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Big data is helping every industry take giant leaps forward. Healthcare should be no exception. Household names like Amazon, Netflix and LinkedIn have made personalized consumer experiences the norm: predicting your next purchase, suggesting products you’ll love, and tailoring your news feed to your preferences. The modern consumer experience is intuitive and frictionless. Patients have come to expect the same of all the companies they do business with – including their healthcare provider. Like these consumer-driven industries, information about lifestyle, interests, purchasing behavior and even social media activity can all help create a more comprehensive picture of each consumer patient, and how they choose their provider. By understanding patients as individual customers, providers can use consumer data insights to offer personalized experiences, creating loyal customers and brand advocates. From building awareness about your brand to customer support interactions, these insights ensure your efforts resonate in the right way with the right consumers at the right time – and in a way that makes the consumer feel like they’ve chosen a provider that ‘gets them.’ We’ve all seen headlines about bad players using consumer data in a negative way, so compliance is key to avoid any mis-steps. Making sure you stay compliant with consumer privacy and data protection laws will keep your organization safe. Data-driven healthcare marketing is a huge opportunity The providers who thrive in the era of value-based accounting will be the ones who embrace a consumer insight-based approach throughout the customer journey. In fact, research suggests companies that leverage consumer insights outperform peers by 85% in sales growth and more than 25% in gross margin. But here’s the rub: while it’s a massive opportunity, using consumer data must be done safely and securely. Consumers don’t want to think about their data being traded in the shadows, even if they’re happy to live-tweet the data from their smartwatch. Trust and transparency are paramount. So, what’s a consumer-centric, security-conscious healthcare provider to do? 3 ways to stay safe and secure using healthcare marketing data Working with consumer (or marketing) data is somewhat new to health. The rules for how you source, store and use it bring a whole new set of compliance concerns. Failure to comply can result in eye-watering fines, not to mention the potentially devastating loss of trust. If you’re handling it in-house, beware of vendors popping up with data solutions that don’t quite make the grade. Here are three ways to practice good data hygiene and keep your organization compliant: Safe sourcing First things first: know where your consumer data comes from. Is your vendor collecting this data from original sources, or via a third party? Do consumers know their data was collected, and how it would be used? Can you point to the original source’s privacy policies? When you use consumer data, make sure you know its source and can quickly point to the privacy policies associated with the data. Working with original source compliers of consumer data, like Experian, can ensure you meet privacy policy rules. Consumers should always be told their data is being collected, why, and by whom. Despite the challenges around the introduction of the General Data Protection Regulation (GDPR), its main requirement is actually pretty simple: don’t use consumer data without active consent. GDPR may or may not apply to your organization, but it’s a good model to work to, especially as others are following its lead (like the California Consumer Privacy Act). Safe storage Tales of data breaches at Yahoo and the English National Health Service send a shudder through healthcare C-suites everywhere. And no wonder – a Ponemon Institute Study found the average cost of security breaches is around $3.62 million per incident, while consumers are reported to be more worried about data privacy than losing their main source of income. Safe to say, secure data storage and processing should be a top priority for your organization. Writing for Law Journal Newsletters, Mark Sangster says: “Privacy and data responsibility must be as important to the officers of a business as profitability is to the investors. As such, privacy and compliance blur together, and security becomes the guardian, keeping the others in check.” Familiarize yourself with the rules around storing marketing and non-medical consumer data, such as ensuring you have a written data security policy, identifying data protection officers, and having strict controls on access to data files so that it’s never shared with anyone who doesn’t absolutely need to see it. The Direct Marketing Association and American Marketing Association both have handy resources on ethics, regulations and data privacy. It may not be light bedtime reading, but it’ll keep you right. Appropriate use of data Marketing data is there to help you find promising prospects and keep them interested. Use it to guide your messages and content. It should never be used to deny services to anyone or create unequal access, so always keep an eye out for potential adverse effects. People love to get useful information, but when it’s a little too specific about their lives, that’s verging on creepy! Don’t give the impression that you know solid facts about them. For example, instead of writing “Dear Family of 4”, choose images that would resonate with that family, or offer health fair invites focusing on pre-teen or infant health, according to what marketing data tells you is more relevant. With marketing data, you can avoid wasting time and money (and the embarrassment of) sending your geriatric services promotion to young newlyweds. Or you can connect the dots between services that marketing data suggests will appeal to the same demographic, such as women’s clinic patients who are interested in fitness, who may appreciate a poster about your orthopedics or dietetics promotion. Mastering healthcare marketing best practice Using customer insights to drive your marketing strategy has huge payoffs for patients and providers. Partnering with a reliable data steward will help you take your data analytics to the next level, and stay compliant at the same time. As the gold standard for consumer data privacy, Experian Health offers access to clean, original-source data and robust analytics platforms that give you the most comprehensive view of your health consumers – and peace of mind when it comes to compliance.

  How well do you know your customers? Do they have kids? Do they drive an electric car? Are they working two jobs? Do they use social media? Are they more likely to watch the Beyoncé documentary or live stream the PGA tour? The more you understand your patients and their inclinations, the more you can customize their experience with your brand. You can match your marketing messages to their personal preferences. You can refer them to information that’s relevant, and not bother them with stuff that’s not. When your patients feel taken care of as individuals, your brand will be top-of-mind next time they need healthcare services. This kind of personalization is at the heart of healthcare transformation. When you see your patients as customers and prioritize their experience above all else, in your services and your marketing, you’ll see returns in the form of increased patient satisfaction, rock-solid brand loyalty, better patient outcomes, and growing revenue. Consumer insights give you the competitive advantage In our Digital Onboarding Report 2017, we found that 60% of organizations considered customer experience to be the number one way to stand out from the competition over the next three years. Healthcare brands can learn from other industries and use data-driven consumer insights to personalize their marketing strategies and enhance the customer experience. In an example from the leisure industry, Adi Clowes, Head of Data & Analytics at Center Parcs said: “Influencing customers’ decisions, buying behavior and loyalty cannot be achieved in silos – it’s about using data to make a difference, connecting the business with their customers across the entire customer journey. At Center Parcs we’re committed to our vision of delivering the most personalized and proactive guest experiences at every single touchpoint. That relies on our ability to bring together millions of interactions, combining the voice of the customer with good quality data, and delivering it back to the business.” Harvard Business School points to big consumer brands like Under Armour, Rent the Runway, Peloton and Uber as examples of how consumer data can be used to make sure their brand is in the right place at the right time with the right message about the right product for each individual customer. From predicting a style of training shoe based on previous athletic purchases, to letting you know how long you’ll have to wait for a cab, other industries are leveraging data insights to optimize pretty much all aspects of the customer experience. The value for customers is immense, and so is the payoff for brands. There’s an untapped opportunity for healthcare to enjoy the same benefits. Kathy Giusti, co-chair of the Kraft Precision Medicine Accelerator at the Harvard Business School observes: “When I worked at the Gillette Co., we lived and breathed market research and consumer dynamics. We studied consumer behavior like crazy and we’re not necessarily doing that on the healthcare side as much.” Other sectors don’t think twice about leveraging consumer insights, like demographic, lifestyle and behavioral data, so why should health? Three ways to use consumer data in healthcare marketing From attracting new customers and supporting existing ones, to customer retention and future planning, insights offer value at every stage of the customer journey. Here are three ways to leverage consumer data for a stand-out customer experience:     Attract new customers Think about how many healthcare adverts you see featuring a happy family with two parents, two kids and a golden retriever, playing sports in their sunny garden. Now consider how many of your patients actually fit this image. Healthcare content often doesn’t match the reality of the condition or the patient’s life. When you learn what ‘real life’ looks like to your target population, you can throw away the tired clichés and stop relying on hunches. Insights help you determine what type of messaging and communication channels resonate best, so prospective patients feel like you’re speaking directly to them. Personalized marketing becomes a time-saver, a trust-builder and a problem-solver for your audience. The bland ‘voted best’ slogans mass mailed by your competitors won’t stand a chance. So how do you build a relationship with consumers you don’t yet know? You need good marketing data, directly from the consumer, and managed carefully by a data partner who bridges healthcare and marketing.     Segment and target your current customers Personalization is a proven way to boost retention. Research shows customized emails convert at a rate six to seven times higher than generic messages. Healthcare payers who tailor members’ experiences see five times higher retention rates. It’s a no-brainer. Consumer data lets you separate out the married couple with teenagers, who make buying decisions on impulse and like spending big on hiking and fishing gear, from the empty-nesters who enjoy horror movies and consider themselves savvy researchers when it’s time to choose a provider. How would your outreach messages differ for each family? Should you emphasize convenience or reliability? Safety or cutting-edge technology? Should your images reflect an active lifestyle or a cosy home? You could guess, or you can let the data guide your decisions and put the most relevant messages up top in your communications.     Gain consumer insights to optimize your offerings Another important way to leverage consumer data is in analytics. Let’s say you’re rolling out a new healthcare app to let patients set up appointments or check test results. Working with quality consumer data can help you identify the early adopters, and build models to help predict likely next adopters, allowing you to allocate resources accordingly. When you know a segment of your audience is uninspired by new technology, you know not to waste effort or budget trying to sell it to them in the early stages. Instead, you can give them alternatives that better match their preferences. You won’t get this from simply knowing their ailments. Clinical and claims data tells you plenty about what’s gone before, but it’s only when non-medical consumer data is pulled into the mix that we see real predictive power. Healthcare consumerism means putting patients first Perhaps it’s time to ask what’s missing from your healthcare consumer marketing strategy. Is it the consumers themselves? If so, you’re not alone. Healthcare marketing isn’t new, but marketing based on consumer insights is something that many healthcare providers aren’t fully tapping into yet. This is about using data to make a difference and connect with your customers in a meaningful way at every touch point. A one-size-fits-all approach just isn’t going to cut it.

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.

Whether it’s due to pressure from governing bodies or price-shopping health consumers, many healthcare organizations are being challenged with price transparency efforts. With so many moving parts to determine a patient’s financial liability, how can accurate patient estimates be provided in a timely manner? Giving patients the right pricing information at the right time Like many healthcare systems, Blessing Health relied on various printouts and spreadsheets of price lists from different departments of the hospital to provide patient estimates. Lists needed to be manually updated, and the staff often relied on outdated information. The process wasn’t standardized, and estimates were inconsistent across the enterprise. While Blessing wanted to make sure that patients were getting accurate information, the estimates didn’t consider a patient’s insurance information. Since patients weren’t understanding their true financial obligation, it caused frustration among patients and employees. In today’s competitive environment, it’s important to reduce instances in the patient journey that might cause irritation. A recent report from Trends in Healthcare Payments, notes that patients who are satisfied with billing are five times more likely to recommend the hospital. At a time when hospitals are being asked to do more with less and reduce the cost of care, manual processes and work must be reduced and automated with data to provide accurate information. Patient liability estimation is a complex process of calculating multiple components, not easily available to users, including insurance benefits, charges, contractual adjustments and provider discounts. If hospital staff are manually estimating the processes, they could be using outdated pricing lists which may not include application of insurance benefits, contract rates, and discounts. As consumers gain access to pricing information, health leaders should invest in data-driven technology that can provide consumers with accurate personalized estimates. Most healthcare organizations already have the basic data they need to use automated technology to construct estimates for basic services, including claims data, real-time eligibility and benefits information, payer contracts and charge description master (CDM) information. Blessing Health knew they needed to find a way to advise patients of their financial liability, as well as give staff a tool they could confidently use to request patient payments upfront to increase collections. They wanted real-time estimates that were personalized based on a patient’s insurance and contract information. To do this, Blessing Health reached out to Experian Health to integrate Patient Estimates into their Allscripts® workflow. What to look for in price estimator tools Healthcare organizations should implement price transparency and collection practices that are standardized across the enterprise. A pricing transparency tool eliminates the need for manually updating price lists, and removes the guesswork and tedious manual processes, which often result in outdated, inaccurate estimates. Price transparency software should also include reporting features that give greater control over the process and can be agile in managing transparency initiatives as well as track potential versus actual collections. A price transparency tool should highlight a patient’s financial situation, as well as their propensity to pay, allowing you to optimize your collection strategies from the start and get patients on the right programs. To help reduce traffic to call centers, a price transparency tool should be integrated into consumer-facing estimates that are personalized and available through a web portal or mobile app. Price estimation can help with patient collections Through an automated, data-driven process, Blessing Health is now able to provide personalized patient estimates that are 80 percent to 90 percent accurate. (Inaccuracies result from unexpected tests or procedures.) As a result, Blessing Health benefited from a 58 percent increase in point-of-service patient collections. Based on the cost to implement these services, Blessing Health experienced a 1,200% return on investment. After realizing success on the hospital side, Blessing Health implemented Patient Estimates for their physician group as well. — Learn more about how you can empower the patient financial experience.

A recent Black Book survey of more than 500 healthcare networks revealed that hospitals in the U.S. have been painstakingly slow in adopting healthcare revenue cycle management (RCM) solutions. At the start of 2018, nearly 26 percent of hospitals had no viable solution in place, and 82 percent of them planned to make value-based reimbursement decisions without one.   For most hospitals, one of the biggest challenges in implementing RCM solutions is finding talent with the right skill set to handle RCM software difficulties. It’s a problem that even the largest healthcare delivery networks face and one that UCLA Health hospitals had to overcome. UCLA Health System Faculty Practice Group (UCLA FPG) employs more than 2,500 physicians with more than 220 primary and specialty practices.   Keeping up with payer contracts   In 2007, more than $4 million in revenue went uncollected at UCLA FPG. The group’s RCM pain points were typical of those in the industry. For example, the group was unable to keep track of over- and underpayments, which made it difficult to adhere to payer contracts. It was also difficult to manage appeals and track recovery as the volume of payer contracts grew and became increasingly more complex.   The difficulty UCLA FPG had in gathering and exporting information, in addition to the complexity and volume of contracts, left it with little negotiating power when dealing with payers. UCLA FPG's numbers continued to fluctuate until implementing Epic alongside Experian Health's Contract Manager.   Using this web-based solution, UCLA FPG has been able to automate and improve its revenue cycle due to the solution’s ability to continually monitor and update every payer contract. This has also helped the healthcare group stay compliant with all payer agreements by making it possible to catch errors faster.   Director of Revenue Integrity Measha Ford states: “We are able to catch Medicare overpayments faster with the contract management system. We recently integrated all our Medicare contracts into the system to have a lower risk of compliance issues since we only have 60 days to refund Medicare back once we identify an overpayment. Having this system, having that ability to load the contracts into the system to catch these potential risks, is very helpful.”   The UCLA network now has fewer administrative write-offs every year, faster AR collections, and reduced denials.   Experian Health's team maintains contract terms, fee schedules, and payment policies and makes sure every claim processed follows UCLA's contract terms. Online dashboards and reports help monitor reimbursement and reduce payment discrepancies through interactive graphs that expose source claim data and practice management system-specific data attributes.   Analyzing contracts before signing up   In addition to tracking and managing contracts, the group also knows exactly how a new contract or redefined contract terms will affect its bottom line. It has intel on real-world “what if” scenarios to provide insight into how various contract terms affect cash flow for the precise mix of services the group provides. It's also able to avoid unfavorable contract terms, as they are easily spotted through analysis.   Are health plans complying with your contract terms? Learn more about how we can help you find lost revenue with data-driven insight.  

Healthcare organizations have been forced to deal with billing challenges for so long that many might consider the struggle to simply be the price of doing business. Denied claims and contractual underpayments are regular occurrences in the payment cycle. And these issues can cause problems in the rest of the healthcare ecosystem when left unchecked. Fortunately, a robust claim scrubbing solution can reduce costs and speed up reimbursement. Healthcare billing costs can add up quickly. The estimated cost of billing- and insurance-related jobs at one large academic healthcare center ranged from $20 to $215 per patient visit, according to a study published in 2018. For years, the State of Franklin Healthcare Associates (SoFHA) was all too familiar with the challenges of the claims process. In 2010, the organization had to keep 12 full-time employees on its payroll devoted to the correction and resubmission of denied claims. When claims are denied, Crowe reports that it takes an average of 16.4 additional days for a hospital to receive payment. And those delayed payments are costly to healthcare organizations. Without the tools that enable a proactive approach, healthcare organizations' only option is to submit claims and then wait to correct the ones that are denied. SoFHA’s large network of 109 providers included a wide variety of specialties and services, from diagnostic imaging and internal medicine to OB/GYN and family practice. SoFHA needed a flexible presubmission claim scrubbing technology that would identify and correct errors before claims could be submitted. To overcome the obstacles in the claim submission process, SoFHA turned to Experian Health's Claim Scrubber. Claim Scrubber stood out to the group in two ways. The first was the price, as users pay a fixed monthly rate rather than pay for each transaction. The other highlight was the ability to build customized claim edits, which are available to all clients immediately when the tool is deployed. For Amanda Clear, SoFHA’s director of business services, that capability made all the difference. “With Claim Scrubber, I have the ability to go into the system and create my own edits,” Clear said. “Other systems either didn’t accommodate customized edits or required you to call, perhaps pay a fee, and go through a long process.” Plus, Claim Scrubber reduces demands on healthcare provider personnel because the tool comes with around 350 edits maintained by a dedicated content team. Payer-specific edits replace between 60 and 75 percent of an organization’s custom edits right away. Claim Scrubber ensures claims are correct and complete the first time they're submitted. Experian Health regularly updates its system with coding and payer changes. The tool adjusts for coding variances on claims submitted to Medicare, Medicaid, and private insurance companies. It reduces denials and drives down rebilling costs for healthcare organizations. With Claim Scrubber, SoFHA generated a clear return on investment, and the group was able to expedite accounts receivable by 13 percent. Perhaps even more telling was the reduction in full-time claim correction employees that accompanied the adoption of Claim Scrubber — a change that occurred in spite of a growing volume of claims. By auditing claims and spotting errors before submission, Claim Scrubber can ease the burden of claims denials and allow healthcare providers to instead focus on their job of providing the highest-quality patient care. --- Learn more about how we can help you ensure all claims are complete and accurate before submission to the appropriate payer or clearinghouse.  

The United States’ health system has become the most expensive in the developed world, and high administrative costs are a big factor. They account for more than 25 percent of spending on hospital care, making American healthcare administrative costs higher than any other country. Much of the problem comes from the complexities of payment. With public health programs, private insurers, and patients themselves all splitting the bill, it’s difficult for hospital administrators to determine who pays what in each situation. Especially during patient registration, they are bogged down by the time-consuming process of verifying patients’ eligibility for insurance and other programs. For these reasons, Martin Luther King, Jr. Community Hospital decided to focus on improving its patient registration process. The private nonprofit safety net hospital in South Los Angeles serves a high-need community and sees about 300 patients per day. Manually checking in all those people meant that MLKCH’s administrative team had an overwhelming workload. The hospital needed an integrated solution. Automation simplifies hospital patient registration The hospital’s staff was spending a significant amount of time checking different payer websites and making phone calls to determine each patient’s eligibility for insurance and various programs. Then, the benefits information had to be copied and pasted into the hospital’s non-integrated platform, which was another slow process that often resulted in inaccuracies. Quality assurance to find and correct those errors was a manual process, too, taking up more of the administrative team’s bandwidth. To free up resources and reduce errors, the hospital wanted to automate its verification processes, streamlining its registration, quality review, and more. MLKCH also needed its hospital patient registration software to work well with the Cerner system it already used. It decided to implement Experian Health’s eCare NEXT® platform. “We decided to use Experian Health’s software within Cerner versus a couple of the products we were looking at, at the same time, because it truly integrated within Cerner,” said Lori Westman, patient access manager at MLKCH. “When we presented this to our CFO, he liked the fact that it was integrated within Cerner; he didn't want us to have to go out to another third-party payer to pull information back. It's all about time and the time we can save on our registrations. That was the biggest selling point — the integration within Cerner and its seamless registrar on the back end. To the team, it's just another program they're working with in Cerner.” The software from Experian Health automates registration and financial clearance, among other patient access processes, which account for up to 80 percent of manual preregistration tasks. The system assesses patients quickly, replacing the information-gathering that staff has traditionally done. For MLKCH, which sees many returning patients, if a patient is already in the system at check-in, eCare NEXT pulls up his or her eligibility automatically when an administrator accesses the account. This saves several minutes, making it a notable patient registration process improvement. The system also eliminates a large portion of redundant tasks. When using the platform to check eligibility with one plan, eCare NEXT also searches for other applicable plans. For example, MLKCH treats a large Medicaid and managed care population, so checking a patient’s eligibility required visits to both the state’s and the health plan’s websites. But eCare NEXT will verify both automatically. Additionally, the fact that eCare NEXT integrated seamlessly with Cerner has improved the hospital’s patient registration process. Because the two platforms work together, patient data has become more accurate and the quality assurance process is less cumbersome. MLKCH was able to implement new QA standards after staff became familiar with the automation tool. The team also found that the enhanced data from eCare NEXT can shape user education and pinpoint areas for further improvements. And while there were some concerns that a new platform would take a long time to adopt, the rollout of the patient registration system was smoother than expected. The administrative team got a robust solution with exceptional support to ensure users have every resource they need. Ultimately, implementing an automation tool eliminated MLKCH’s most time-consuming registration tasks, allowing staff members to focus only on the tasks that needed their attention. This made their jobs easier and more efficient while also reducing training needs and improving compliance. The registration process became much faster. Automating preregistration tasks and eligibility verifications has also ensured MLKCH’s administrators have more accurate eligibility information. This integrates with Cerner to increase the quality of patient records. But the most important benefit of improving the patient registration process has been how it affects patients. These time savings get passed on to them in the form of quicker registration and less hassle proving eligibility. Using eCare NEXT has not only helped the hospital's administrators, but it has also allowed MLKCH to enhance patient service. Westman adds: “We get fewer denials because we're getting true verification data, and our patient volumes continue to increase. So the fact that we can take off two to three minutes, at least, on half of our registrations is speeding up the work for the team, and the turnaround time is much better for the patients.” Need to streamline your patient access department? Learn more or schedule a demo with us today.

Healthcare providers should be able to focus on what's important: their patients and the care they need. However, providers and their staff must spend much of their time on administrative tasks. A study by AMA Prior Authorization revealed that providers are spending two business days per week just completing prior authorizations. That doesn't even account for other administrative tasks. Meanwhile, providers rely on more payers and plans than ever before, which is often tied to their clinical performance, and patients are becoming increasingly more responsible for the cost of their care. This is leading to an increase in operating losses per physician of 17.5 percent of net revenue in 2017. Providers must prioritize their revenue cycle efficiency if they want to remain financially solvent in the ever-shifting healthcare field. To safeguard its revenue, Schneck Medical Center in Indiana, the only hospital serving four counties, wanted a way to optimize claims follow-up by identifying and targeting the claims needing attention as quickly as possible. This was especially important because an estimated 10 percent of the population lacks insurance and 13 percent lives in poverty in the primary county the medical center serves. Schneck's goals were to: Ensure denials did not exceed 3 percent of net patient revenue. Achieve the estimated total net preventable denials of $3.2 million or a 2 percent increase to operating margin. Reduce denials by confirming patient insurance eligibility, verifying medical necessity, and obtaining prior authorization when appropriate. Makenzie Smith, director of patient financial services at Schneck, said that industry pressures to reduce healthcare expenses and provide a better patient experience are what drove the healthcare organization to look at the revenue cycle technologies and processes it had in place. A better denials management system The denial management process can be cumbersome, especially for community hospitals like Schneck. It takes up too many resources and far too much time. Schneck was looking for better denial analysis reporting and automation software so it could more effectively manage denials and significantly increase collections. The organization's search led to Experian Health's automated approach to tracking the root causes of denials and identifying the trends in order to improve procedures. The software tool provided a comprehensive solution and allowed Schneck to optimize its claims workflow with remittance detail and analytics. It now helps the medical center identify denials, holds, suspends, and zero pays and uses electronic remittance advice and claim status transactions to identify appeals won or lost with payers. This allows Schneck to identify and target the claims that require immediate attention. The payoff With executive leadership buy-in and support, Schneck created a new, better process for claims denial management by: Reviewing preventable denials with customized queues in real time. Identifying directors with staff responsible for checking a patient's benefits and obtaining prior authorizations. Reviewing all denials over $500 in the revenue cycle department. Establishing a schedule for reviewing denials each month. Schneck's new streamlined process and real-time visibility into denials data has allowed staffers to work on denials more efficiently. The ability to link denials to a specific staff member in a specific department has further streamlined the process. The relationship between the front and back office has improved because both sides have achieved a better awareness of processes. With the right denial analysis and automation, healthcare organizations like Schneck can manage denials effectively and increase collections significantly.

There’s no doubt that identity theft is a concern for any industry that handles sensitive customer information; health care is no exception. In 2017 alone, the U.S. Department of Health and Human Services reported 477 healthcare breaches. Together, they compromised nearly 5.6 million patient records. Without adequate IT security, everything that organizations use to improve patient engagement and the continuum of care – especially patient portals – becomes an open door for hackers. But how do we keep patient data secure without burdening patients? We asked Victoria Dames, Experian’s senior director of identity management, how the healthcare industry is evolving to solve for identity theft, as well as best practices all healthcare organizations can adopt to better meet this growing threat. In the world of healthcare, both patients and providers are understandably hyper-sensitive about the exchange and security of healthcare data. How is the industry arming itself to protect data? Are there any shifts you’ve witnessed in security practices over the past few years? Absolutely! The industry has quickly evolved into leveraging technology to share data between organizations and with their patients, but this does bring inherit risk. Criminals also took notice to this shift, and medical identity theft became one of the fastest growing types of identity theft with a roughly 22 percent annual growth. With this evolution, the industry has tightened up on data access, especially as it pertains to the patient. Over the last five years, we’ve seen the shift to enable technology to help identity-proof patients before granting them access to sensitive information. This used to be a manual process. What are some of the best practices healthcare organizations can adopt to limit instances of medical identity theft? First, organizations must understand where their access points are throughout their ecosystems. With 64 percent of patients citing a privacy issue as a key concern for accessing health information online, they should inform patients that they’re providing secure methods for access to their information. Additionally, healthcare organizations must evaluate how physicians access different types of data and portals. As healthcare caught up to electronic records and systems, portals for e-prescribing also arrived. Given the nature of this use case, providing a heightened NIST level of identity proofing is required. The key is to assess what level of identity proofing is needed at each entry point to keep balance on security and the end-user experience. When you look to the future of healthcare, what types of digital technologies and solutions do you see providers putting in place to prevent fraud and protect patient data? Technology moves quickly and so do we. Identity proofing has seen an acceleration in the use of biometrics at different points of entry throughout healthcare organizations, which strengthens our solution. We are starting to see the use of biometrics, similar to your phone face ID, used more broadly through healthcare in conjunction with existing identity-proofing solutions. Experian achieved the Kantara Initiative certification with adherence to the latest guidelines achieving NIST 800-63-3 IAL2 (National Institute of Standards and Technology Special Publication Digital Identity Guidelines 800-63-3 for Identity Assurance Level 2 (IAL2)). This reinforces our commitment to support clients in authenticating consumers, while balancing a positive experience. Learn more about Experian’s identity management solutions.