Tag: patient engagement

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

With Google’s acquisition of Fitbit in November 2019 and Apple’s recent foray into smartphone-based clinical research, the ‘big four’ tech giants are ramping up their efforts to take a slice of the $3.6 trillion healthcare industry pie. These investments aren’t new. Between 2013 and 2017, Apple, Microsoft and Google’s parent company, Alphabet, filed a combined 300 health-related patents, while Amazon has been looking to expand into the pharmacy space since the early 2000s. Historically, it hasn’t been easy for new players to get into the healthcare game. Up to now, tech companies have mostly stayed in their lanes, using their expertise in cloud-based computing, artificial intelligence and supply chain management to break into health markets around the edges. What gives them a big advantage now is the rise of healthcare consumerism, especially in the digital realm. Patients expect to be treated as individuals, with communications and services that are convenient and tailored to their needs. The personalization that so delights them is powered by their own health data and a focus on the consumer experience – two of the tech companies’ biggest strengths. Providing a consumer-centric experience has been challenging for the healthcare industry. In fact, it’s been challenging for many legacy industries (banking, insurance, etc.). Amazon and others have a head start in being able to leverage vast quantities of consumer data and turn insights about their customers’ lifestyles, behaviors and preferences into a better consumer experience. How can healthcare providers compete? Understanding consumer data is key to a better patient experience and better population health The buzz around consumer data opportunities isn’t limited to the tech world. Recognizing the role of consumer data in improving both the patient experience and population health, more health systems are investing heavily in data analytics, looking at how they use data to market to their consumers and address the social determinants of health. Mindy Pankoke, Senior Product Manager for Experian Health, says: “Consumer data is becoming more important in healthcare because patients are people. They're more than a clinical chart or claims form. They have lifestyles, they have interests, they have behaviors. This is called consumer data. ‘Social determinants of health’ has become a huge buzzword in the healthcare industry and it's more than buzz. It's data about people's lifestyles that we can use to improve their health.” Over 80% of health outcomes are attributed to the social determinants of health, so knowing who your patients are and what they need is increasingly important if you want to improve their wellbeing. When you understand what’s going on in your patients’ lives, you’ll know whether they need assistance with transportation, understanding their healthcare information, managing a care plan or accessing healthy food. You can communicate with them in the most effective way and point them towards services that could help them access care and avoid more serious conditions. And even better, much of this can be done through time-saving automation tools. Where to start with consumer data Today’s leading healthcare providers are using consumer data in three main areas: 1. Streamlining patient communications Whether a patient is getting treatment for a broken leg or multiple chronic conditions, their healthcare journey probably involves hundreds of touchpoints with your organization. Consumer data helps you cut to the chase and give them the exact information they need to make their next decision or complete their next task, in the most convenient way. Data analytics allow you to create a slicker patient experience, by giving the right message in the right format – whether that’s in marketing to new patients, sending bill reminders, or encouraging wellness checks. 2. Segmenting patients according to social determinants of health In a study of 78 social needs programs published this month, Health Affairs reported that health systems invested more than $2.5 billion in interventions focused on housing, employment, education, food security, community and transportation, between 2017-2019. Clearly, some patients will benefit from these services, while others won’t. There’s no point giving the same information to every patient. Consumer data lets you segment your patient population and target information about social programs to the ones who need them most. 3. Creating bespoke services for your specific patient population Consumer insights tell you exactly what’s blocking your particular patient population from accessing care, now and in the future. You’ll know how many have difficulty attending appointments, how many might struggle to read complicated instructions and how many will be too busy to download and use your new healthy recipe app. Analyzing your population’s needs and tendencies allows you to predict future demand for different services and develop interventions to solve those specific challenges. Future-proof your consumer data strategy by working with a trusted partner As the big tech companies are coming to discover, healthcare data regulations are complex. You need to know where your data comes from, for the sake of both accuracy and permissibility. Working with a trusted data vendor in the health space can help ensure the reliability and integrity of your data, as they will have expertise in the appropriate use of consumer data in healthcare. They’ll help you pull insights from only the most relevant, current data, so you can build a competitive consumer experience on the strongest foundations. Find out more about how Experian Health’s consumer data analytics can give you a holistic view of your patients and the social determinants that affect their health.

When it comes to value-based care, there’s really just one measure that matters: patient satisfaction. As CMS incentivizes providers to help patients find better care, improve population health and lower healthcare costs, more top health systems are seeing patient engagement as the path to value-over-volume success. Patients are finding themselves footing more of the bill for medical expenses, so elevating the patient experience is essential. If they’re not satisfied, they’ll simply take their dollars elsewhere – not what your CFO wants to hear. Helping patients feel more engaged in their health creates a more satisfactory experience, and in turn, boosts patient loyalty. And what’s more, by giving them opportunity to make informed decisions about their care, you can also reduce preventable admissions, avoid no-shows and fix the revenue leaks in patient collections. It’s beneficial for everyone. Here are four strategies to help you boost patient engagement and create a more consumer-friendly experience in your organization. 4 ways to boost patient engagement 1. Use segmentation and customization The first route to consumer-friendly care is about treating each patient as an individual. With advances in data analytics, it’s now possible to group your patients according to risk (whether that’s risk of a particular disease, exposure to a social determinant of health, or likelihood of non-attendance at follow-up). This allows you to be more targeted in your marketing efforts, provide patients with information that’s more relevant to them, and help each patient move to the next stage of their healthcare journey. Stanford Medical School sees this data transformation as central to its vision of “‘Precision Health’ – a more preventive, predictive, personalized and precise” approach to healthcare. Analytics give you a wealth of insights about the clinical, financial, behavioral and social factors affecting your patients, so you can personalize your patient engagement strategy to each member’s specific preferences and needs. As noted in research undertaken by Frost and Sullivan on behalf of Experian Health: “Analytics help us select patients who will respond to engagement strategies and de-select patients who won’t respond are needed. Not everyone responds to engagement in the same way.” By prioritizing precision marketing, you can create a culture of precision care. 2. Help patients take ownership of their health journey Value-based care is an opportunity to empower patients to be active players in their health. Greater transparency into the billing process, access to healthcare data and consumer-friendly tech can all help patients see what’s happening at each stage of the process. When they’re more informed, they’re more likely to adhere to care plans, turn up to appointments and successfully navigate payments. Your patient portal is a good place to start. Research shows that use of portals enhances patient engagement, satisfaction and health outcomes. Patients can access their records, view test results, schedule appointments at a time that suits and sort out bills with less of the stress. It helps patients ask the right questions and builds a trusting patient-provider relationship. 3. Improve the patient financial experience When two-thirds of Americans are worried about being able to cover unexpected medical bills, any way you can make the payment process more transparent is a big plus. Help your patient navigate the financial side of their healthcare experience with clear, real-time information about their coverage status, estimated co-pay calculations and appropriate payment plans based on their specific circumstances. Putting them at ease will help them meet their financial obligations without leaving a bad taste. In this way, you can build consumer trust and optimize your revenue cycle at the same time. 4. Use SDOH data for proactive outreach Research shows that medical tests and treatments alone are not enough to determine the outcome of a patient’s healthcare journey. We should be paying more attention to the social and economic factors that can get in the way of care. Because when patients struggle to access care, it’s harder for them to follow treatment plans or show up to important follow-up appointments. In a value-based world, tackling social needs is a growing priority for providers seeking to improve population health. When you have a more complete grasp of each patient’s motivations, support networks and personal circumstances, you can create a more efficient patient engagement plan. You’ll avoid wasting resources on patients who aren’t in a position to respond and instead can adopt outreach strategies to help those patients access the care they need. This might include offering alternative payment plans, signposting to logistical support such as childcare or transport, or referring to local community services, such as cooking classes or social clubs. To do this, you need reliable, relevant and accurate consumer data and the capability to draw actionable insights. Experian Health’s unrivaled consumer marketing data can help you better understand your patient population so you can communicate with them and support them in the most effective way. Consumer-friendly care is the new currency in value-based accounting – and the key to positive patient engagement. Find out more about how Experian Health can help your organization lift your patient engagement strategies for greater patient satisfaction, better health outcomes, and a healthier

    In today’s fast-evolving healthcare industry, consumer expectations are changing. Individuals are footing an increasing portion of medical bills, so they’re paying closer attention to their healthcare options. And with digital technology enabling choices for everything from where to bank to what to eat (and even who to date!), patients are now expecting a similar consumer-centric experience when it comes to their health. But what exactly are they looking for? Providers should respond to this rising consumerism with two things: convenience and engagement. Many patient tasks are time-consuming, tedious and repetitive. The use of outdated technology draws unfavorable comparisons with the intuitive apps used in other industries. And all too often there’s a one-size-fits-all approach to marketing. The opportunities to improve the patient experience are huge. As the competition for consumer business heats up, providers should look for ways to step up their patient engagement strategies to attract new consumers and inspire loyalty among existing members. Consider how to make it as easy as possible for patients to access the care they need, whether that’s through frictionless scheduling, simplified registration processes or proactive communication about free transportation options. Data-driven technology and automation can help drive improvements in both convenience and engagement. Here, we look specifically at how automation could help you meet changing consumer expectations in the world of patient access. How can automation make patient access more convenient for consumers? Patients hate administrative and financial tasks that take them away from family, friends and other priorities. When looking for an easy, streamlined patient access experience, they might ask: Can I make appointments online? Can I get an out of pocket estimate for my cost of care? And can I price-shop my services? Can I do my pre-registration work before I show up for my appointment? Can I manage my bills and all my health information online? Can I do all of this from my mobile or tablet device at a time when it’s convenient for me? Automation can help you deliver against these expectations and remove stress and hassle from many patient access tasks. By using consumer data and technology to trigger the next stage in the process, you can help patients navigate the complex healthcare system, making registration, billing and payment more convenient. For example, online self-scheduling lets patients plan appointments when it suits them. You’ll increase appointment and referral rates, improve call center efficiency, reduce no-shows and enhance the overall patient experience. Or how about offering patients a one-stop-shop for managing all their healthcare admin, through a digital patient portal? This makes it much quicker and easier for them to get price estimates, set up payment plans, update insurance information and stay on track with appointments and treatment plans. By automating the registration and billing processes, you’ll improve self-pay collections and decrease bad debt. If you can say “yes” to the above questions, you’ll be making life easier for your patient access staff too. Reliance on manual data entry processes means staff are constantly battling bottlenecks and dealing with avoidable errors and duplicate records. Not only does this waste employee time, it opens the door to major safety issues and lost revenue: patient identification errors can cost up to $2,000 per patient and are associated with a third of denied claims, costing the average hospital $1.5 million each year. How can automation support better patient engagement? This isn’t just about removing obstacles or introducing speedy tools. You can use automation to improve patient engagement at various touchpoints during the patient access process. Consumer data paired with automation can help you nudge patients by text or email to make appointments, so they don’t miss out on important checks. You can deliver personalized updates, reminders and offers, so your patients feel taken care of and know exactly what’s happening throughout their healthcare journey. Using lifestyle, demographic, psychographic, and behavioral data from the highest quality sources, you can also use automation to segment your audience into groups based on all sorts of variables, in order to communicate with them about the right services, at the right time. Now is the time to leverage technology for a better patient access experience. It’s clear that awareness of the potential ROI in automation is growing. Still, many providers have only scratched the surface when it comes to integrating automation within their revenue cycle operations. Given that 66% of patients would switch providers for more convenient access, it makes sense to consider how you can leverage technology to simplify all sorts of patient tasks, from pre-registration to payments. Learn more about how automation could help your organization create a better patient access experience for consumers.

  Healthcare consumerism is on the rise. Your patients no longer see themselves as passive participants in their healthcare journey—they’re active consumers, who have come to expect the same frictionless experience they might find in other industries. They have options. If they’re dissatisfied with their experience, they can go back to the menu of providers and choose something different. But when patients feel supported and respected through their healthcare journey, they’ll remain loyal to your organization, even becoming brand ambassadors. Following the Medical Group Management Association’s (MGMA’s) Annual Meeting in New Orleans a few weeks ago, it became clear that nurturing patient loyalty remains at the top of the list for medical groups looking to stay competitive in an increasingly consumer-driven market. For providers wanting to create an outstanding patient experience (and encourage greater patient loyalty), a good place to start is improving access to care. Win patients’ hearts and minds before they’ve even set foot in your facility. The goal should be to leverage advances in digital technology to make it as easy as possible for patients to find physicians, access schedules, book appointments and take control of their health. Improving patient access through digital care coordination Medical groups should look at how they are using data and digital technology to improve the patient experience in three key areas: Scheduling Laying the groundwork for a positive patient experience starts with making sure the appointment process is as painless as possible. Imagine a mother is woken during the night by her sick infant. Using a traditional scheduling model, she’d have to wait until the next day to call and schedule an appointment with the pediatrician. But if she could schedule an appointment there and then through the pediatrician’s website, this would not only be more convenient and reassuring for her, it would reduce operational strain on the medical practice, who would have fewer calls to handle. Online self-scheduling is the most convenient way for patients to both find a physician or specialist and access care, all on their own terms. By implementing online scheduling, medical groups will see higher rates of patient satisfaction and engagement and an increase in patient acquisition and retention. Care referrals The referral process is another common pain point for patients. For such a crucial process, it’s surprisingly consumer-unfriendly. Patients struggle to connect with recommended specialists and when they do, they often can’t get an appointment for weeks. Many organizations don’t realize how much revenue they could be losing when frustrated patients look elsewhere for care. With a more sophisticated referral process, providers can transform the discharge experience and ensure patients get the follow-up appointments they need—within the same network. One health system in the south east has generated tens of millions of dollars simply by booking follow-up appointments before patients even leave the facility, so they’re less likely to be lost to out-of-network referrals. Decision support Most providers have scheduling rules that determine which patients their clinicians should see and when. What they don’t always have is a way to automate the process so that patients can book online or seek a referral, while still following these scheduling criteria. The provider needs to be confident that if a patient with knee pain wants to book an appointment with an orthopedic specialist, they need to be sure they don’t inadvertently choose someone who specializes in shoulder injuries or pediatrics. The problem isn’t solved by booking by phone. Securing referrals through a call center can be a cumbersome process, eroding patient trust and contributing to scheduling bottlenecks and staff dissatisfaction. But when scheduling is digitized, providers no longer have to worry about these challenges. Automating decision-making creates a simpler process for everyone and most importantly, ensures the patient connects with the right specialist in the least amount of time. How analytics can help you create a consumer-centric organization For leaders considering how to create a more consumer-centric health system, re-imagining patient access should be a top priority. A tool such as Patient Schedule gives your patients a convenient and simple way to manage their appointments and follow-up, so they see the right clinician at the right time, without any of the usual hassle that comes with the scheduling process. On the flipside, automating your patient access protocols also gives your team the intel required to increase capacity to see patients and boost revenue through better acquisition and retention. You’ll be able to track how many patient visits turn into booked appointments, identify the points at which patients drop out of the process and spot bottlenecks in your scheduling. These insights could reveal endless opportunities to make simple tweaks that will give both patients and staff a smoother ride through patient access. Data analytics mean you no longer need to be operating blind when it comes to unblocking the bottlenecks in patient access. You’ll know exactly where to focus your efforts to improve the experience for your patients and grow your competitive advantage at the same time.

  When a doctor pulls up a patient’s record, it should be a safe assumption that the information on the screen relates to the patient sitting in front of them. It should contain every detail of the patient’s medical history, along with their current address and accurate personal information. It certainly shouldn’t contain anyone else’s data! Yet all too often, patient records are plagued with inaccuracies. Around 30% of patient data in electronic health records is incomplete or inaccurate, and up to half of records are not linked to the correct patient. The ONC estimates that around a fifth of patients may not be matched to their entire medical record within an organization, while more than a half of records shared between organizations contain errors. Despite all of modern medicine’s ground-breaking achievements and our increasingly digitized world, the ability to share information between different payers and providers in a reliable and secure way remains frustratingly out of reach. Could a universal patient identifier unlock interoperability? Imagine a healthcare ecosystem where administrators and clinicians can safely exchange information without worrying about whether it’s inaccurate, incomplete, or incompatible with each other’s systems. Interoperability could make life easier for healthcare staff and patients alike. While regulations such as the Affordable Care Act introduced many carrots and sticks to drive up adoption of electronic medical records to support interoperability, they also revealed a critical gap in healthcare: the need for a universal patient identifier (UPI). This is an identifier that would help manage patient identification across the whole healthcare ecosystem. A UPI would allow providers and payers to follow patients throughout all their major medical and life events and be sure that the information they hold for their member or patient is 100% accurate, current and complete. Instead, the absence of a UPI, compounded by the sheer volume and fluidity of patient data, has created significant issues downstream. Billing errors, unnecessary treatment and testing, HIPAA breaches, prescriptions filled for the wrong patients and many other issues all play a role in the growing number of preventable medical errors (estimated to be the third leading cause of death in the US). Striving for truly interoperable patient information should be a priority across the entire healthcare industry. Still, while federal funding for a UPI is currently being considered by Congress, we’re seeing more and more industry-led responses to help improve patient identity management. 5 benefits of using a universal patient identifier for interoperability Improve patient safety How can physicians be sure they’re recommending the right treatment for a patient, when there could be a vital piece of information missing from their medical history or allergy list? How can a pharmacist feel confident handing over a prescription, when there’s a chance the patient in front of them isn’t the same patient named on the script? A UPI can help avoid ‘wrong patient’ events and allow providers to share information to spot trends in recurring errors so that action can be taken to prevent them in future. Lower healthcare costs The West Health Institute found that that medical device interoperability could save the U.S. healthcare system more than $30 billion per year. For individual providers, UPIs could improve productivity by reducing the amount of time clinicians and hospital staff spend trying to sort out inaccurate records. And with nearly a third of claims denied as a result of patient misidentification, this could mean savings in the region of $17.4 million for the average hospital. A better patient experience Patients are right to be frustrated when their physician doesn’t have up-to-date records about them, or their provider sends appointment reminders to an old address. Expecting patients to fill out multiple forms (often multiple times) is inefficient and hardly contributes to a positive patient experience. A tool such as Universal Identity Manager can help providers exchange timely data, eliminate duplicate records and coordinate care, so the patient is supported throughout their healthcare journey. Stronger privacy Electronic records linked with a UPI allow healthcare organizations to phase out manual processes—which is not only more efficient, but also helps minimize the risk of patient data falling into the wrong hands. It’s much easier to keep the data secure when it’s contained in a single record, compared to multiple versions of a record filled with scribbled notes and random updates that could easily end up attached to the wrong record. Experian Health’s Precise ID gives healthcare organizations a HIPAA-compliant way to authenticate patients and reduce the risk of a data breach during enrollment. Better data to tackle the social determinants of health As consumer data opens up new opportunities to improve population health, a network of shared data will be essential for identifying trends in the social and economic factors that affect medical outcomes. Interoperable data sets and technologies can enhance the way public health data is collected and used, for better patient outcomes and population health. Interoperability currently remains a challenge, but the tools exist to improve the way information is shared and used across the healthcare ecosystem. By integrating clinical data into the patient access workflow, you can increase productivity, reduce costs, and ultimately improve the patient experience. Contact our team to find out how this could help your organization achieve more efficient, accurate and actionable data sharing.  

Imagine being able to offer your patients a financial experience that doesn’t stress them out. That makes patient billing quick and simple. That knocks off a few minutes from each patient registration. And that even boosts your revenue. These are just some of the benefits attendees at last week’s Cerner Health Conference were considering as they discussed opportunities for faster innovation, smarter working and transformation in the future of healthcare technology. When it comes to working smarter, attendees seemed to agree that one aspect of the healthcare experience comes out top for providers and patients alike: the cost of care. This is especially true because patients are increasingly responsible for paying their healthcare costs. And since the way services are reimbursed is constantly changing, patients are often left in the dark about how much they’ll have to pay, or how they’ll be able to afford it. Patients are struggling under the weight of financial burden We know this can have serious implications for their physical, emotional and financial health. A recent survey by the Nationwide Retirement Institute showed that as many as one in three patients aged 25-45 are delaying medical care because they’re worried about the cost, instead keeping their fingers crossed and hoping that the issue will disappear by itself. A third shop around for better prescription prices, with many not taking their meds as often as instructed in order to save money. More than half of patients wouldn’t be able to afford an unexpected bill over $1000, while a staggering 530,000 families are bankrupted by medical costs every year. Healthcare providers often end up bearing the burden of uncompensated care, or waste valuable time and resources working to uncover missing or undisclosed coverage. Either way, all this wrangling for payment has a major impact on the organization’s bottom line as well as the patient financial experience. To tackle some of these challenges, we’ve teamed up with Cerner® to support healthcare organizations to provide more compassionate and convenient billing practices. At last week’s conference, we launched the Cerner Consumer Financial Engagement suite, a newly embedded experience within Cerner’s Consumer Framework that will optimize the billing process for both patients and providers, powered by Experian® data. 3 ways the Cerner Consumer Financial Engagement suite can optimize your patient collections One of the biggest pain points for patients when it comes to managing their healthcare bills online is needing to switch between different systems for different administrative tasks. This new partnership will let patients who use the Cerner Consumer Framework access and manage all aspects of their online healthcare account in one place, creating a more convenient financial experience. The new tool will help providers improve patient collections in three ways: Smarter patient engagement When you have insights into your patients’ financial circumstances and propensity to pay, you can make more informed decisions about how to approach collections and get them on the right program from the start. Using Experian’s industry-leading datasets, providers will be able to use the Consumer Financial Engagement suite to spot patients who may benefit from alternative payment plans or financial assistance and make personalized offers that are compassionate and relevant. Giving patients a one-stop-shop for managing bills Patients are coming to expect a better experience – similar to what they might see in online retail and financial services. When it’s easy for them to settle their bills, they’re more likely to conclude their healthcare journey on a positive note and feel reassured about sticking with your organization the next time they need care. With an all-in-one patient dashboard showing current billing information, insurance deductible status, transparent cost estimates and tools to activate pay plans or financial assistance, the Cerner Consumer Framework creates a frictionless and transparent billing experience, leading to fewer late or unpaid bills and more satisfied patients. Simple and efficient collections When it comes to payments, proactive communication can help ward off some of the sticker shock that comes with unanticipated treatments and bills. The new financial engagement tool uses a simple interface that makes medical billing clear and quick for patients. When consumers aren’t put-off by the technology, they’ll be more likely to act promptly to get billing out of the way. In addition, providers will be able to add their own branding, so the patient experience is consistent from start to finish. Creating a positive patient financial experience powered by reliable data In today’s climate of increasing costs, big data and healthcare consumerism, data and analytics are now the driving force behind an efficient revenue cycle. Person-centered healthcare services that prioritize quality and patient outcomes should be a given, but the financial experience is an integral part of the total equation. This is especially true when we consider that the three biggest pain points for consumers during their healthcare journey are all related to payments! Learn more about how data-driven technology, such as the new Cerner Consumer Financial Engagement suite, can help you offer patients a better financial experience and optimize revenue at the same time.

  I attended the Fall 2019 Conference of the National Association of Accountable Care Organizations (NAACOS) in Washington D.C. and wanted to share some insights on how top-performing Accountable Care Organizations (ACOs) are using data to drive improved quality and cost of care. Over the last decade, we’ve seen the number of ACOs surge. Propelled by the shift from volume- to value-based care, over a thousand ACOs operate across the U.S., bringing together groups of physicians, hospitals and other providers with a collective ambition to enhance quality of care, reduce healthcare costs and improve patient outcomes. While some ACOs participating in the Medicare Shared Savings Program have succeeded in improving quality and realizing some savings for the program, the value-based model is still evolving, and results can be mixed. More dramatic and holistic moves will have to be made to convert today’s annual incremental savings of 1 to 2% to make a dent in the estimated annual waste of nearly $389 billion in administrative complexity and another $45 billion due to lack of coordinated care. So what separates the top performers from the rest? At NAACOS last week, speakers confirmed that the most successful ACOs are those that effectively shift care towards primary care physicians (PCPs) and away from acute settings and skilled nursing facilities, implement a process for continuous improvement and adopt a performance-first culture. This is easier said than done. Here’s my top recommendations to help ACOs leverage data-driven insights to lower costs while improving patient outcomes. Offering insights into member utilization of healthcare resources in real-time I recently worked with a client that needed real-time alerts of member activity including admissions, discharges, and Emergency Room (ER) visits. These insights enabled this client to proactively manage active member episodes of care, optimizing the setting and deliver of care for the member’s specific needs. For example, a member was frequently visiting the ER with complications from his Chronic Obstructive Pulmonary Disease (COPD) condition that the client’s care team was managing. This was a needlessly costly way to treat the symptoms. To help get their members the right care at the right time, this client started leveraging automated alerts for their members as they presented within the healthcare continuum. The next time this patient sought treatment in an out-of-network ER for their COPD, their primary care physician (PCP) received an alert about her patient as soon as they registered, before a doctor had even seen him, and certainly before an ER workup converted to an admission. The PCP called the attending ER doctor to share the patient’s history and ensured the ER physician that this patient would receive next-day follow-up care in the PCP’s office. Knowing that follow-up was in place and the patient wasn’t in immediate need of care, the ER physician discharged the patient home. Given that the average cost of an admission can run $22,000, and an outpatient visit less than $500, the savings delivered by this kind of care coordination becomes significant. More importantly, the member experience is much improved in that they get to go home instead of an unnecessary overnight stay in the hospital. And this is just one example—multiply this kind of episode management across all member encounters and consider the improved member quality of life across all attributed lives and the savings for the health plan or ACO in the aggregate. Real-time alerts provide a win-win for both patient and ACO by affording care teams the opportunity to optimize the setting of care for quality and cost. Care coordination for episode management To improve episode outcomes and reduce readmissions, visibility into the compliance of a patient’s post-discharge care plan through the duration of the entire episode is critical, so well-coordinated care requires that clinical context be shared between providers. A frequent barrier to this flow of useful data is that clinicians’ electronic health records (EHRs) aren’t always interoperable. To solve for this, some ACOs are attempting to move all their providers to a single EHR and care management module. However, for some this may not be an option. In these cases, ACOs can opt for Care Coordination Manager: a rules-driven, closed-loop messaging and distributed workflow orchestration platform that enables health plans, ACOs, allied health, and community partners to share and assign care plan requests across a diverse provider community. Care Coordination Manager is vendor-agnostic and able to populate EHRs and care management modules at the point of care with key clinical context. This flow of tasks and content supports high-quality coordination of care and management through transitions of care. Proactively address non-clinical barriers to health for improved patient engagement and health Another characteristic of top-performing ACOs is that they utilize a 360-degree view of their members to address potential barriers that prevent members from engaging in their own healthcare. These SDOH factors can include things like housing or financial instability, food insecurity, limited access to transportation or healthy food options, and other non-clinical factors. Only about 20% of costly health episodes are due to medical factors, so it’s vital for ACOs to incorporate a more comprehensive and actionable understanding of the social needs of the populations they serve. For example, medication adherence is a bigger challenge for a patient who may have difficulty getting to a pharmacy or understanding medication instructions. Identifying and mitigating these risks up front gives the patient a better chance of adhering to their prescribed regimen, which in turn gives them a better chance to stay healthy, ultimately lessening the disease burden and thus the cost of the ACO’s membership while improving the patient’s quality of life. ACOs can take a proactive, preventative approach to addressing these challenges by collecting and analyzing member data and using these insights to tailor interventions. Patient-supplied information through surveys, like PRAPARE, is a good starting point, but surveys can be limited by access to the patient as well as the patient’s ability or willingness to answer honestly. Additionally, unless mapped to structured data such as ICD-10 Z codes, survey data is challenging to scale for broader insights into the ACO’s membership. Instead, consider healthcare consumer data that’s sourced directly from a reliable vendor. Analysis of this demographic, psychographic and behavioral data allows you to flag patients based on need, so you can identify the best way to communicate with members to help them own their healthcare journey. For example, in a recent report by the Department of Health and Human Services’ (DHS) Office of Inspector General (OIG), one ACO described how asking patients with chronic conditions to make a daily call to a care coordinator led to 43% fewer emergency room visits and 47% fewer readmissions. As ACOs grow amidst pressures to take on downside risk and manage costs while improving quality—timely data collection, sharing, analysis and action will continue to provide the foundation of high-quality episode and population health management; along with engaging members and community partners in the healthcare journey. What’s clear from discussions at the NAACOS conference last week is that the opportunity exists to work smarter across many emerging payment models. Could data be the key to unlocking that opportunity? McLain Causey is Director of Product Management at Experian Health.

Last week, I spoke at the technology briefing of a national health plan group to give a presentation on the role of consumer data and patient identity in healthcare and how social determinants of health (SDOH) can help payers improve population health and lower costs. To illustrate the importance of leveraging consumer data for SDOH outcomes, I like to use the example of Vern. Vern is 78 years old, lives alone in a lower income apartment complex and hasn’t attended a wellness check in several years. Last month, he had an unexpected trip to the emergency room (ER) due to heart disease and continues to be readmitted for his condition. But why does he keep getting readmitted? Is it because he can’t afford his prescribed medication? Is he having a difficult time finding transportation? Or could it be that when it comes to healthy eating—buying fresh product on a weekly basis is challenging for him? These are some of the SDOH that could be contributing to Vern’s readmission—not solely his now heart disease. Had his care team known more about Vern, aside from his condition, they could have proactively addressed some of his barriers to care and prevented the ER admissions—saving them from costly care episodes and preventing negative outcomes for Vern. By utilizing SDOH insights, Vern’s care team can help ‘even the playing field’ for him by understanding his non-clinical barriers to health, what key things are driving those barriers, and what makes sense to address them.  All of this, of course, underpinned by an accurate identity (but, let’s talk universal patient identification another day!). With SDOH insights, Vern’s care team could have gotten him to his wellness checks, his condition would have been detected earlier and he would have received the services he needs proactively. This would save countless dollars in repeated readmissions, ER visits and other costs associated with a chronic condition that can’t get better when your members don’t have the luxury of prioritizing health over basic needs. To avoid these missed opportunities, many healthcare organizations are turning to consumer data to understand their patients or members better. Insights on SDOH are transforming the care experience for people like Vern, as well as saving money for patients and the healthcare industry. Here are three ways consumer data is driving improvements in population health and lowering healthcare care costs at the same time: Helping patients lead healthier lives Research shows that clinical care alone is not enough to safeguard a person’s health. Up to 80% of health outcomes are attributable to non-medical factors such as your financial situation, stability of living arrangements, access to transportation and healthful food options, amongst other things. Around 68% of Americans are affected by at least one of these SDOH, which can make prioritizing good health a challenge. When healthcare organizations are more informed of the SDOH impacting their patients or members, they can take steps to help prevent avoidable hospital visits, ED utilization, appointment no-shows and worsened conditions by encouraging and facilitating earlier intervention. For example, 1 in 8 Americans are food insecure.  If care teams are able to recognize when this is an issue for the people they’re caring for—they can look at partnering with community organizations, like a local food bank or meal delivery service, to address gaps in nutrition for better health outcomes. Reducing the financial burden of healthcare expenses In the U.S., healthcare has the world’s largest gross domestic product (GDP) spending (18%).  By helping your members overcome barriers to attending appointments and potentially discovering health issues sooner, the healthcare industry can reduce the costs of healthcare. For example, 3.6 million Americans miss out on medical care due to transportation problems. If care teams knew who they were and what specifically is impacting them ahead of time, they could step in to arrange transportation or offer alternative options, like telemedicine, so problems can be detected earlier. Not only is this better for the patient’s health, it’s better financially too—emergency room visits cost an average of nearly $2,000 while inpatient hospital stays come in at an average of $10,000. When 33% of ER visits are from those experiencing homelessness—the extreme condition of housing instability—it’s imperative that we consider more than a patient’s profile from a claims or clinical data perspective. Offering a better patient experience When healthcare organizations can see each patient as a whole person, they can offer better engagement plans that make prioritizing their health a smaller mountain to climb. Does your patient prefer information by phone, text or email? Do they use their patient portal? Are there other services they might benefit from, that can help improve their health in other ways? Armed with the right data, you can answer these questions and tailor your communications with each patient, ultimately helping them achieve better outcomes. What’s more, when you leverage consumer insights to improve your population health strategies, you’ll also create a better patient experience through improved care coordination, prompt referrals and timely information sharing—making the whole process better for everyone. Translating consumer data into intelligent business decisions With reliable consumer data sourced from Experian—an original-source provider and data steward when it comes to consumer privacy—you can learn more about your patients and make the right care management decisions to address the non-clinical barriers to health impacting the health of your members and your organization. Learn more about how to leverage consumer data to help improve outcomes for your patient population. Mindy Pankoke is a Senior Product Manager for Experian Health