Last week, I attended the ONC Symposium on Patient Matching for Prescription Drug Monitoring Programs (PDMPs) and conversations with pharmacy stakeholders confirmed that momentum is growing for an industry-wide solution to the patient matching challenge. Recent legislative movements could see a removal of the ban on federal funding for a universal patient identifier (UPI), while within the industry, we now have a range of exciting collaborations and innovative solutions on the table to help improve patient identity management. As someone who works closely with pharmacy leaders, PDMP administrators, health IT experts and standards organizations, I’m optimistic about what patient matching technology could mean for the pharmacy world. Here’s why. When life doesn’t match health events In today’s healthcare system, patients move through several facilities and services, seeing multiple doctors, pharmacists, nurses and other clinicians. In between those interactions, life happens. A patient might move to a new house. Get married. Have kids. Relocate to a different state. Maybe they visited Pharmacy A for their medications while living in San Francisco, but delivered their first child in Hospital B, after moving to Los Angeles with a new surname and different address. How does the health service know this is the same person? Who is keeping track? Patients with similar names can have their records combined, while data entry errors lead to the same patient having multiple unmatched records. The ONC itself has found that 10-20% of patients may not be correctly matched to their entire medical record within an organization, rising to 50-60% when data is shared between organizations. For pharmacists, the fact that nearly 80% of prescriptions are delivered electronically means the opportunities for data entry errors to creep in is worryingly high. How can they be sure that the prescription they’re holding is for the patient across the counter? A prescription in the wrong hands could be fatal. PDMP facilitators face the same problem when trying to improve patient match rates for the proper tracking of opioids. Since the data comes from various sources, often formatted differently and not always including required fields, PDMPS are forced to do the best they can with what they have. To further complicate the issue, states across the U.S. do not have a common, underlying method of uniquely identifying patients to be able to exchange information across state PDMPs. While PDMPs establish central repositories of prescribing and dispensing records of medications classified as controlled substances that can be accessed online by authorized individuals and agencies—individual state PDMPs vary in required prescribing information and in data submission time, usually with a week or more of delay. An additional challenge exists since not all programs share their data with other state PDMPs, preventing information exchange and reducing the effectiveness of the programs. The answer is to have a single, complete picture of each patient that can be accessed by all relevant organizations in the healthcare ecosystem – but how close are we to achieving true interoperability? Why EMPIs aren’t the answer The common solution historically has been  to use an enterprise master patient index (EMPI) to link all versions of a patient’s record within a health eco-system (such as in a pharmacy, a physician’s office, or a PDMP). The problem is these usually rely on limited historical and demographic information, which may have gaps or errors that end up being replicated in any service using the EMPI. A universal patient identifier that integrates patient information from reliable health, credit and consumer data sources can give pharmacies and other providers a much more comprehensive view of their patients than traditional matching approaches. Referential matching technology, as recommended by Pew researchers, uses unique identifiers and third-party data to provide continuous updates to the master patient index, so you know you’re giving the right prescription to the right person. Collaborating for better patient matching solutions One example of how this is already being used to link patient prescription data at scale is in Experian Health’s collaboration with the National Council for Prescription Drug Programs (NCPDP), which sets the standards for the digital exchange of pharmacy-related healthcare information. Lee Ann Stember, President of the NCPDP, says: “We needed a single, unified and accurate view of the patient that could address the patient safety and business issues that plague our healthcare system.” To this end, we’ve teamed up to create a patient matching solution that provides a framework for establishing a unique patient identifier across the entire US healthcare network. This is a vendor-neutral, cost-effective solution that lets providers exchange information efficiently and accurately. There’s less chance of a prescription being given to the wrong patient and causing unwanted and even fatal interactions. In August 2018, NCPDP working groups approved the UPI as a standard field. This means the UPI may be used by other partners to improve the accuracy of patient data exchange. The PDMP Reporting Standard was among those identified as suitable for communicating the UPI. With this standard, pharmacies will be able to submit the UPI directly to PDMPs so that patients can be matched using the UPI instead of probabilistic or manual processes. A UPI can help states who share data improve their matching because it is a real-time solution that will feed into the management of controlled substance prescriptions across state lines, creating better visibility into interstate prescriptions and more importantly improving patient safety. The current lack of transparency into controlled substances—who is filling, when they are filling, how often they are filling, etc.—is feeding the national opioid epidemic which is taking a significant human and capital toll. Working towards an industry-wide solution Our strategic alliance with NCPDP was inspired by a shared desire to leverage data for the common good. We want to give more providers the opportunity to benefit from this UPI solution, to help address some of the patient safety challenges facing the healthcare industry. That’s why Experian Health is offering access to our Universal Identity Manager (UIM) Batch product for no charge. This tool strips out duplicates in your patient data and gives you a UPI that can be used across different health entities, enabling secure information exchange. It can even provide updated demographic information using the United States Postal Service CASS address standardization. Given the advances already made in trialling innovative solutions for the secure and accurate exchange of prescription data, the pharmacy industry is well-placed to lead the way in adopting more comprehensive and reliable patient matching frameworks. As we know, better data means better care. More accurate patient matching not only improves patient safety, but allows for better care coordination, financial savings and greater operational efficiency. — Find out more about how the Universal Identity Manager and other identity management solutions can help pharmacies improve patient matching. Matt McGrath is Vice President of Pharmacy Strategy and Solutions at Experian Health. 

For many patients, the unknown cost of unexpected care is a source of anxiety: two-thirds of Americans are “very worried” or “somewhat worried” about being able to cover unexpected medical bills. No wonder, when around 56% say they wouldn’t be able to afford an unexpected bill over $1,000. In cases where insurance doesn’t cover the entirety of the bill, responsibility for paying the balance falls to the patient. The lack of price transparency leads to confusion and stress for patients, and unnecessary administrative costs for providers, who are left to chase payments from growing numbers of self-pay patients. Moving towards more transparent pricing Traditionally, patient billing has been calculated at the end of the revenue cycle, after insurance adjustments have been made. In recent months, a push for meaningful price transparency is emerging as a result of consumer demands about the cost of care, pressure from governing bodies, and bipartisan support for a legislative solution to surprise billing. In response, healthcare organizations are increasingly looking to move patient billing to the front of the revenue cycle, to give consumers greater clarity about what to expect when their bill arrives. Estimating patient liability is far from simple. It calls on front office staff to make complicated calculations based on insurance benefits, charges, contractual adjustments and provider discounts. If staff are doing this manually, they may find themselves using outdated pricing lists that don’t include current insurance information, rates and discounts. So how should providers ensure their front office staff have the right tools in place to give accurate, personalized estimates for each patient? Data-driven technology can help reduce surprise billing Data-driven technology that automates, simplifies, and unifies the revenue cycle can ensure timely communication on billing between healthcare providers and insurers. This means your front-office team can base estimates on accurate, up-to-date information. To reduce the risk of errors creeping in, price transparency and collection practices should be standardized across the enterprise. A pricing transparency tool eliminates the need for manually updated price lists and removes the guesswork that often leads to mistakes. It can also include reporting features that let you track potential and actual collections, so you have greater insight into the opportunities for revenue cycle optimization. Helping patients navigate the cost of care As patients bear more out of pocket payment responsibility, they expect a better consumer experience. Creating an optimal patient collections strategy and frictionless experience is ever more important. Full transparency calls for accurate and up to date pricing to be available to patients before they receive care, along with a detailed breakdown of what their insurer will cover. When they know what the difference is, they’ll know upfront how much they’re likely to need to pay. Additionally, clear and proactive communication around the billing process can help eliminate the shock factor, improve the patient collections process, and create a better patient financial experience all round. You could provide a text-to-mobile experience that delivers a text message with a secure link to the patient’s estimated bill. Or you might integrate a price transparency tool into your patient portal or mobile app, that lets patients see a personalized cost breakdown based on real-time pricing and benefit information, alongside methods for secure payment. A price transparency tool can also help you gather insights into a patient’s financial situation and propensity to pay, so you can optimize your collection strategies from the start and get them onto the right program. El Camino Hospital in California set an organizational objective to improve price transparency. Terri Manifesto, Senior Director (Revenue Cycle) says: “We decided to do a soft launch of a patient estimator tool, and the very next day, even without advertising it yet, our patients found the tool on the website and started using it. The feedback was excellent. We’re providing a lot more estimates than we could before because it’s 24/7 and patients can use it on their mobile device, their laptop or their desktop. Some advice I’d give other hospitals is to think of the patient when you’re deciding what to do to best communicate your prices. What would the patient want?” Working with a partner such as Experian Health lets you combine industry-leading technical expertise and payment tools with your own knowledge of your patients, so you can create the best payment experience for your consumers. Using data-driven technology, you can work to eliminate the pain of surprise bills and promote price transparency, resulting in greater revenue opportunities and customer loyalty.

Most healthcare consumers spend only a tiny fraction of their lives in the clinical world of medical appointments and procedures. Where and how they spend the rest of their time has a far bigger impact on their health and well-being. So why are some providers still relying primarily on clinical data to devise their care plans? Clinical data is crucial when it comes to a patient’s diagnosis and treatment options, but it tells you nothing about their ability to stick to a care plan when they get home. How do their living situation and lifestyle habits play into the physician’s treatment recommendations? Consumer data is the missing piece of the healthcare jigsaw. When providers have insights into their patients’ social and economic circumstances, they’re better placed to spot the factors that might hinder access to care, and offer a more holistic, tailored and effective support plan. The predictive power of consumer data Let’s imagine a single mom of two small kids, working two jobs. Her daily life is a race to get everything done on time, give her children what they need and still make ends meet within her weekly budget. When a reminder for her annual wellness appointment flashes up on her phone, she adds it to her mental to-do list. But by the time the appointment comes around, the stress of taking time off work and scraping together the cash for gas or bus fare means she puts it off. She doesn’t go. Six months later, she ends up in the emergency room with symptoms of a serious illness. Had her provider known about the barriers in advance, they could have supported her to get to her appointment and discover her illness sooner. As Dr. David Berg, co-founder of Redirect Health says, “the most important part of getting good results is not the knowledge of the doctors, not the treatment, not the drug. It’s the logistics, the social support, the ability to arrange babysitting.” Consumer data, such as car ownership, employment status, income level and family information can give you these insights early enough to take action. You’ll know whether your patients can get to their appointments easily, whether they can afford childcare, and a whole host of other factors that might affect their ability to stick to a care plan. And once you know those things, you can offer tailored support to give them the best chance of success. How to gather non-clinical insights According to PwC, around 78% of providers lack the data to identify patients’ social needs. Many have basic demographic information on their patient populations, but are missing the more sophisticated insights that could help them better support patients. It doesn’t have to be complicated, but there are a few considerations healthcare providers should vet as they gather and use consumer data to help drive care plan compliance: Evaluate the pros and cons of patient surveys The obvious way to find out more about your patients’ needs is to ask them directly. A survey at the point of registration can help you understand what barriers may prevent them from attending appointments, taking prescriptions or following other medical advice. However, surveys can be time-consuming and expensive to administer, and recording answers by hand can lead to errors. How a patient interprets the questions and how your team interprets the answers may affect the usefulness of the survey data. And a patient’s circumstances may change between completing the survey and trying to follow the care plan. This approach also only includes patients who manage to attend an appointment in the first place. Those without access to care such as the mom in the example above, would be omitted from the survey, so you would miss out on discovering how to help them. Tap data vendors to deepen your consumer insights A third-party data vendor can give you access to data on your patient population’s income, occupations, length of residence and other social and economic circumstances. When this data is packaged up for your care managers, it can be used to inform proactive, preventative conversations with your patients, to solve any non-clinical gaps in care. It’s more cost-effective than patient surveys and removes the risk of personal bias and interpretation. Ensuring the reliability and integrity of your data vendor can be a challenge. Data brokers often use consumer data collected in retail and other industries, which may not be completely relevant to your activities or collected in a way that meets the requirements for use in healthcare settings. It’s crucial to be able to verify the source of the data and confirm that individuals were told how their data would be used and given the choice to opt out. Always ask your vendor if they are an “original source compiler." Working with a data vendor in the health space, such as Experian Health, can help avoid these pitfalls, as they will have expertise in the appropriate use of consumer data in healthcare. Understand permissible use of consumer data to stay compliant To use consumer data successfully, you must have confidence in both its accuracy and your ability to safeguard patient privacy. For example, are your data collection processes compliant with the General Data Protection Regulation (GDPR) and the California Consumer Privacy Act 2018 (CCPA)? Working with a data management partner who collects data directly from consumers means you can verify that all privacy requirements and opt-outs are in place. They’ll also help you scrutinize hundreds of public and proprietary data sources, so you use only the most relevant, up-to-date data to inform your decision-making. By evaluating and understanding these three areas, you’ll be able to leverage consumer data to tailor your patient engagement and support and make it easier for your patients to comply with their care plan. The more you are able to see and treat each patient as a whole, individual person, the better their health outcomes are likely to be. Consumer data lets you do that.

Medical identity theft is a growing concern for healthcare organizations in the digital age. In 2017, healthcare data breaches accounted for 24% of all data breaches, rising to 29% in 2018. In just 12 months, the total number of personal medical records exposed jumped from 5.3 million to 9.9 million. In fact, healthcare data breaches tend to expose many more individual records than other industries. For example, according to the Identity Theft Resource Center, 43.9% of breaches in the first half of 2019 were in business, while only 36.9% were in healthcare. But for healthcare, this meant exposing a staggering 77.4% of all records left vulnerable to identity theft, compared to just 9.5% by business breaches. The potential impact of a healthcare data breach seems to be further-reaching than in other fields. At the same time, healthcare is slightly behind other industries when it comes to data security. Financial services have a two-decade head start to refine their anti-fraud strategies. This, coupled with the fact that medical identities are worth 20 to 50 times more to fraudsters than financial identities, means medical identity theft is increasingly appealing to criminals. It’s a big concern, but healthcare organizations can use data to fight data theft. When you’re armed with the right information, you can put in place the right strategy to protect your patients. What is medical identity theft? Medical identity theft is when someone uses another person’s health-related identifying information without them knowing. This could include their name and address, Social Security number, health records, or insurance information. Fraudsters can use this information to access medical services without paying, submit false insurance claims, or buy drugs. They pretend to be someone else to access services illegally. In addition, that personal information could be used for other kinds of identity fraud or blackmail. What are the consequences of medical identity theft? Karly Rowe, Vice President New Product Development, Identity & Care Management Product at Experian Health, says: “For patients, the impact of having their personal information stolen, and then possibly used to make false claims in their name, can be hugely violating. When someone’s record becomes overlaid with a thief’s record, this can have massive consequences for that person’s future treatment. It’s a major stress to sort out – both administratively and financially. And for organizations, there’s obviously the reputational hit. The relationship between provider and patient is based on trust. When you fail to secure your patients’ most personal information, you risk losing that trust for good.” It’s also a major cost. Medical fraud in the U.S. is estimated to cost somewhere between $80 billion and $230 billion, with the cost to individual providers and payers coming in at around $2 million per breach. To tackle the problem, healthcare organizations are stepping up their security practices across the board. A HIMSS survey, in partnership with Experian Data Breach Resolution, reported that data security strategies have improved. Ninety-two percent of those asked had performed a formal risk analysis, and more than half had increased their patient data security budget. A number of organizations also teamed up to form the Medical Identity Fraud Alliance, to mobilize the industry to tackle the problem. Still, there’s a ways to go. 3 ways to leverage data insights to prevent medical identity theft Protecting patient data calls for a data-based solution. Here are three ways to leverage consumer data and technology to protect your patients and keep their information safe: Resolve patient identities. Accurate patient data is the cornerstone of data management. If your records aren’t entirely reliable to begin with, keeping them safe and secure will be much harder. Put preventative measures in place to minimize the risk of duplicates and errors. Assigning a Universal Patient Identifier (UPI) will let you follow the entire patient journey, so you have a complete, accurate and secure picture of each patient. Protect patient identities. Patient portals allow people to access their health information from their personal devices. It’s convenient and can improve engagement and health outcomes. Unfortunately, they can also become vulnerable to breaches by data thieves. You have to make it easy for patients to use portals, but difficult for fraudsters to get their hands on that personal data. As patient portals gain popularity, you must have the right technology in place to validate and protect patient identities. Automating patient enrollment with a tool like Precise ID® can help authenticate patient identities from the start using identity-proofing, fraud management and device recognition. Enrich patient identities. With data insights, you can check that your patient is who they say they are the moment they arrive in reception. Using the broadest and most trustworthy datasets, identity verification solutions make constant checks, so you have a single, accurate and 360° view of each patient. Not only is this ‘golden record’ the cornerstone of patient care and experience, it’ll let your staff update patient data during intake without manual corrections. Medical records contain some of the most sensitive personal information, so it’s vital to safeguard it with the strongest security that exists. — Download this free eBook to learn how to evolve today's patient matching technologies or find out more about how to protect your patient data and prevent medical identity theft.

When nearly 80% of health outcomes can be traced to non-medical social and economic factors, we need to look beyond the medical world to improve them. Perhaps a lack of transportation prevents a patient from attending an appointment, or juggling two jobs makes it difficult to collect a prescription. Maybe a patient’s care plan calls for lifestyle changes that are simply unrealistic in their current circumstances. When life gets in the way, there’s only so much the physician can do. Creating and maintaining a healthy, happy population truly takes a village – from your clinical team to the community resources around your organization. For many healthcare providers, there’s probably a lot more going in their ‘village’ than they realize. Do you know who your patients really are, beyond their lab tests? Do you know what nearby services are at your disposal to help you offer the best possible care? Knowing your patients and your health improvement ‘village’ means you can offer a personalized experience to your patients, to improve their care management and ultimately help them achieve better health outcomes. 3 ways to tailor care management for better patient outcomes Let’s imagine two patients, who have both recently broken their wrists and been treated in your facility. Gene is 71 years old and David is 34. From the clinical perspective, it might be reasonable to assume that David, being younger, should simply receive discharge directions and a time for a follow-up appointment, and be on his way. Gene, being older, might require a series of follow-ups. But thinking of the village analogy, is there more you could learn about Gene and David to engage with them in a way that’s tailored to their specific needs? Here are three ways social determinants of health data can help you do just that. Use non-clinical data to get to know your patients Non-clinical data can help you learn more about your patients and the lifestyle factors that might affect their health. This allows you to address issues like excessive healthcare utilization, preventable readmissions, no-shows and low patient engagement. Surveys at the point of registration are one way to get fresh socio-economic insights. But these can be cumbersome to implement, and findings can be limited by the nature of the questions. You might also review geographical and community-level data to discover your local population’s income, housing situation, employment status, and so on. This can be useful for population-level care planning, but it’s not patient-specific. A better way is to analyze securely collected marketing data for more specific and accurate information. This could tell you that Gene’s living situation actually has a minimal impact on his ability to access care, healthy food and reliable housing. Additional follow up appointments may still be appropriate, but perhaps less urgent. By contrast, you might find that David has limited access to care because he lives alone and far from public transportation. His lifestyle suggests he’d be unlikely to prioritize getting gas to drive to a follow-up appointment over getting to work. In this situation, a remote health appointment might be the better plan. Know your community resources Once you know what David and Gene might need, you can point them towards any appropriate community resources to increase their chances of a quick recovery. Of course, to do this, you need to know what and where these resources are. For example, can you link David to an appropriate home health or telehealth program, or is there a non-emergency medical transportation service in your area to get him to his appointments on time? If Gene needed support to follow a healthier diet, would a local food bank be available? If either had an unstable living situation, would you know which local or national housing coalitions could help put healthcare within reach? Tools such as NowPow, Aunt Bertha and Healthify exist to connect the dots between patients, providers and wider community resources, and close the gap in holistic care. Be proactive and preventative by holding conversations with your care teams prior to seeing patients When you have reliable insights and data analytics to anticipate what patients like David and Gene might need, you can work with your care teams to develop a shortlist of options ahead of time. In this way, they’ll have realistic and ready-to-use solutions to give the patient right there and then. To truly get the most out of social determinant of health data, your care coordinators need easily digestible patient profiles which they can understand and use in a split-second. Bringing the whole patient into the care plan Healthcare is growing more and more sophisticated in identifying ways to better manage care for patients by using data science and machine learning to predict health events. These insights help coordinate care plans that are preventative and proactive. Essentially, it’s about knowing your patients as well as possible, and being able to quickly match them to the services they need. ⁠— Discover how we can help you leverage social determinants of health data for your patient population, so you can bring in the whole ‘village’ of resources to support them on their healthcare journey.

Experian Health announced it has acquired MyHealthDirect, a SaaS-based company specializing in digital coordination solutions in scheduling. We interviewed Jason Considine, Experian Health general manager of patient engagement and collections, to learn more about the acquisition, as well as opportunities arising in healthcare due to the rise in consumerism. What led to Experian’s interest in MyHealthDirect and the ultimate acquisition? We’ve had a relationship with MyHealthDirect for several years. Experian Health has been reselling the MyHealthDirect solution since 2017, and we’ve long recognized that their platform’s digital care coordination capabilities would be a great match with our existing solutions. MyHealthDirect's platform links patients with the right providers, offering online scheduling tools and referral coordination to ensure more timely access to care for patients. These solutions have proven to increase appointment and referral rates, improve call center efficiency, reduce no-shows and enhance the overall patient experience. By coupling this technology with our Experian data, we can ensure patients are getting the care they need in the management of chronic diseases and wellness programs. This acquisition evolves our core revenue cycle management capabilities and helps us make gains in the patient engagement space with all-new innovative offerings. You referenced “digital care coordination.” What does this mean and how does it apply to healthcare? Digital care coordination, as it applies to the MyHealthDirect suite, is comprised of self-scheduling, call center, referral coordination and automated outreach solutions, making it easier for people to access healthcare. By combining these scheduling solutions with Experian’s existing digital patient engagement solutions, we can deliver a seamless consumer-centered experience – from serving up an estimate, to streamlining the registration process, to providing consumers with the ability to pay their healthcare bills via multiple channels. Today’s healthcare consumer expects a turnkey, personalized, on-demand experience. When you think about the best engagements we all enjoy in retail, financial services, travel and entertainment, the expectation is that the healthcare experience should be no different. We need to arm consumers with the ability to streamline their healthcare and make it easier for them to access care. Why is the scheduling component so key in the overall patient journey today? Scheduling is the one of the very first steps of the care journey and booking an appointment has traditionally been a poor experience. Common frustrations include not being able to reach the provider, finding out that no appointments are available, or being forced into a time-consuming three-way call between the health plan and provider. Without fast and easy access, patients may not be able to get the care they need. When healthcare plans use technology to better connect patients to needed care, quality scores for patient experience rise and efficiencies are gained. Can you give us an example on how more automated approach to scheduling could lead to better health outcomes for the consumer? Sure. Take for instance an individual who is living with diabetes. It is important for this person to have regular check-ins with their provider to monitor their condition and adjust care plans accordingly. If this person is challenged to see their provider, or doesn’t have regular appointments booked, they could run the risk of becoming an unhealthy diabetic, being faced with additional health challenges. By tapping into digital appointment scheduling, a provider or payer could create an automated outreach plan to make the scheduling hassle-free. Appointments could be streamlined and scheduled directly on the phone via IVR or text, and appointment reminders can be delivered. How do you see providers responding to the rise in healthcare consumerism? It’s no secret that healthcare costs are rising, and consumers are increasingly bearing more of those costs. Providers, therefore, are telling us they need to deliver a better experience. They are asking for digital technologies to gain rich insights into consumer behavior and then adjusting their care delivery plans accordingly. They recognize that consumers have a choice on where to take their healthcare business, so they need to compete. In the case of scheduling, MyHealthDirect conducted some research and revealed 66% of patients would switch providers for more convenient access. In that same study, 77% of patients think the ability to book, change or cancel appointments online is important. My point? Those providers and payers investing in on-demand tools to interface with their consumers will win, simplifying many of the administrative tasks associated with healthcare. — Learn more about scheduling solutions.

Managing the revenue cycle draws in considerable resources for healthcare organizations, even when it’s working as planned. The American Medical Association puts direct transaction costs and inefficiencies associated with the “claims management revenue cycle” at around 25-30% of overall healthcare spending. But when errors are made and claims end up being denied, providers could end up missing out on as much as   The total revenue leakage is probably higher, when you consider the opportunity cost of staff time spent sorting out denials. Among the most common reasons for denials are missing or incorrect billing information, non-covered charges for care, and absent authorizations. Thankfully, these are all issues that can be minimized with the right strategies and tools. By optimizing your revenue cycle from the outset so that claims are right first time, you can save hassle and expense later on. Here are 7 ways to proactively reduce claim denials in your health system. Figure out why claims are denied First things first. You need to understand where denials are occurring in your revenue cycle and why. You can determine the root cause of denials by analyzing data that’s already available to you alongside information on industry trends. A business intelligence tool can help you use advanced data analytics to find opportunities for improvement, and generate actionable insights that are focused on your specific KPIs. Once you know where the weak points are, you can get the ball rolling with solutions. Prioritize the big-impact fixes In all likelihood, most providers will have the opportunity to improve the claims process at several points in the revenue cycle. You can’t do everything at once, so identify the areas with the greatest potential impact on your hospital’s bottom line. Can denials be traced to a particular department, service line or physician? Has a certain payer changed their approach? Compare the cost of implementing processes to tighten up the weak points in the cycle with the amount of revenue likely to be recovered to ensure you get the biggest ROI for your efforts. Automate patient access for more accurate claims Up to half of denied claims occur early in the revenue cycle, during patient access and registration. Automating the patient access workflow with real-time data can create a more efficient and accurate process, linking front and back office staff with shared systems that minimize errors and staff time. Martin Luther King Community Hospital experienced these efficiencies first-hand, when they integrated eCare NEXT® within their existing Cerner® system. As a result, their registration process became more streamlined, enabling them to cut two to three minutes from more than half of their registrations. Ensure patient matching is as accurate as possible Incorrect patient matching is a major source of revenue leakage for many providers, with around a third of claims denied on the basis of inaccurate patient identification. When it costs $25 to rework a claim and around $1000 for each mismatched pair of records, that’s a lot of lost revenue. Resolve your patient identities with the most robust data sources, and not only will you reduce claim denials, you’ll also have a more complete picture of each patient, which in turn will give them a better patient experience. Streamline prior authorization checks A survey by the American Medical Association found that prior authorization checks created a substantial burden for providers, with physicians spending an average of nearly 15 hours per week dealing with related tasks. For patients, this process can lead to delayed or even abandoned treatment. Using automated software, you can check claims against payer rules for medical necessity, frequency, duplication and modifiers, so you can quickly spot any claims that may be denied and correct them before submission. Process claims effectively Once you’ve streamlined the front-end of the claims process, you should of course look for ways to improve efficiencies throughout the rest of the cycle and immediately before the claim is sent to the payer. In fact, providers are expected to invest up to  , as the need to crack down on denials grows. Submitting claims in the correct format is a common and frustrating challenge. Since each payer has different requirements and formatting preferences for claim forms, edits should be customized. A revenue cycle service provider can help you build these custom edits and check each claim line by line, so you can submit with confidence and avoid having to redo them later. Monitor and analyze your revenue cycle Regular analysis is essential to consistently improve denial rates. By monitoring your internal processes across a range of metrics, you can gain a holistic view of the entire revenue cycle to see where there are further opportunities to optimize performance and prevent denials. When you have confidence in the freshness and accuracy of your data – including patient access data, payer performance information and patient matching – you can make confident decisions about exactly what needs to happen to improve your claims denials. Learn more about how leveraging data-driven insights to tighten up your claims management systems and take proactive steps to find lost revenue.  

  Medical identity theft is a growing problem for the healthcare industry: nearly 15.1 million patient records were compromised in 2018, an increase of nearly 270% on the previous year. While providers are busy rolling out patient portals and electronic medical records to better serve consumers, criminals are sneaking through the cracks to steal patient data and profit from vulnerable health systems. The rapid rise in medical identity theft is partly explained by the fact that it goes undetected for much longer than other types of identity theft, giving criminals more time to use stolen personal information for financial gain. It’s also a lot more lucrative. Medical identities can be used to access treatment and drugs, make fraudulent benefits claims and even create fake IDs to buy and sell medical equipment. This can be devastating for victims, both emotionally and financially. Unlike credit card theft, where victims aren’t considered financially liable, 65% of people who fall prey to medical identity fraudsters are left with hospital bills running into the tens of thousands. The compromised medical record is tough to reconcile, jeopardizing future medical treatment. For providers, a data breach can mean significant reputational damage and loss of trust, and huge financial consequences – each breach costs an average of $2.2 million. But what’s most alarming for providers is that more than half of data breaches originate within the organization. Unfortunately, many providers lack sufficient security protocols and detection tools to safeguard the data they’re holding. The good news is that the tools exist to help you protect your patient data. What can healthcare providers learn from other industries about identity protection? Banking and financial services have pioneered identity protection over the last twenty years, and healthcare can learn a lot by looking at what’s worked in those industries. For consumers, using digital technology to pay your bills, book flights and buy pretty much anything is the norm, all with reassuringly quick fraud detection and resolution. Healthcare has been a little slower to embrace digitization in this way. Despite the opportunities, fears around security, privacy and inconveniencing patients have stalled efforts to transform outmoded processes. Drawing on two decades of innovations in other fields, fast-paced technological developments mean many of the early challenges around implementing safe and secure patient portals have been overcome. 6 strategies to keep patient data safe Here are six smart ways to ensure your organization has done everything possible to safeguard patient data.     Tell your patients how you’re keeping their data safe Patient trust is at the heart of a successful patient-provider relationship. Share the steps your organization is taking to secure patient information, so patients feel reassured and confident in using their portal. Data security should be a key strand in your patient engagement messaging.     Verify patient identities to protect access to medical records To avoid HIPAA violations, it’s critical to ensure you’re giving access to the right patient. Secure log-in monitoring and device intelligence can help you confirm that the person trying to log in is who they say they are. When something doesn’t add up, identity proofing questions can be triggered to provide an extra check. In an exciting new development, the healthcare industry is also starting to see the use of biometrics to supplement existing identity-proofing solutions. Just as you might use facial recognition to unlock your smartphone, there are now ways to authenticate your healthcare consumers’ identity using the same technology.     Automate patient portal enrollment You want your portal to be as secure as possible, but not at the expense of your patients’ time and effort. An automated enrollment process can eliminate the hassle of long, complicated set-ups and reduce errors at the same time.       Arm your organization with a multi-layered security strategy There is no silver bullet for protecting patient information—it will require various tools. A robust data security strategy will be multi-layered, including device recognition, identity proofing and fraud management.     Educate staff on security threats and warning signs Data breaches aren't all malicious – human error is a massive component, from mailing personal data to the wrong patients, to accidentally publishing data on public websites or leaving a laptop behind after getting off the subway. Training staff on the potential pitfalls will help them help you in protecting confidential patient information.     Develop a robust device strategy ‘Bring Your Own Device’ arrangements (BYOD) are convenient for staff and patients, but personal devices need to be secured when accessing patient information across the network. Make sure your teams, patients and visitors are aware of how to log-on securely to WiFi and follow best practice to keep data safe. In a climate of ‘doing more with less’, healthcare leaders are turning to other industries to find ways to boost quality of care and streamline operational efficiency. Automation, digitization and consumer-centric approaches make good business sense across the board, but they’re sensible investments for your data security strategy too. Investing in secure patient identities is a way to prevent painful and unnecessary losses down the line – and it’s what patients have come to expect. ⁠— Find out what more you could do to shore up your data security and prevent medical identity theft.

“Build it and they will come” might work for 1980s movie characters, multinational coffee franchises and beloved sports teams, but it’s not a great engagement strategy for most consumer-facing organizations – especially in healthcare. Take patient portals, for example. Giving your patients a way to access their health records can help improve their health outcomes, increase compliance with care plans, and create a more positive healthcare experience overall. But do your customers know the portal exists? Do they know how it could serve them? Do they trust it? You’ve built it, but how many patients are actually logging on? In 2017, over half the US population had access to a patient portal. Around half of those people used it at least once in the previous year. Of those who didn’t, 59% said it was because they didn’t feel they needed to access an online medical record, and 25% were worried about privacy and security. This tells us two things: If healthcare providers want to increase the number of patients using their portal, they need to proactively communicate the benefits to those patients, and healthcare providers could do more to reassure patients they take portal security seriously. If patients discover that using the portal is better than not using it, and that they can do so securely, they will be more likely to log on. You can address both in your patient engagement and marketing strategies. Perhaps the better mantra is: “if you solve their problem and tell them about it, they will come”. Balancing portal security and patient convenience Your patient portal is more than just a platform for patients to access test results, sort out bills or schedule appointments. It’s a way to nurture the patient-provider relationship. And at its heart, that relationship is about trust. One way to build trust is to ensure your portal meets the strictest of security measures without creating an excessive admin burden for patients. You can do this with a security strategy that layers up several protective measures to help you tackle common areas of vulnerability, including weak ID verification, over-reliance on password-protection, and failure to encrypt sensitive data. A few practical ways to keep your patient portal secure include: using ID verification when someone signs up for the portal using device intelligence and identity proofing when a user signs in to the portal deploying extra security checks where the risk of identity fraud is higher putting systems in place to flag and respond to security breaches as fast as possible. A solution like PreciseID® can help you take care of your patients’ privacy and security behind the scenes. They’ll see just enough to reassure them that you’re taking their security seriously, without any protracted log-in process that puts them off using the portal altogether. Marketing your patient portal so more patients benefit from it Solving your patients’ concerns about security is just one route to boosting portal utilization. Another important way to ensure more patients use and benefit from the patient portal is to actively encourage them to access their online records regularly. Research suggests individuals who are encouraged to use their online medical record by their provider are almost twice as likely to access it, compared to those who weren’t actively encouraged. So how do you convince your patients of the benefits of regularly logging on? That it’s not just a convenient way to manage their medical journey, but could result in better health? The answer lies in consumer data – the lifestyle, demographic, psychographic and behavioral information that gives you a fuller understanding of what drives your patients. Experian Health’s ConsumerView data analytics can capture insights that let you reach out to your consumers with the right message, in the right way, at the right time.  Do they live a busy lifestyle? Reassure them that the portal can save them time. Are there lifestyle factors that may hinder their adherence to medication? Encourage them to use the portal to make sure their prescriptions are up to date. If you discover your consumers are big social media users, you might target your portal engagement campaign through those channels. Equally, if a consumer doesn’t have any social media accounts, there would be no point investing in Facebook ads. Personalization makes your patients feel taken care of, leading to greater trust, loyalty and satisfaction. Increase patient portal engagement today In the wake of consumerism and IT transformation across many other industries, a tailored and digitally secure healthcare service is a must.  “Consumers now expect to be provided with a turnkey, individual experience that is fast and seamless,”  said Kristen Simmons, Experian Health’s senior vice president of strategy and innovation. Your patient portal must be seen to provide a valuable and secure service. While there’s a way to go to increase the number of patients making full use of portals, the tools exist to support healthcare providers’ engagement goals. Learn more about how your organization can leverage consumer insights to improve patient retention and engagement.