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COVID-19 is beginning to stress the healthcare system, and typical protocols are being upended. But health systems and medical groups are already rising to the challenge of getting patients tested while, at the same time, prioritizing the protection of their communities and staffs. Below are some solutions being implemented: Online screening Many providers are tapping into online scheduling solutions, responding to the COVID-19 crisis with simple splash pages. Posting questions that screen for symptoms can channel patients seeking testing/treatment for COVID-19 down a specific pathway to get the care they need. Those who need other types of care can still book through the solution, directing them to the right provider and appointment. Screening paths allow access to be prioritized and managed accordingly. Mobile testing Providers are also using mobile test units. These enable providers to administer more tests in a geographically diverse manner, without having to expose their internal clinic and hospital environments to contagion. Patients can simply drive through and receive a test while remaining in their car. Some health systems are combining this with online scheduling, allowing patients to schedule appointment slots for testing. This helps manage the flow of patients, reducing call center volume. Health plans are also modifying Some health plans are taking a similar approach, using mobile testing units and a call center scheduling platform to book testing appointment slots for members. Likewise, they can send a link enabling members to self-schedule for a testing slot via text message or email. This type of proactive member engagement to vulnerable populations is key to reducing the impact on Emergency Departments, while helping diagnose individuals so they can get the care they need. Call center operations Call centers are being overwhelmed with volume – and there is more to come. New methodologies to handle the response are complementing normal operations. Some providers have started to publish a dedicated line for COVID-19 calls that connects to a separate call center pod. Others have quickly added scheduling protocols in the scheduling system to route patients to the right care, or mobile-testing unit, based on responses to the questions agents ask. By automating the Q&A in the platform, patients are guided to the right care, and agents need minimal training to assure accuracy. As the number of COVID-19 cases continues to grow in the U.S., more tactics will be introduced to streamline scheduling, testing and care. Technology will certainly be one key lever for healthcare providers to better serve their communities and keep patients and staff safe.

The number of uninsured American adults has been rising steadily since 2016, reaching a four-year high of 13.7% in the last quarter of 2018. The challenges have been well-documented: low levels of health insurance contribute to health inequality, poor population health, and worse outcomes for individuals as people hold off seeking care. For providers, a growing uninsured population usually leads to an uptick in uncompensated care and a hefty blow to their balance sheet. Affordability is the main driver of this trend (due to rising premiums and tighter household budgets), but a big part of the problem is simply confusion around who is entitled to what. People may have coverage they don’t know about or have forgotten. Media reports and reduced outreach for Obamacare have left many wondering whether support from public insurers is even still available: a Kaiser Family Foundation study in 2018 found that around a third of Americans believed or weren’t sure if the Affordable Care Act had already been repealed. No wonder fewer people are signing up. Finding missing coverage is a challenge for most providers, but with the right discovery strategy, it’s possible to drive down the number of accounts ending up in bad debt collections or written off as charity designations. Top-performing providers use a four-part strategy, encompassing the following: 1. Look beyond self-pay patients For most healthcare providers, the search for missing coverage usually focuses on self-pay patients. In fact, many Medicaid, Medicare and commercially insured patients also have unknown additional coverage. Unearthing this secondary and tertiary coverage can help ensure the full amount is paid. Jason Considine, Senior Vice President and GM of Patient Experience at Experian Health, says: “Finding missing secondary or tertiary coverage for patients with Medicaid or Medicare can help hospitals capture the full amounts they’re entitled to and reduce the risk of revenue loss. Hospitals can claim against any balances not covered by public payers, but only if they look for additional coverage.” This means hospitals shouldn’t focus solely on scrubbing self-pay accounts. By searching additional commercial coverage and combing through Medicare and Medicaid coverage, you might be surprised at the level of reimbursement available for amounts that would otherwise have been written off. 2. Perform coverage checks as soon as possible The sooner you check for coverage, the sooner you can verify the accuracy of the account – and the sooner you can get paid. Essentia Health in Minnesota implemented a coverage discovery strategy that ran comprehensive coverage checks throughout the whole patient process. Patient accounts were scanned before they received care, then again at the time of service. Finally, searches for active insurance were performed 30, 60 and 90 days after service. Kathryn Wrazidlo, Patient Access Director for Essentia Health, says: “We found 67% of coverage for patient accounts that were self-pay or uninsured at the time of pre-service, and 33% at the time of post-service. This has helped patients because we’re actually billing their insurance versus billing them for self-pay. It’s helping staff because they’re billing the insurance company much quicker. There’s less rework. We’re decreasing the amount of time the account is sitting in AR by billing much sooner in the process.” 3. Access the widest possible datasets The whole point of the coverage discovery process is to track down coverage your patient doesn’t know about. So why would you limit your search to what they can tell you? Equally, searching through payer databases within what are often very limited search parameters can be a painstaking process. A more logical approach is to use a search strategy that covers historical data, demographic information and multiple proprietary datasets to cross-check patient accounts for previously unknown coverage. A tool that offers weighted confidence scoring and discrepancy checks can further reduce the risk of false positives and errors. With this approach, Experian Health’s Coverage Discovery tool analyzed more than 16.6 million accounts and found 3.6 million coverages, resulting in $5.8 billion billable charges found in 2018 alone. 4. Digest the data with reliable reporting tools Of course, checking more accounts and accessing wider datasets means you’re going to have far more data to handle. Automated scrubbing tools, quick-look dashboards and reporting software can give you instant access to the information you need. Working with a reliable partner can help you sift the data for additional coverage, and also provide insights into ways to boost workflow efficiencies and make life easier for your team too. Wrazidlo says: “We use the power reporting that’s offered with the Experian product and we also do reporting internally. The reporting helps us know whether the product is working for us or not. We can see how much we are recovering… My staff really enjoy using it.” Find out more about how Coverage Discovery could help you find additional coverage more easily, so you can get paid sooner and in full.

Any kind of identity mix-up is disturbing, but when it occurs within the healthcare system, the fallout can be severe. At best, misidentifying patients leads to lowered consumer confidence, but at worst it can compromise a person’s essential medical treatment. As a healthcare professional, you want to be absolutely certain that comprehensive and correct data is associated with each person who comes in for care, and that you’re utilizing the most advanced measures to make it happen. Universal patient identifiers are an integral part of that goal.  Patient Safety Awareness Week is the perfect time to convey that message clearly and positively. What is Patient Safety Awareness Week Patient Safety Awareness Week, organized by the Institute for Healthcare Improvement, is an annual recognition event dedicated to boosting the public’s knowledge about health care safety. In 2020, it runs from March 8th to the 14th. Patient Safety Awareness Week is your ideal opportunity to proactively inform and reassure patients of your commitment to safety. New systems, such as universal patient identifiers (UPI) developed by Experian Health, were created to ensure that patient demographics are as complete and error-free as possible through patient matching. Impact of patient identity problems Many patients may already have concerns about their records, having heard about problems from the news, friends or relatives, or have personally experienced identity misidentification. According to an ECRI Institute report, approximately 30% of the patient data that’s held in electronic health records is either incomplete or inaccurate. So how bad can the damage of patient misidentification be? The Ponemon Institute reported that roughly 86% of all clinicians witnessed a medical error that was caused by patient misidentification. And most disturbing: a study by the National Institutes of Health discovered more than half of all the deaths attributed to medical errors are a result of identity errors. Identification mistakes don’t just lead to unnecessary patient suffering either. These unforced errors undermine the very foundation of healthcare organization: trust. The organization that makes them suffers a serious blow to their brand. How patient identity mistakes are made Human error has been most often to blame for patient identity mistakes. Every day, healthcare providers handle an astonishing influx of information, as hundreds of thousands of electronic patient records flow in from a vast number of different systems and departments. All the while patients’ names and addresses change, which in turn requires updates. Inputting all that data manually is a major challenge, and inconsistencies typically occur in the data entry process. In fact, the National Center for Biotechnology Information found that the greatest proportion of mismatches are centered around a patient’s middle name and their Social Security numbers. Misspellings and entering first, last, and middle names into the wrong fields are also common. Once identity mistakes are entered, a patient can have duplicate records and disparate facts, matching past diagnoses and prescribed medications. Billing problems, too, can result. A patient’s statements might not be sent to the correct mailing address, resulting in them experiencing unnecessary credit troubles. Solutions to identity problems In order to consistently and correctly match patients with their medical records, innovative technology has been developed. UPIs use Experian’s consumer demographic information and methodologies to identify record matches and duplicates in a patient’s file. Once a unique UPI is created for the patient, the potential for identification mix-ups is vastly reduced. More, UPIs lead to efficiencies that drive costs down for all concerned. It’s expensive and laborious for healthcare provider employees to record and update such a high volume of patient data by hand. Rectifying mistakes is not only time-consuming, it can cause insurance issues to arise. Certainly, obtaining the best treatment is paramount to patients, but keeping healthcare costs to a minimum is also important. 79 million Americans are struggling with overwhelming medical liabilities, found The Commonwealth Fund. However, a survey conducted by Black Book found that patient matching discrepancies can lead to nearly $2,000 in extra inpatient costs per person. No one should pay more than they have to for their healthcare, and UPIs can make sure bills are appropriately assessed.  For this year’s Patient Safety Awareness Week, spread the word to your patients that measures have been put into place to protect their identity. As of the end of 2019, every person in the U.S. has been assigned a UPI, and correct and complete information will be associated with each patient. Everyone should be aware that you are taking steps to ensure the accuracy of their medical records — which keeps them safe and their financial obligations down.

Recovering underpayments from commercial insurers costs the healthcare industry billions every year. When payments come up short against what the provider expects, it’s not just the missing revenue that puts a dent in the bottom line – the staff time spent on reprocessing bills takes an extra bite out of the organization’s margins. Underpayments can be attributed to confusion around changing payer policies, inadequate claims data and simple human error. But when providers are focused on creating the best possible patient experience, keeping track of payer behavior is a task that’s easily crowded out. Unfortunately, failing to spot underpayments or keep tabs on those policy changes could lead to bigger revenue loss further down the line, in the time-suck that is collections recovery. From the payer’s perspective, it can be hard to understand why providers don’t just fill out claims according to the agreed rules. For providers, those rules seem to be in constant flux and different for each insurer. Ultimately, it’s a lack of communication that’s at the heart of the problem. Clean claims are only possible when payers tell providers exactly what they need, and providers have the systems in place to deliver that and check that payers are themselves following those rules. Within the industry, we already measure so many aspects of the revenue cycle, but are we paying enough attention to the payer-provider relationship? Is communication the missing metric? Three essential ingredients for a healthy payer-provider relationship Managing payer contracts can often be time consuming, complex and costly. Many healthcare providers are focusing on three strategies to help build better relationships with their payers, to take the stress out of this process and ensure they get reimbursed quickly and fully: Better communication. When you’re clear about what your payers need, you can make sure all your staff and systems are set up to deliver that. It’s impossible to fix the sticking points in your claims processing if you don’t know where they are. With a method to support better communication with payers, you can negotiate contracts that better suit both parties, keep track of changes to payer policies and move quickly when payers aren’t holding up their end of the bargain. You’ll know when a payer has made a payment at an out-of-network rate or reverted to rates in a previous policy and you’ll have the data your payer needs for a quicker recovery process. Two-way accountability. One way to build a better relationship with your payers is to hold each other accountable. Providers need to have systems in place to be able to hold payers to account for underpayments, but also to hold themselves to account for under billing. With a robust contract management tool, you can monitor payer compliance with contract terms and clarify what’s expected on your side to ensure you submit clean claims every time. Efficient processes: When the payer landscape is constantly changing, you need to have solid workflows to manage your claims processes as efficiently as possible. Automation and software solutions can help you minimize staff time spent manually checking payer policies, as well as generating the data you need to challenge underpayments. With a dashboard showing you real time claims data all in one place, your team will be able to identify, discuss and resolve queries with payers much more quickly than with disparate manual systems. How better payer monitoring saved one practice group $3.5 million in a single year In 2007, UCLA Health System Faculty Practice Group (UCLA FPG) saw $4 million go uncollected, largely down to difficulties tracking payer contracts. As the volume of payer contracts grew, it was harder to catch underpayments and manage the recovery process. Measha Ford, Director of Revenue Integrity at UCLA FPG says: “Before using Contract Manager, we didn’t have a method in place to track under and overpayments so there was a lot of lost revenue.” Without an efficient system in place, it was extremely challenging to manage collections data, monitor payer performance and spot when claims were being paid at out-of-network rates. This put UCLA FPG in a tough position to try to negotiate the best possible contracts with payers. By implementing an automated system, UCLA FPG could keep a closer check on payer contracts, eventually sustaining a recovery rate of 80% and recouping $3.5 million in one fiscal year. The data collected has not only helped to build a more predictable revenue cycle, but also supports more strategic decision-making when modeling new and amended contracts. And for Measha and her team, being armed with up to date, reliable data makes managing the relationships with payers so much easier, saving them time and effort that can be better used elsewhere. Find out more about how Experian Health Contract Manager can help you create friction-free interactions with your payers.

Before brands like Apple and Amazon became synonymous with consumer culture, the healthcare experience didn’t have much motivation to change. If you felt ill, you’d go see a doctor. The doctor would check you over, make a diagnosis and set you on the appropriate path to treatment. It was on you to initiate contact: your physician’s only job was to provide whatever care was needed, once you were in the system. Today, the healthcare journey can look quite different. Patients have options. In an increasingly crowded market, it’s now up to providers to reach out and woo healthcare consumers. To stay ahead of the competition, providers must seek innovative ways to attract new consumers and inspire loyalty among existing members. Chris Wild, Experian Health’s Senior Director of Consumer Engagement Solutions, says: “Health systems have started taking a good, hard look at how they engage with patients, whether that’s marketing to new populations or encouraging patients to come in when they are sick. It all comes down to data. With a complete picture of the patient, you can loop together clinical information with insights about their lifestyle and attitudes, so you really know who they are and what they’ll need from your health system.” Three ways consumer data can help you attract and retain patients Data-driven marketing and engagement is a growing opportunity for providers. With the right data platform, it’s easier than ever to leverage reliable, high-quality data and analytics to better understand and serve your patients. In fact, Wild suggests there are three main ways marketing data can benefit healthcare providers (you can watch Wild talk about these on video): 1. Marketing to new and existing members Why should prospective patients choose your hospital or physician’s practice? What would prevent existing patients from being tempted to switch providers? Understanding what makes your patients tick lets you pinpoint the exact benefits, priorities and language that will resonate with them most. As Wild says: “If you’ve got five health systems competing in a town of 1.5 million people, how are you going to differentiate yourself? Once a patient picks up a provider and they’re relatively satisfied, they don’t change a lot. They’re starting to look at things like quality. They’re starting to look at cost and what’ll give them the biggest bang for their buck, but getting to them first is a big first-mover advantage for sure.” ConsumerView bundles up reliable information on around 500 demographic, psychographic and behavioral attributes to help you get to know your target market, so you can get the right message in front of them at the right time. 2. Engaging with patients to improve health outcomes Even if you’re the only health system in town, there’s still a need to engage. You want your patients to achieve the best possible health outcomes and often that requires them to take ownership of their health. You can help them do that by encouraging them to come in when they are sick, or by pointing them toward services that could make it easier for them to access care. To do this effectively, you need to know what your patients need. ConsumerView has around 1500 verifiable data points on 300 million US consumers, covering about 98% of the US population. These can be used to discover how your patients think about their health and how they make their buying decisions. When that’s merged with your own information about their clinical journeys, you can give them a truly personalized healthcare experience. 3. Future-proofing your services Finally, you can use these analytics to better understand your current patient population to make smarter decisions about the investments you need to make in future. Where are the bottlenecks in the patient’s healthcare journey? Where should you put new services? Robust data analytics help you say, “we need to invest here and this is why.” Wild says, “I’m working with one analytics team that’s looking to better understand where they’re going to allocate physical and human resources so they can follow up with their patients more completely. They’re digging in deep to understand what their current patient population looks like, and then using that data to understand what their future population may look like.” Data analytics helps you predict demand for services, so you can direct resources accordingly. You’ll be able to identify trends in patient pathways, so you can engage with patients earlier and make sure they get prompt care and support, giving them a better chance of a good outcome and saving your organization time and resources. Learn more about how your organization can drive marketing results through customer segmentation, targeted messaging and analytics

It’s amazing to look back at how far medical science and digital technology have come – and how those two worlds are increasingly intertwined. Ten years ago, the idea of managing your healthcare bills or making appointments through an app on your phone would have been unthinkable. Now we take it for granted! But having all these tools at our fingertips means there’s more data being shared between different services and platforms. As a healthcare provider, you might be accessing and sharing patient data multiple hospitals, primary care services, pharmacies, patient portal providers, payers and more. It’s vital to make sure that data is accurate. Research by RAND Corporation revealed that between 8-16% of patient records are duplicates. Trying to provide care on the basis of unreliable data is inefficient and expensive for providers, who lose staff time and revenue trying to match up records and reconcile the data on file with the patient in front of them. According to RAND, a mid-size health system absorbs as much as $96 for each duplicate. What this means for patients is even more worrying. According to the US National Institutes of Health, “195,000 deaths occur each year because of medical errors, with 10 of 17 being the results of identity errors or wrong patient errors.” In a value-based system where patients are covering more of the costs themselves, the financial impact of having unnecessary repeat tests or longer-in-patient stays due to delayed treatment is an added pain. Currently, standard health IT products have some catching up to do, as only 10% of duplicates are spotted. But looking ahead, the future of patient identities is promising. Unique patient identifiers are key to unlocking value-based care The twin trends of value-based care and healthcare consumerism are bumping up patient expectations. They expect a seamless experience. They expect their records to be updated immediately. They’re confused when one department doesn’t have access to information that was just shared with another. And they definitely don’t want to see different services working off different versions of the same record. The answer for many high-performing health systems is to introduce unique patient identifiers (UPIs). This allows a patient’s record to follow them throughout their healthcare journey, ensuring that at every touchpoint, clinical and admin staff are confident in the accuracy of the information they hold. But transitioning to any new system can involve a bit of culture shock for those involved, and so careful planning is essential. What steps can providers take to make sure they implement a patient identity management strategy that’s built to last? How to future-proof your patient identity platform 1. Make sure everyone’s on board with the plan First, whatever solution you’re using to manage patient records, it’s essential that your patients, staff, payers and any other parties involved all buy in to the new approach. Changing the way you handle data and introducing new digital tools such as UPIs can often call for a mindset shift in the way your team and consumers think about data. Be sure to communicate the benefits of UPIs to patients, payers and staff. For example, UPIs can: improve patient safety, by preventing duplicate and inaccurate recordslower healthcare costs, by eliminating inefficiencies and errorssafeguard patient privacy, by keeping records securecreate a better patient experience, by supporting patient-centered carehelp staff access up to date information about their patient’s healthcare situation 2. Choose a UPI system that works within and outside your network Some providers use hospital- or practice-based patient identifiers, where a master patient index is used to link all versions of a patient’s record held within a single organization. An enterprise master patient index (EMPI) does the same, but across several facilities or services. A cross-enterprise solution makes it much easier to manage patient identities across your entire network, without having to wrangle disparate records that don’t interface well with each other. When this system is based on ‘referential matching’, which uses wider data sources and UPIs to build a more connected and accurate data ecosystem, you’ll get a much more complete view of your patients and far fewer inaccuracies. 3. Use data analytics to improve decision-making UPIs bring another advantage: they enable you to analyze health, credit and consumer data for a single patient, giving you useful insights about your patient population as a whole. A network of interoperable data can help you spot trends in the social and economic factors that affect health and wellbeing, so you can target your resources more effectively. As the world of public health data matures, it’s highly likely that UPIs will become the norm. Data-sharing remains a challenge, but by using digital tech to your advantage, you can improve the way patient records are managed in your health ecosystem. Learn more about how UPIs could help close the patient data gap in your organization.

At the end of 2019, Experian Health announced that every person in the U.S. population, an estimated 328 million Americans, had successfully been assigned a unique Universal Patient Identifier, powered by Experian Health Universal Identity Manager (UIM) and NCPDP Standards™ (the “UPI”). Universal Patient Identifiers (UPIs), created with a comprehensive view of patients from health, credit header, and consumer data sources, are thought to significantly reduce the challenges that stem from the misidentification of patients which span patient safety, financial, and operational inefficiencies. But what does 100% coverage mean? And what does this mean for the future of healthcare? To take a deeper dive, we sat down with Victoria Dames, an Experian Health leader in the identity management space to learn more. 1. It doesn’t get more perfect than 100%, so tell us more. What exactly does 100% coverage mean? Experian Health developed an algorithmic engine known as our Universal Identity Manager about five years ago. Since this time, we’ve worked closely with many providers, pharmacies and payers to help address their duplicate records. We’ve been monitoring our adoption and enumeration by unique patient identifiers against 328M individuals in the US population (2010 Census) and achieved this milestone at the end of 2019. Through our broad network of provider clients, which include hospitals, pharmacies, payers, and healthcare technology companies, patients who have received care from participating entities over the past few years have been enumerated.  As new patients enter the healthcare ecosystem, this number will continue to grow.  2. Why are universal patient identifiers (UPIs) needed and how do they benefit providers and patients? The Universal Patient Identifier (UPI) helps providers link the right records together, preventing duplicate records from being created. For example, think of all the ways duplicate accounts or variances can occur: address differences, name variations (Katherine, Kathryn, Kathy, Kat), maiden names and potential user entry error. With the UPIs, providers can link records together and have one complete record and view of the patient, ultimately leading to a better patient experience. It’s important to note that the UPI is not something the patient knows or sees, but rather part of the technology. It can be embedded within a hospital’s information system, for example. It simply links a patient’s records together, so a provider has a complete view of the patient’s identity. The flow of communication happens when participating healthcare organizations send Experian Health patient demographic information; the system provides the organization in return with the insights and identifiers that they need to better manage patient identities and prevent duplicate records. The UPI can be attached - if the situational requirement is met - to active claims in real-time transactions effectively improving the integrity of patient records. During this process Experian Health does not rely on or use any clinical information about the patient; Experian Health only leverages the minimum data elements needed to successfully match an identity.  3. How did you get numbers assigned to all Americans? When a healthcare organization enlists our help, we process all their historical records through the UIM, returning a Universal Patient Identifier (UPI). The initial run of this data helps resolve existing duplicates which can date back several years. Working with multiple providers and pharmacies, we were able to get numbers assigned to all Americans. The number will continue to evolve of course, as the population changes with births and deaths. 4. Are there privacy risks with this? Experian Health is a HIPAA-compliant Business Associate when it receives PHI from customers.  It takes its privacy obligations very seriously.  As to UIM, privacy risks are minimized by the fact that the UIM does not leverage any medical records, prescription histories, or provider systems. The purpose of the solution is to assist healthcare professionals to better match an individual’s identity through data assets that would normally be unavailable to a healthcare provider.  5. Does a UPI function similar to a credit report, meaning it provides a singular view of a patient’s medical history? It depends on the situation.  If a provider has a patient in their EHR twice under two spellings of the patient’s name in error, then yes, the UPI would link those two profiles, creating a singular view of the patient in that provider’s system. Additionally, the UPI generated by Experian Health is designed to help facilitate interoperability between healthcare providers.  For example, if your pharmacy has you listed under your maiden name of Smith and your doctor has your married name of Wilson, during the ePrescribing process, your ePrescription might not get associated with your prescription profile. If both providers have the UPI on record and submit it during the transaction, the systems will match the patient using the UPI. It’s important to note that the UPI is technology for entities and is not patient facing. 6. What is the direct benefit to consumers; will it help them control their medical data? Consumers will benefit depending on how a provider implements and utilizes the UPI. For instance, if a provider has two medical records, and they merge this into one record, the patient will see one consolidated record. Imagine two patient profiles for the same individual at a pharmacy.  One prescription is filled under each profile and the two separate prescriptions, if taken together, could lead to a severe reaction. If filled under two different profiles, the automated process to screen for drug interactions would not identify this harmful reaction. But the UPI directly solves for this issue. 7. What are the next steps and goals for Experian Health as it pertains to UIM? Our goal is to continue to partner with healthcare organizations to help prevent and resolve their duplicate records. We are continuing to invest in our technology and capabilities within identity, as we care deeply about patient safety and data integrity. Having a single, unified and accurate view of the patient is a challenge that plagues the healthcare system, and now we have a comprehensive solution that reduces the barriers to make healthcare safer.

The stats are alarming: Up to 80% of health outcomes are not due to medical factors, but to a patient’s social and economic circumstances—such as their income, housing situation and even whether they own a car.68% of Americans are affected by at least one social determinant of health (SDOH).Approximately 24% of hospitals and 16% of physician practices screen for food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence—which means the majority don’t screen for all relevant social needs. The healthcare industry has been talking about the importance of addressing social determinants of health for years, but many struggle with how to collect the insights. For example, if 68% of Americans are affected by at least one SDOH, how do they even discover the one? What is the ideal way for providers to screen for SDOH? Should they simply ask the patient? Do they start a visit with a survey, probing for details that could ultimately impact care management decisions? Providers know these sensitive topics – housing instability, financial instability, food insecurity and onward – can be tough and uncomfortable conversations. So, where to begin? Should you rely on patient surveys to capture SDOH? Patient surveys can be a useful way to find out about many potential barriers to care. However, they bring limitations: Your insights will be limited to the patients who show up—so anyone who has struggled to attend an appointment (and therefore potentially with higher needs) will be left out It can be time-consuming and expensive to give staff the time and space to conduct personal interviewsThey rely on patients to be willing to share openly, but some may not feel comfortable doing soThere is room for error in how questions and answers are interpreted by both the survey team and respondentsSocial circumstances can change over time, so it’s possible that the information gleaned in the survey may not be relevant a few months down the line. Knowing SDOH can have such a huge impact on a patient’s health certainly means clinicians should discuss these topics in the exam room, but relying solely on patient surveys and conversations could lead to gaps in intel. When should you screen for SDOH? Screening for social needs when a patient first registers or engages with your services is a good starting point. But what happens when their situation changes between diagnosis and treatment? What if they disclose a social need to a specialist that wasn’t flagged on their initial intake form? Does your staff know how to discuss sensitive social issues? Can they create a safe space for patients to share? Have you got clear referral pathways when an issue is flagged? Look for possible touchpoints in the patient’s journey where referrals to support services would be appropriate. Looping in the relevant primary care services is a good way to make sure your patients are connected to community-based programs and supported throughout their journey, whenever a new or changed social need is identified. What types of data could offer the SDOH insights a provider needs? Geographical and community-level data can help a healthcare organization understand their patient population’s income, housing situation and employment status. These are useful for population-level care planning but aren’t patient-specific. A better way is to analyze securely collected consumer marketing data for more specific and accurate information. Working with a trusted data vendor that is a compiler of original-source consumer data can help you navigate your options. The real predictive power of SDOH data comes when you combine patient-specific information obtained through screening, with consumer databases. A third-party vendor can help you access data on your patient population’s income, occupations, length of residence and other social and economic circumstances. Your care managers can use this to inform proactive, preventative conversations with patients to solve any non-clinical gaps in care. Bottom line … When healthcare organizations have a holistic view of patients—and the SDOH that play a role in their lives—they can take steps to help prevent avoidable hospital visits, emergency department (ED) utilization, appointment no-shows and worsened conditions by encouraging and facilitating earlier interventions. The key is to start with the right data.

Did you ever have someone tell you, “there’s no magic pill” for reaching a goal? It’s a somewhat ironic analogy, given that so many people struggle to take their meds as prescribed. Following a medicine schedule actually takes a lot of organization and discipline, never mind the financial and emotional cost of having a daily reminder that you’re not well. It’s estimated that 50% of patients don’t take medications as prescribed. Sometimes a patient is busy and misses a dose. Maybe they forget whether they’ve taken it already and accidentally take double. Perhaps they feel better and decide to stop a course of meds early. Or maybe they can’t get to the pharmacist to get their refill on time. Unfortunately, medication non-adherence (MNA) can have a more direct impact on a patient’s condition than the specific treatment itself, according to the World Health Organization. Non-adherence is thought to contribute to nearly 125,000 deaths and 10% of hospitalizations each year. It costs the health care system between $100–$289 billion each year, and according to a study by Walgreens, for every 1% improvement in adherence, $50 can be saved in healthcare spending. The causes are varied. Of course, patients have a role. But healthcare organizations operating at various points along the care continuum can also play a big part in helping or hindering patients in sticking to their prescriptions. Doing so is in everyone’s interest, as tackling non-adherence can help reduce readmissions and avoid more serious medical conditions, improve patient loyalty, yield financial savings and create a better experience all around. Here are three ways different healthcare organizations can help patients stay on track with their meds: 1. Keeping accurate patient records from hospital to home When a patient is hospitalized, it’s fairly easy for them to stick to a medicine schedule. Drugs are dispensed in the same building and brought right to the patient’s bed at the appropriate time. The problems arise when the patient goes home. They may leave hospital with new prescriptions which can be confusing and if they already have a prescription, the admission itself can disrupt their usual routine. As things stand, hospitals tend not to be reimbursed for interventions to improve adherence, so these are less likely to be prioritized during care transitions. But given the likely improvements to patient outcomes and consumer loyalty, and the fact that hospitals could save $37 for every dollar spent tackling MNA, these interventions are worth a second look. A simple but effective place for hospitals to start is in improving patient identities. When your clinical teams know they have a 100% accurate and up-to-date record for each patient, including their current prescriptions, they can help the patient stay on track and prescribe new medicines with confidence. New identity management platforms such as Universal Identity Manager can help you keep track of patients and their meds, reducing the risk of medical errors and avoiding billing mistakes associated with duplicate prescriptions and preventable readmissions. This ‘golden thread’ of patient information can also improve communications within and between providers in your health system, such as Accountable Care Organizations (ACOs), pharmacies and other community providers. 2. Understanding and addressing wider barriers to adherence Common barriers to adherence often relate to a patient’s circumstances at home, such as not being able to get to the pharmacy because of a lack of transport, or because the opening hours don’t fit with their work schedule. For patients juggling work, childcare and other responsibilities, refilling their prescription can easily slip down the to-do list. Pharmacies can help by offering logistical support such as automatic refill programs, home delivery and help with organizing medication into pill boxes. But how do you know which intervention will be most relevant? This requires a wider understanding of the make-up of your patient population and their needs, preferences and behaviors. Understanding the social determinants of health can help you identify the specific barriers to care for your healthcare consumers, so you can put in place the right response. 3. Develop patient engagement strategies to help patients take their meds It’s not just those directly involved in providing care who can help improve MNA. Payers can help in two major ways: firstly, by supporting members to overcome barriers such as cost and confusion, and secondly, by working with hospitals and pharmacies to help them develop effective strategies to reduce non-adherence. For example, Blue Cross Blue Shield of Arizona (BCBSAZ) has introduced a text messaging service to send reminders to members about their prescriptions, with a $45-50 discount on copays for those that refill on time. It’s hoped this program will tackle behavioral barriers to adherence such as procrastination or forgetfulness, while also addressing price concerns. Chris Hogan, Chief Pharmacy Officer at BCBSAZ described the program “as being a very high tech, modern, simple and effective addition to our overall initiative to improve medication compliance.” This kind of personalized patient engagement can be very effective in helping patients to stay on track. With ConsumerView, you can access a wide range of high-quality demographic, psychographic and behavioral consumer data, to help you offer personalized support such as digital reminders to your patients. You can develop engagement strategies tailored to the specific needs of your patients in just a couple of clicks. Could one of these strategies help your organization do more to improve medication management? Learn more about how we can help you help your patients – and your bottom line.