare organizations now face. Last year, approximately half of all hospitals in the country collectively lost more than $500 million in reimbursements because they had not learned to overcome this roadblock. In most cases, the difficulty doesn’t stem from provider inadequacy, but rather from the inability to effectively coordinate patient care among multiple providers and departments. From treatment specifics and aftercare instructions to prescriptions and follow-up visits, there are plenty of cracks in the communication pavement for important details to fall through. Here's the unavoidable fact: Suboptimal care coordination results in higher readmission costs to hospitals, even for patients with highly treatable conditions. In turn, providers lose much of their profitability, which further hinders their efforts to improve quality of care. Two key (and often missing) factors in care coordination are advanced IT strategies and patient engagement. The only connection among inpatient, outpatient, and long-term care teams is the patients treated in each. Therefore, providers should make it easy for patients to be proactive in their own healthcare. In large part, that requires technology that allows all patients and their care teams to communicate easily and securely, at any time and across any device. Modernizing healthcare communication while reducing hospital readmissions If healthcare providers could simply call or instant message each other with details about patients’ medical conditions, then coordinating care wouldn’t be as strenuous. Without a secure platform, however, healthcare providers might leave sensitive patient health information out in the open for anyone to steal. That liability would be multiplied among numerous physician groups, specialists, skilled nurses, home health aides, and more, possibly affecting several cities and states. All of that is in addition to hazards created by patients who log into public Wi-Fi networks and carelessly leave their mobile devices unattended. There are a lot of elements to consider, but providing a safe and convenient communication platform for patients and their healthcare teams eliminates most security concerns. With a care coordination platform, communication is protected across a broad provider spectrum, no matter what device is used. For example, after a patient is released from the hospital, the Care Coordination Manager generates and delivers real-time messages to members within the patient’s care continuum. These messages, which include discharge details, a checklist for contacting the patient, and schedules for future visits, are automated and delivered within a closed-loop system for optimal safekeeping. Better coordination equals fewer readmissions Closing communication gaps between patients and care teams is a big factor in reducing hospital readmission rates. With this in mind, as a rule-driven platform, the Care Coordination Manager automatically sends email or texts to patients and caregivers about meaningful events. By doing so, patients and their teams stay on the same page at all times with notices for completed test results, newly prescribed medications, and schedule or treatment adjustments. With the platform's two-way, real-time communication capabilities, patients can also ask questions and receive answers about their conditions almost immediately. This helps keep patients informed and engaged, and it encourages them to seek self-care solutions rather than visit the hospital repeatedly for minor concerns. In addition, different providers on the team can easily request information from each other. The Care Coordination Manager is unique and requires virtually no additional training for doctors and staff to utilize. The platform offers all of the benefits of secure, automated communication without the time-consuming catch-up training that often comes with implementing new systems and processes. Of its many advantages, however, the most significant is that the Care Coordination Manager patches up the cracks in care coordination and communication where important patient care information often gets lost. When patients and their healthcare teams can connect and discuss sensitive health information without the worry of security and efficiency, the better care becomes. As a result, organizations can reduce readmission rates across the board, which equally benefits patients and healthcare institutions, all while keeping the main goal of providing quality care top of mind.

During HIMSS17, Experian Health's Nicole Rogas, Senior Vice President of Sales, sat down with IntrepidNOW to discuss the healthcare industry, challenges providers are facing and women in health IT. Excerpt below. "...it’s an industry that changes consistently, and Experian Health has the data and the history to be able to arm both our clients, which our providers, and the consumer, which is the patient, with information to help them make better healthcare decisions. We are hearing more about it in IT and as well as other areas of healthcare really nationally. Women do play a very important role in the future of healthcare, and I think the focus on it now brings to light some of the sort of special issues and challenges we face as women that are very different than what man may face as they grow their career. ...a lot of the challenges for our providers is to understand how to function as a business, and I know that that might sound crazy, but healthcare is always been a service, and most of our economies today, most of our people today believe that it’s really their right to (have) healthcare, and I think what’s happening is our healthcare providers are having to function more like a business organization to ensure that they are providing care at really great quality care, but in an efficient way. They are able to build and get reimbursed for that care, and then that they are able to arm their patients with the right information pre and post care to help keep them engaged in both their financial and their clinical journey. So I just think it’s a big time in our industry." Listen to the full podcast

There has been a lot of uncertainty with regards to what the future holds for healthcare in the U.S., but the reality is that the move away from transaction-based services where providers are paid by transaction or by interaction with their patients, into a world where some of those services will be paid as bundles, is a reality. At Experian Health, our perspective is that there isn’t going to be one single form of payment. There isn’t going to be only fee for transaction or only fee for value type payments.  There is going to be a variety.  And our solutions can help providers handle that. When we talk to our largest providers, they want to make sure that they are prepared for the future of healthcare, and that their payment and revenue cycle is robust enough that they can handle whether it is a fee for transaction interaction with the provider or with the patient as well as fee for value. In order to do that, they have to optimize their operations. There is a lot of belt tightening happening in the industry and people are trying to see and understand how best to organize, how best to analyze and facilitate that payment cycle. We believe that data and analytics are two of the key ways to do that. Our software tools as well as the data that we embed into that software helps optimize the revenue cycle. Listen to the complete podcast

On April 27, millions of workplaces, employees, parents and children will celebrate the 24th year anniversary of the Take Our Daughters And Sons To Work® Day program, which encourages girls and boys across the country to dream without gender limitations and to think imaginatively about their family, work and community lives. This national, public education program connects what children learn at school with the actual working world. Experian Health's offices will be participating in this program as part of its Women in Leadership initiative. Learn more about it and how your organization can participate.

Below is a collection of some of most compelling article we've read in recent months. We hope you find these interesting, too! One Goal; One Contract: How a Nationwide Health Data Sharing Framework is Revolutionizing Interoperability https://www.himss.org/news/one-goal-one-contract-how-nationwide-health-data-sharing-framework-revolutionizing-interoperability   7 things to know about Aetna's ACA exchange exit https://www.beckershospitalreview.com/payer-issues/7-things-to-know-about-aetna-s-aca-exchange-exit.html   5 steps to cybersecurity for Internet of Things medical devices https://www.healthcareitnews.com/news/5-steps-cybersecurity-internet-things-medical-devices    CMS: ICD-10 specificity kicks in Oct. 1, 2016 https://www.healthcareitnews.com/news/cms-icd-10-specificity-kicks-oct-1-2016   3 leadership skills crucial for a culture change http://www.beckershospitalreview.com/hospital-management-administration/3-leadership-skills-crucial-for-a-culture-change.html