Tag: data

Nearly a quarter of patients have received a surprise medical bill, according to new data from Experian Health and PYMNTS. 4 in 10 patients said they ended up spending more on healthcare than they could afford, with the average surprise bill amounting to $675. Even insurance-savvy patients fall foul of surprise billing: 31% of patients who were familiar with the coverage landscape ended up paying more than their estimates suggested. Healthcare providers will need to implement solutions that can generate accurate price estimates before patients seek care, and prevent surprise billing. Without accurate cost estimates, patients are more likely to cancel appointments, which could cause their health conditions to get worse and eventually cost more to treat. This also creates avoidable and expensive administrative work for providers, who must chase payments from growing numbers of anxious, self-pay patients. To prevent surprise billing, healthcare organizations can look to data and digital tools. Advanced analytics provide greater clarity about each patient's financial situation, generate more accurate estimates and improve the patient payment experience. Inaccurate estimates persist despite the No Surprises Act Consumer demand and legislative action on surprise billing have led to an escalation in the push for more accurate estimates. But estimating patient liability is far from simple. It requires complicated calculations based on the patient's coverage, provider charges, payer contracts and potential discounts. Undertaking this manually can be time-consuming and error-prone, so many providers are turning to automated solutions. In a recent conversation with Healthcare Finance News, Jason Considine, Experian Health's Chief Commercial Officer, notes that providers expect to invest more in digital patient estimates solutions, particularly as the regulations expand. Those investments are likely to include technology to deliver accurate estimates and patient-friendly payment methods, and increased use of advanced data analytics to optimize collections. Surprise billing is at odds with a high-quality patient payment experience Beyond compliance, accurate estimates are essential for a positive patient experience. A poor financial experience can leave a bad taste in the patient's mouth, even if the clinical care was outstanding. So, what does that positive experience look like? The key is to think like a consumer: make the billing process as clear, convenient and compassionate as possible. Patients are looking for accurate and up-to-date pricing to be available before they receive care. And clear, and communication around the billing process can help eliminate the shock factor and improve patient collections. For example, providers could integrate a tool such as Patient Estimates, to give patients an accessible, personalized cost breakdown based on real-time pricing and benefit information. Patient Financial Clearance assesses a patient's individual financial circumstances to provide accurate estimates and recommend appropriate payment plans. And pricing information, payment plans and links to secure payment methods can be offered via a range of self-service, mobile-optimized patient payment solutions. El Camino Hospital in California used Patient Estimates to improve price transparency. The Senior Director (Revenue Cycle) said: “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?” Data-driven technology can prevent surprise billing Tom Cox, President at Experian Health, is optimistic about how the patient payment experience might evolve in the second half of 2022, as shared in a recent PYMNTS publication. He believes improvements come down to having the right data in place: “Payment options are increasingly digital and more convenient, payment plans are more common, and price estimates have become less of a rarity. There is also greater use of non-clinical data to get a broader view of patients and their unique financial solutions. Data, coupled with the right technology, can help providers make sense of it all and enhance the patient journey.” Data-driven technology can help simplify the payment process for patients, from accurate estimates to convenient payment methods. With PatientSimple, providers can leverage Experian's unmatched data and advanced analytics to identify the optimal financial pathway for consumers. It then guides patients toward that pathway through a user-friendly self-service portal. Patient Financial Advisor offers a similar experience via mobile. Patients can avoid the stress of surprise medical billing and plan for upcoming expenses. With tools that allow them to pay medical bills from anywhere, at any time, many patients will pay upfront, speeding up the collections process. Working with a partner such as Experian Health lets providers combine what they already know about their patients with industry-leading technical expertise and payment tools. With support to implement the right data-driven technology, providers can prevent surprise billing, resulting in regulatory compliance, greater revenue opportunities and customer loyalty.

Telehealth adoption has been a bumpy ride. Remote and virtual healthcare services struggled to gain traction pre-pandemic, only to become a life raft for safe access to care when infection rates began to climb. After that initial surge, telehealth usage leveled off at around 38 times pre-pandemic levels for much of 2021. Now, while uptake has dipped slightly as patients return to in-person care, the way healthcare is delivered has changed forever. Having seen what digital healthcare solutions can do, providers are continuing to embrace telehealth and digital tools as a route to improve equity, access and efficiency. According to a new report by Grand View Research, the telehealth market is expected to reach $787.4 billion by 2028 – a compound annual growth rate of 36.5% from 2022. Research from Experian Health and PYMNTS confirms that patients similarly expect digital tools to remain on their healthcare menu, with two-thirds using patient portals. Healthcare providers must keep patients' digital demands firmly in their sights, to improve patient engagement and secure a competitive edge. For providers thinking about their next digital steps, where are the emerging opportunities and pitfalls? How to harness the benefits of digital healthcare solutions: 1. Satisfy consumer demand with hybrid models Research shows that digital-first patients prefer using online tools to schedule appointments, obtain test results and make payments. Providers can satisfy consumer demand by offering hybrid models that include in-person and digital tools. Experian Health's suite of patient access solutions allows patients to choose when and where they engage with their provider and reduces friction around booking and billing. Clean data and reliable patient matching can give patients a seamless experience as they move between online and in-person interactions. 2. Connect with diverse communities to increase access to care Adoption of telehealth and digital opportunities goes beyond consumer satisfaction. Opening healthcare's digital front door enables communities that often find it challenging to access care, such as rural and lower-income communities, to overcome obstacles. Online scheduling tools can give busy families and those who may be juggling multiple jobs opportunities to book appointments at a time and place that suits them best. Data on the social determinants of health and patients' financial circumstances can be used to direct those in need to financial assistance, so patients don't miss care out of concerns about cost. Digital healthcare solutions can also be a better fit for younger patients who automatically reach for their mobile devices to interact with services. 3. Automate to save resources and mitigate rising inflation Automated and self-service digital healthcare tools that eliminate the need for manual input are also far more efficient than analog alternatives. Providers can save valuable staff time and resources and redirect them to where they're most needed. A more efficient and adaptive approach to healthcare delivery can help combat rising inflation and ride out economic shocks. Pitfalls to avoid when implementing digital health solutions: 1. Close the expectation gap – especially around payments Despite these advantages, a gap remains between how patients say they want to use digital tools, and whether they can actually use them. For example, in The Digital Healthcare Gap report by Experian Health and PYMNTS, 32% of patients who don't currently use patient portals said they'd be interested in doing so if one was available. There's a similarly stark gap between the number of patients seeking upfront cost estimates and those who get them. Only 24% of patients said they had access to a patient portal that offered pricing estimates. To increase patient satisfaction (and bump up collections rates), providers must expand portal capabilities to include cost estimates, payment plans and other services that patients repeatedly say they need.Closing the expectation gap will be particularly relevant to providers that want to attract new and younger consumers, who are more likely to expect and use digital healthcare solutions. 2. Eliminate disjointed data with interoperabiliy Digital and data-driven tools are only as powerful as the data they’re built on. If patient information is inaccurate or incomplete, the convenience and ease expected of digital healthcare solutions start to break down. Providers must find digital healthcare solutions that are convenient for patients to use, but also compatible and easily integrated with the wider information ecosystem. A unique patient identifier is one way to ensure that these innovative tools and apps work together and ensure staff have access to up-to-the-minute patient information. Getting the back-end setup right will ease friction in the patient journey. 3. Avoid missed opportunities to scale with actionable analytics As the pandemic has shown, telehealth and digital healthcare solutions have the power to open access to care, but only if they are made available to the right patients at the right time. Experian Health's data and analytics solutions allow providers to identify gaps in digital strategy delivery, understand and segment patients, and adopt a flexible and responsive approach to create a frictionless patient journey. Find out more about how Experian Health can support healthcare organizations to maximize the opportunities in implementing digital healthcare solutions and secure the digital advantage.

When it comes to the patient journey, knowledge is power. That's where targeted patient outreach comes in. Informed patients can make better and faster decisions about their healthcare. By arming patients with answers and easy access, they’ll be less likely to miss appointments or fall behind on payments. Instead, they’ll enjoy better health outcomes and a more satisfying healthcare experience. As digital services evolve, healthcare providers need to find new ways to engage patients. That means embracing digital tools and data analytics to make sure patients get the information they need through their preferred channels, and at a time that makes them most likely to act. Knowing what patients need gives providers the power to communicate with more patients, more effectively, and deliver outstanding patient experiences. This article looks at three specific use cases for targeted patient outreach. These include reducing pressure on staff, closing gaps in care and streamlining patient collections. Use case 1: Targeted patient outreach can help reduce pressure on call center teams and increase appointment bookings One of the biggest pain points for patients is having to schedule appointments by calling a specific number at a specific time, and then being put on hold until an agent is available to help. A recent survey by Experian Health and PYMNTS found that over the last year, one out of every five patients chose to skip this option and have booked their appointments through digital channels instead. Instead of just providing patients with a number to call during office hours, providers can make it even easier for patients to book appointments by deploying a patient outreach solution that connects patients to an online scheduler. Automated text message (SMS) and interactive voice response (IVR) campaigns can be used to send patients a link to schedule their appointment immediately. Waitlists can also be managed with this technology, by sending automated messages that enable patients to accept earlier appointments that may become available and cancel their existing appointments to make the slot available to others. Reminders are useful, but the ability to make an appointment is far more likely to result in bookings. Not only is this convenient for patients and enables them to see their doctor sooner, but it also helps offload call volumes for busy call center staff. Automated outreach capabilities can reach many more patients than a traditional call center setup. It can also process thousands of calls and messages per day without agent input. Use case 2: Targeting at-risk patients to close gaps in care Targeted patient outreach also plays an important role in closing gaps in care, so patients get preventative and follow-up treatment without delay. Historical patient data and data on the social determinants of health (SDOH) can be leveraged to identify at-risk patients and ensure they get timely, relevant and actionable information about their care options. For example, researchers in Pennsylvania found that patients with lung cancer were more likely to attend screening appointments after receiving some form of outreach, compared to those receiving standard care. Similar prevention-focused approaches have been suggested to identify patients at risk of chronic kidney disease, to address gaps in screening and early intervention. SDOH data and targeted patient outreach solutions can also be used to support populations that typically struggle with access to care, such as immigrant, minority and lower income communities. Outreach messages can include information about health education, local resources, links to book wellness visits and details of screening programs. Use case 3: Streamline patient collections and avoid lost revenue with targeted patient outreach In addition to tailored messaging around scheduling and health education, automated patient outreach solutions can be used to streamline patient collections with bill reminders and self-pay options. For example, PatientDial is a cloud-based dialing platform providing inbound and outbound automated calls. This speeds up collections by giving patients self-service options, such as balance retrieval, bill requests and pay-by-phone. Similarly, PatientText sends automated text messages with a link to a provider’s patient portal and contact center phone number. Frequency and content can be customized, and since there’s no send limit, providers can scale their campaign to as many messages as needed. Both tools reduce the need for agent involvement and provide insights to help improve performance. PatientDial in practice: Sanford Health used PatientDial in combination with Collections Optimization Manager to route collections calls to the appropriate agents based on the patient’s ability to pay. This led to increased collection rates. The system also generated $2.5 million in patient payments by verifying billing information, and an additional $60k was found through better management of accounts for deceased patients. Targeted patient outreach should be personalized, proactive and process-driven The key to success in each of these use cases is to be proactive. With the right data and patient outreach solutions, providers can anticipate the information that patients will need and deliver the must-know details in a tailored and timely format. Patients will be empowered to manage their own healthcare journey, while providers will lighten the administrative load and see higher collection rates. Find out more about Experian Health’s patient outreach solutions.

An efficient revenue cycle management (RCM) system is a win-win for patients and providers. Friction-free solutions that cover everything from booking appointments to paying bills create a more satisfying patient experience and allow patients to focus on their health. Providers can lower administrative costs and generate more revenue from data-driven billing and collections operations. To ensure the patient’s financial journey goes ahead without a hitch and avoid revenue leakage, the RCM system can’t skip a single step. Experian Health’s 10-step healthcare revenue cycle flowchart sets out the necessary ingredients for success. See the healthcare revenue cycle flowchart below: Step 1: Patient registration The healthcare revenue cycle flowchart begins with the patient’s first interaction with the healthcare organization. First impressions count. Patients want to be able to book appointments and complete registration quickly and easily, and providers that offer patient portals are seen as more attractive. Opening up the digital front door with online self-scheduling and self-service registration also helps providers increase operational efficiency and minimize manual errors that could lead to claim denials. Reliable patient intake software can verify patient identities, reduce manual processes and deliver a flexible patient experience – laying the groundwork for the entire RCM process. Step 2: Eligibility and benefits Next, providers need to check whether the patient’s insurance plan covers their expenses. To increase the likelihood of reimbursement, providers should give patients clarity about their coverage status and be vigilant about locating any missing or forgotten coverage. Coverage Discovery allows providers to check for undisclosed coverage at every patient touchpoint. By quickly uncovering previously unidentified coverage, bills will be cleared sooner with fewer write-offs to bad debt. This part of the RCM process is also a good time to help patients plan for their financial obligations. Patient Payment Estimates gives patients accurate estimates and links to financial assistance and easy payment methods, straight to their mobile device. With the right data and digital tools, providers can deliver a transparent, compassionate and convenient patient payment experience that encourages payment earlier in the revenue cycle and supports a healthy cash flow. Step 3: Data entry With RCM processes relying on data like never before, maintaining accuracy is paramount. Providers must be able to verify and protect patient identities to ensure the right information is linked with the right patient. Accurate data entry decreases the costs associated with medical billing errors, and improves interoperability as more patient data is created, collected and shared. A digital patient identification solution can build a single, accurate view of each patient, using a unique patient identifier to hold the information together like a golden thread. Automated patient enrollment using PreciseID® allows existing data to be auto-filled, while tools such as Universal Identity Manager maintains data in an interoperable format, to further protect against errors. Step 4: Prior authorizations Before treatment begins, providers must determine if prior authorizations are needed. If so, they must submit a request to the payer. Without prior authorizations, providers may see their claims denied, which increases costs, causes time-consuming rework, and creates a stressful experience for patients. With online prior authorizations, providers are guided through a workflow that automates inquiries, status checks and submissions. It auto-fills payer data using real-time information about each payer’s prior authorization requirements, stored in Experian Health’s pre-authorization knowledgebase. Prompts for manual involvement ensure the process is as efficient as possible, to expedite treatment and secure timely payments. Step 5: Patient encounter At the time of treatment, information about the services a patient receives will be added to their patient record. This sets the stage for accurate coding and billing. To ensure no essential information is omitted, providers must keep up to date with regulatory changes. For example, the Appropriate Use Criteria program introduces new requirements for providers ordering diagnostic imaging services. Providers should examine their workflows in advance to avoid any costly compliance errors. The patient encounter is also an opportunity to double down on creating positive patient experiences, and to anticipate any potential RCM issues. Communicating clearly about any changes to medical bills and checking again for coverage will keep the revenue cycle moving. Providers may also consider incorporating data on the social determinants of health to support efficient discharge planning and prevent high-cost readmissions. Step 6: Charge posting In the next step of the healthcare revenue cycle flowchart, providers must submit the claims to the relevant payer using the appropriate charge posting or charge entry process. Documentation must include a detailed breakdown of all the services provided to the patient, alongside patient information, history and insurance or payment plan status. Again, getting every detail right will secure more timely payments that match the expected amounts. Step 7: Coding and billing Before patient billing gets underway, providers must check payer codes for the services that have been delivered. Payers use diagnostic (Dx) codes, place of service (POS) codes, current procedural terminology (CPT) codes, Healthcare Common Procedure Coding System (HCPCS) codes and others to determine payable amounts. If codes are not inputted correctly, claims are likely to be denied. Automated claims management software can check that every claim is clean and error-free before being submitted. Experian Health’s claims management software incorporates standard government and commercial payer’s global edits as well as client-specific customized edits so providers can submit claims with confidence. J. Scott Milne, Senior Director of Product Management at Experian Health, says providers can leverage tools such as Claim Scrubber and ClaimSource to automate and prioritize claims to maximize reimbursement: “Both of these solutions are focused on the most important revenue cycle goal – to submit the claim correctly the first time. With the combination of Claim Scrubber and ClaimSource, healthcare organizations give themselves the opportunity to decrease denial rates, increase cash flow and decrease the overall accounts receivables.” Step 8: Claims management After the claim has been filed, the payer’s claims adjudication process begins. Payers will check eligibility, benefits, coding and contract rules to determine their financial responsibility. They may decide to pay in full, pay a partial amount, or deny the claim, with the reasoning set out in an Explanation of Benefits (EOB) statement. If the claim is denied, the provider needs to decide if it’s worth reworking and resubmitting the claim. Rework is expensive and time-consuming, so many providers use a healthcare clearinghouse to check claims before they’re submitted. Providers may also consider using a tool like Enhanced Claim Status, which submits automated status requests based on payers’ individual timelines, and provides responses that include the payer’s proprietary codes and descriptions. This facilitates early intervention into claims that are flagged for denial, which improves productivity and faster reimbursements. Providers also get detailed denial analysis and monitoring reports to pinpoint the root cause of denials, so they can be fixed promptly. Step 9: Payer Contract Management The complexity and volume of payer contracts can leave providers with little negotiating power when it comes to querying and collecting underpayments and delays. Providers need robust processes to audit payer performance and keep track of changing payer requirements to ensure timely reimbursements. Experian Health’s Contract Manager helps providers stay on top of changes to payer payment policies, identify patterns of non-reimbursement, and appeal denials in the most effective way. It identifies inconsistencies between pricing claims and paid amounts, so providers avoid missed revenue opportunities. Positive provider-payer relationships make the revenue cycle management process easier for everyone. With reliable contract management tools, communication and two-way accountability are much more effective. Step 10: Patient Billing and Collections The final step in the healthcare revenue cycle management flow chart is to bill patients for the remaining amount they owe. Balances are collected by in-house collections teams or outside collections agencies. Revenue cycle management software makes this process smoother and more efficient. For example, Patient Financial Clearance assigns each patient to the appropriate financial pathway based on their individual circumstances, while Collections Optimization Manager can be used to build custom segmentation models and workflows. That way, resources can be focused on the accounts most likely to yield revenue. Then, once the patient’s bill has been issued, collections software can be used to create a compassionate and convenient payment experience and complete the revenue cycle. Find out more about how Experian Health’s Revenue Cycle Management Solutions help healthcare organizations deliver outstanding patient financial experiences, optimize RCM workflows and increase cash flow.

Healthcare data is mushrooming. Each patient generates hundreds of megabytes of data each year, from electronic medical records to activity logs on fitness trackers. The volume of data and diversity of sources is growing exponentially, churning out a wealth of information about patients' medical histories, socio-economic circumstances, consumer preferences and lifestyles. This is a gold mine for healthcare leaders and clinicians who want to improve clinical care and treatment. It reveals opportunities to reduce healthcare costs and address population health challenges. But with the rush to focus on fresh insights, there's a mountain of historical data piling up in the background. Is this “old” healthcare data still useful? How can healthcare organizations ensure that their decisions and strategies are based only on the most relevant data? Determining the relevance of healthcare data Value-based care and efficient workflows rely on up-to-the-minute healthcare data. After all, what use is a diagnosis that fails to take account of a patient's new medications? Why risk delayed payments by failing to check a patient's current billing address? When providers have a full understanding of a patient's current circumstances, they can deliver the best possible patient experience. Providers are right to focus on box-fresh data (such as Experian's unmatched, originally sourced healthcare, marketing and credit bureau data), but historical data shouldn't be overlooked. What matters is how the data correlates with other data points. Can it be relied upon to fill in gaps in a patient's profile? To answer these questions, providers should look at the source, format and content of their datasets. Can the original sources be verified? If historical data was recorded manually and stored in paper files, is it compatible with today's digital systems? How can historical healthcare data be used?   While clinical decisions shouldn't be made solely based on historical data, such data can help enrich patient profiles and build a fuller picture of the patient's life. For example, data that reveals a patient's past behaviors and habits may help to explain current symptoms. This can lead to improved health outcomes and a better patient experience. When used in conjunction with more recent data, historical data can help providers create robust patient profiles and promote stronger patient engagement, better allocation of resources and more equitable access to services. Fortunately, multiple tools exist to help providers make sense of all their data to draw accurate, timely and actionable insights. For example: 1. Unique patient identifiers help eliminate erroneous patient data Utilizing more data points means there's a higher chance of duplicate data creeping into patient profiles. Providers need to watch out for information that shouldn't be there, information that's missing, or information that's associated with the wrong person. Inaccurate and incomplete patient information can lead to medical errors, reduced quality of care and suboptimal patient experiences. A unique patient identifier helps eliminate identification errors and create a single source of truth for each patient. Universal Identity Manager protects each patient record, allowing both new and old data to be combined in a standardized format. The unique patient identifier makes it easier for providers to verify patient information at each touchpoint in the patient journey, so that new information can be checked against existing records to maintain a clean patient database. 2. Consumer marketing data helps create personalized patient experiences Older data offers additional insights into patients' behavior, lifestyles and consumer preferences, which can be combined with new information to create a personalized healthcare experience. For example, by leveraging third-party data from a reliable source such as Experian, a provider might discover that a patient has a preferred language that's different to the one being offered. Being able to refer the patient to a physician who speaks their language will create a much better patient experience and avoid potential misunderstandings. Experian now offers nearly 200 language codes, making it easier for providers to communicate effectively with individual patients. A consumer marketing tool such as ConsumerView also enables providers to tailor the content, method and timing of marketing communications. This supports value-based care by making it easier for patients to engage with healthcare communications and access the support they need. 3. Improved revenue cycle analytics can increase reimbursements Of course, being able to access increasing volumes of current and historical data is only useful if that data can be turned into actionable insights. The more accurate the data points, the more reliable the analysis will be. This is particularly true of revenue cycle analytics, which encompasses everything from patient access and billing to reimbursements and payer performance. Experian Health's web-based business intelligence tool gathers together multiple data streams into a single analysis, so providers can make better decisions across the entire revenue cycle. User-friendly dashboards give staff at-a-glance summaries of what's happening across the revenue cycle, while allowing them to drill down to see detailed trends analysis for specific key performance indicators. A reliable data partner can help providers harness vast datasets Harnessing these ever-growing datasets to generate the most relevant insights is no mean feat. By partnering with Experian Health, providers can enrich patient profiles with originally sourced, reliable data and secure the greatest ROI from Experian's unmatched suite of analytical tools. Providers can tap into thousands of healthcare, credit, marketing and lifestyle data points to get a 360-degree view of their patients. They can validate the source, standardize the format and interrogate the content of new and historical data with Experian Health's user-friendly software. With clean, comprehensive data presented in a timely and accessible way, providers can future-proof their workflows and capitalize on the transformative power of big data – old and new. Discover how Experian Health's data and analytics tools can help healthcare organizations build robust patient profiles by leveraging both old and new datasets.

According to Jason Considine, Chief Commercial Officer at Experian Health, mounting financial pressure on consumers could lead to more patients missing healthcare payments. “Federal aid packages are being unwound, the country’s opening back up so people are spending money on things they weren’t spending money on before, and to compound that problem, we have inflation coming in at levels we haven’t seen in decades,” Considine said in a recent interview with PYMNTS. “That’s going to have an impact on consumers.” As households continue to feel the strain from rising inflation and other factors, providers need to embrace price transparency and move quickly to implement digital patient payment solutions and get ahead of growing medical debt. Expedite payments with transparent pricing The first task for providers is to make it easier for patients to plan for their medical bills by sharing cost information in advance. Among Experian Health’s clients, Considine has noticed increasing investments in tools that provide clear, upfront patient estimates. “Historically, this has been an area where providers haven’t met the needs of consumers. As patients, we’ve always wanted estimates. This is not a new thing… but providers are getting better at this, and regulation is helping. We’ve seen an acceleration, though there is certainly a long way to go.” Patient demand and price transparency regulations (like the No Surprises Act) are driving faster adoption of patient estimate technologies. However, providers need to go further than simply providing price estimates. Providers need to be proactive in helping them access and understand those estimates. In a recent survey by PYMNTS and Experian Health, 15% of patients said they run into challenges when obtaining accurate cost estimates for appointments and procedures. While the technology is there, patients aren’t always using the tools. Only 6% of patients with access to patient portals (that included access to cost estimates) said they knew the cost of care in advance. Providers need to cater to their customers and help remove hurdles that stand in the way. Experian Health’s patient estimate solutions go beyond simply providing estimates. These solutions give patients clear breakdowns of their expected out-of-pocket expenses, delivered online or by text message. They also connect patients to information about financial assistance options and payment plans and close the payment loop with direct links to pay. Clear up coverage confusion by identifying insurance early Another way to eliminate consumer confusion is with tools that help identify any missing or undisclosed insurance coverage, so payers and patients are billed correctly the first time. Considine says, “Oftentimes patients don’t understand their healthcare insurance. It’s quite complex and they may not know if it covers certain services. There are also a number of reasons why providers don’t collect the right insurance information during the registration process. There are tools available to make sure you’re actually billing the insurance when insurance coverage is available. That’ll increase the likelihood of payment and reduce pressure on consumers.” One example is Experian Health’s Coverage Discovery solution, which checks for any coverage eligibility early on and often throughout the patient journey. Providers get paid faster, avoid the collections challenges of self-pay receivables, and ease consumer frustrations about confusing coverage arrangements. Cater to consumers with patient-centered payment plans Considine says patients will gravitate towards the most convenient financial experiences, where they can get an understanding of what they owe before coming in, easily enroll in payment plans, store credit cards on file, and find easy ways to pay and engage with their provider online. When it comes to payment plans, the data is available to help providers guide patients toward the most appropriate financial pathway. Considine notes that leveraging data to make smarter decisions helps consumers and patients alike. If the data shows that a patient is eligible for financial assistance, they can avoid unnecessary bills, which makes for a great patient experience. “And if the patients do need a payment plan, we can know that ahead of time and offer the right payment plan based on their financial disposition.” By simplifying the financial journey with patient-centered payments, providers can ease pressure on consumers, avoid lost revenue and foster patient loyalty. Get paid faster by providing easy ways to pay After clarifying the amounts to be paid, checking for available coverage, and determining the right payment plan, the final piece in the patient payments puzzle is the payment process itself. COVID-19 accelerated the use of digital payment tools. According to Experian Health and PYMNTS research, a quarter of consumers used digital methods to pay for their most recent healthcare visits, with 14% choosing to pay through patient portals. Providers that offer a range of flexible payment options and give digital-first patients a seamless consumer experience are going to stand out from the competition. Digital patient payment solutions are now table stakes. Act now to protect against a wave of medical debt While the impact of inflation over the coming year remains to be seen, Considine says that providers should move now to invest in technologies that offer convenience, flexibility and transparency to patients. “All of those things are going to expedite payments for providers and help reduce pressure on consumers, but I wouldn’t wait. These solutions can typically take a little bit of time to get implemented, and then adopted by patients, so the time is now for providers to get ready, prepare and implement these technologies.” Download Experian Health and PYMNT’s joint report, Accessing Healthcare: Easing Digital Frictions in the Patient Journey, to discover more about how patients are using digital patient payment solutions and opportunities to expedite healthcare collections.

During the COVID-19 pandemic, national and state health departments needed timely and accurate patient data to communicate quickly with citizens and make decisions about the local public health response. With support from Experian Health, the Council of State and Territorial Epidemiologists (CSTE) utilized Universal Identity Manager to provide members with reliable and accessible data tools to help slow the spread of disease. Here’s how the Tennessee Department of Health (TDH) used those resources to improve contact tracing and patient outreach amid mass relocations. According to Pew Research Center, more than a fifth of US adults changed their residence in 2020 because of the pandemic, or knew someone who did. In Tennessee, Epidemiologist and COVID-19 Team Lead David Fields identified mass relocation as a major obstacle to patient outreach during the pandemic. Job losses caused residential displacement, meaning that a patient’s health record didn’t always show the most current address. Because of the nature of their work, migrant farmworkers often have fluid living situations. This means that they rarely have a continuous home address and will share the same address or phone number with others, which hinders effective communication. And the private laboratories that expanded into COVID-19 testing often relied on stale contact data. These are some of the primary challenges that confronted the team in Tennessee working to verify data they were receiving. Experian Health helped TDH close the gaps in patient records using the Universal Identity Manager (UIM) platform. With UIM, records are matched using a unique patient identifier that combines industry-leading demographic information with the highest quality reference data to create the Experian Single Best Record. This accurately identifies separate records that belong to one person, creating a “golden thread” that follows the patient throughout their healthcare journey. TDH was fielding around 150 demographic data requests from community health departments per day. Before the pandemic, David’s team responded to these requests using proprietary and third-party databases that aggregated data held in public records. UIM complemented this approach with faster records matching, which allowed the team to provide quicker and more reliable patient contact information. In particular, UIM supported more efficient contact tracing during mass relocations by providing accurate phone numbers for citizens with positive COVID-19 test results and data for "hard-to-contact" cases. This solution also helped TDH create statistical analyses for the spread of COVID in the local populace by providing demographic data – such as gender and race. Find out more about how Universal Identity Manager accurately matches and protects patient data across multiple data sources, to create a single, longitudinal view of each patient and real-time insights to improve public health decision making and patient outreach.

Solving the patient identity problem and ensuring that each patient record is accurate and airtight is a top priority. Healthcare providers want to be 100% confident in answering “yes” to the following questions: Is the patient who they say they are? Is the right medication being administered to the right person? Is the correct bill being sent to the patient’s current address? By validating patient identities, providers can secure patient trust, deliver high-quality care, and avoid losing revenue to identity errors and fraud. Unfortunately, patient identity management is only becoming more complex. While telehealth and remote patient access are opening healthcare’s digital front door to meet changing consumer needs and expectations, a mountain of sensitive patient data is piling up. This data is a gold mine for fraudsters who steal and sell patients’ personal information or use it to access services and prescriptions without paying. It’s distressing for patients and creates a major financial and administrative burden for healthcare staff. A nationwide patient identification system may still be some way off. However, providers can optimize patient matching in their own health systems by working to reduce vulnerabilities and adopting cutting-edge interoperable patient matching technology. Better patient matching means better patient care and protected profits The human cost of incorrect, incomplete or outdated patient medical records is significant. Patients could be given the wrong medication or diagnostic procedures. Allergy information can be missed. Patient test results can be mislabeled or mixed up. In Experian Health’s State of Patient Access 2.0 survey, almost half of providers said inaccurate and incomplete patient data was an obstacle to proactive follow-up, which could cause gaps in care and avoidable complications – which are critical to value-based care compensation. Duplicate and mismatched patient records also create massive inefficiencies that can threaten an organization’s financial health too. With telehealth claim lines climbing by 2817% between December 2019 and December 2020, reliably authenticating patient identities in both existing and new services will be critical to future financial performance. Resolve, protect and enrich patient identities with universal identifiers Having the right technology to resolve and secure a patient’s information when they log on to patient portals and telehealth systems is the first step. Automating patient enrollment with Experian Health’s PreciseID® ensures the patient is who they say they are. This solution utilizes best practices in identity-proofing, fraud management and device recognition. But this system only works if the records being matched are accurate. A universal patient identifier provides a single, accurate, 360° view of each patient throughout their healthcare journey. An interoperable format allows systems to talk to each other and protects against duplicates, errors, inefficiencies and fraudulent activity. Universal identifiers aren’t available nationwide yet, though there has been some encouraging movement. Congress is working to remove the ban on funding for such measures, while the Centers for Medicare and Medicaid Services are taking steps to promote data standardization. For health systems that want to maintain a golden record for each patient within the bounds of their own operations, Experian Health’s Universal Patient Identifier allows staff to connect, verify and protect patient information. Choosing the right patient matching technology Traditional matching technology relies on demographic data and uses deterministic or probabilistic methods to link records with identical identification information. However, relying on a single source of data means that previous errors are inherited by new versions of a patient’s record. Demographic data isn’t unique to individual patients, which can lead to mismatched records and create extra manual work to fix. Experian Health uses referential matching technology to build a complete view of patients from reliable health, credit, and consumer data sources. The universal patient identifier connects disparate datasets and instantly updates the master index of patient records with new data points. Referential matching can only ever be as good as the data that is being matched and Experian is a global leader in data accuracy, across numerous sources, and is continually updated. Victoria Dames, VP of Product Management at Experian Health, says, "With Experian’s reference data, we’re able to create a longitudinal record of each individual and reconcile their data as they change names, addresses and see different providers. You need to know that it’s the same person, especially with the pandemic acting as a catalyst for digital technologies such as telehealth. It also helps organizations bring data together and ensure data integrity through mergers and acquisitions. Dealing with large volumes of data is a big hill to climb, but with the right technologies it can be that much faster.” As telehealth and digital patient access services gain traction, solving the patient identity problem becomes increasingly urgent. Universal Identity Manager combines industry-leading consumer demographic information with the highest quality reference data and powerful unique patient identifiers to create a single view of each patient. With better patient identity management, providers can protect against errors and fraud, and reassure patients that their personal information is safe. Find out more about Experian Health’s identity management solutions.

No healthcare organization is immune to the problem of bad data. One in five patients has found errors when looking at their electronic health record (EHR). This includes incorrect information about their diagnosis, medications, test results and more. If the data held in patient records is incomplete, inconsistent, or inaccurate, this can lead to poor clinical decision-making, substandard patient experiences, and gaps in treatment or follow-up. In Experian Health’s State of Patient Access 2.0 survey, patient identity management emerged as a major challenge for healthcare providers, with almost half of the respondents saying that inaccurate and incomplete patient data hindered follow-up contacts and patient outreach. “Dirty” data also presents a major financial risk, costing healthcare organizations millions of dollars per year. Many providers have stepped up their digital offerings in the last few years, particularly in response to the pandemic. While digitalization offers huge advantages, it does have an unfortunate side effect. As more data is created, shared and accessed, there are more opportunities for mistakes. Some industries may accept a certain amount of rogue data as inevitable, but in healthcare, it mustn’t become the norm. Patient data needs to be consistent, complete and standardized to ensure the highest standards of care. The Centers for Medicare and Medicaid Services (CMS) recognizes the need for an easier and more secure exchange of healthcare data, and are taking steps to facilitate interoperability. As these provisions are finalized, providers can act now to embed data standardization in their digital services. Better data means better decisions, better care and lower costs. As the digital transformation continues, providers must implement strategies to eliminate inaccuracies, enable consistent identity management, and ensure data is standardized across all their systems and networks. In this article, we share three steps to help your organization ensure that patient data remains complete and consistent for better patient identity management. 1. Start with the right patient data As the saying goes: garbage in, garbage out. Reliable patient records require the right information to be added from the start, or errors will follow the patient throughout their healthcare journey. This will only continue compounding over time. A 2021 survey of Experian Health clients revealed that incomplete data arises for a variety of reasons. This ranges from patients not filling out forms correctly prior to their visit or forgetting their insurance cards, to staff having limited time to complete documentation. Typos, misspellings, duplicate data and missing information can also cause identity errors.* Providers should reduce the risk of inaccurate data from being added to a patient’s record in the first place. A standardized approach to data formatting is a good place to start. For example, if a patient is accustomed to writing their date of birth in a European format, with the day before the month, they may enter this incorrectly when filling out online patient access forms. Configuring calendar drop-down menus in such a way that prevents this will avoid these basic but costly errors. With a Universal Identity Manager (UIM), each patient’s record can be maintained in a standardized format. Probabilistic and referential matching techniques are used to check the patient’s identification information against existing databases, for a more complete view of the patient regardless of any data gaps. 2. Solve patient matching challenges with robust identity verification It doesn’t matter if patient records are accurate if staff pull up the wrong record when they speak to a patient. Providers should prioritize consistent identity management to ensure clinical and non-clinical staff see the same and correct information, regardless of where or when a patient interacts with their organization. Identity Verification validates the patient’s identification information during pre-registration and check-in by instantly accessing demographic information. This includes the patient’s name, address, Social Security number, date of birth, phone number and insurance coverage data. If there’s a mistake, it’s easily found and corrected. 3. Standardize data to maintain clean patient databases Victoria Dames, Vice President Identity Management at Experian Health explains why standardization is so important: “The increasing use of digital services means that more healthcare data is being exchanged within and between health systems than ever before. However, in order to leverage the opportunities that come with a more connected healthcare system, we need that data to be as reliable as possible. Preventing inaccuracies before they occur will be much more cost-effective than scrambling to fix them after the damage is done. With a standardized approach to data collection and management, healthcare organizations can maintain reliable records for every individual patient and stay ahead of the game as more data is generated and shared.” Unique Patient Identifier (UPI) helps providers eliminate duplicate records so there’s a “single source of truth” for each patient. After the UIM matches the patient’s information within a single and accurate patient file, a UPI is assigned to that record and maintained in a master index. This is far more secure than a traditional matching algorithm based on Social Security numbers, which can be vulnerable to errors. Together, these tools help healthcare providers create and maintain a “golden record” for each patient. Data quality will always be a challenge. However, with the right data standardization strategies, providers can make better decisions. This will create better patient experiences and better health outcomes while limiting the financial impact of dirty data. Contact Experian Health today to find opportunities to clean up your healthcare data for better patient identity management. *Survey of Experian Health clients, October 2021 Are you an Experian Health client? Then we invite you to join our Innovation Studio research community. Your ongoing input is key to driving improvements to our tools and products! Sign up here!