Data and Analytics
As Spotify and Amazon can attest, digital technology plus personalization is a winning formula. Consumers want anytime-anywhere access to the services and products they enjoy, without having to sift through irrelevant information. They want tailored recommendations that will make their life easier. More than eight in ten consumers say they’re more likely to choose businesses that treat them like a person instead of just a number. The pay-off for business—and health plans—is huge: by paving the way for better services, better relationships and a better consumer experience, personalization boosts profits, too. There’s one challenge: delivering personalization requires data. Health plans that want to offer a member-centric experience need the right insights to build a complete picture of what individual members need and want. Yet many health plans are forced to work from stale or incomplete data, notably when CMS hands over a new list of members or a new employer signs on to the plan. A system like that makes it nearly impossible to provide meaningful personalization, and consequently, the member experience suffers. With originally sourced data and consumer insights, health plans can fill in the missing links in member profiles and maximize opportunities to improve the consumer experience. Here, we look at how three specific data-driven strategies could help your health plan attract and retain satisfied members and demonstrate digital excellence by using personalization to drive improvements in communications and care. Personalize member communications for maximum engagement By looking beyond simple demographic data and clinical information, health plans can discover what really matters to members. Consumer data provides detailed insights about the kind of content that will resonate most with the member’s lifestyle, interests and health circumstances. Health plans can tailor their marketing messages accordingly, by highlighting articles about the treatment of relevant medical conditions or sending reminders ahead of annual check-ups.Health plans can also discover when and how to communicate with members so they’re most likely to respond. When member profiles reveal who prefers an email or a text and when, health plans can elicit higher levels of engagement, improve the consumer experience and see better results from targeted outreach campaigns. Make improvement decisions based on the most relevant data Consumer insights can also be used to develop improvement plans that zero in on exactly what members need for the best possible health outcomes. Combining insights on patient behavior patterns with an understanding of the challenges facing individual members means health plans can segment members, so the right support goes to the right place.For example, efforts to drive up medication adherence are going to be far more successful if based off accurate and current member profiles. Specific members can be sent automated, personalized reminders to fill out prescriptions in good time before they run out. Compare that to a “spray and pray” awareness campaign using generic messages that are likely to be ignored. Data-led improvement strategies are operationally efficient and create a better experience for members. Help members overcome social barriers to health Finally, when member profiles include a snapshot of how social and economic factors influence their ability to access healthcare, health plans can take action to offer support. Closing the gaps in care that arise when a patient fails to turn up to their appointment or ends up being readmitted to hospital, can often involve quite simple solutions. If data suggests the member has small children, but there’s no other adult in the household, it makes sense to cross-promote childcare services. Similarly, if the member isn’t known to own a car, a health plan could offer information on free transportation.Understanding these social determinants of health can help health plans offer proactive support so members enjoy better health outcomes in the long run. Experian Health’s rich datasets give health plans access to member-level insights on more than 330 million consumers, with data analysis and automation tools to help make business decisions based on the most relevant, current data. Contact us to find out how we can help provide the personalized experience members are looking for.
Many thought the end of COVID-19 was in sight with the availability of a vaccine, and while that is somewhat true, an entirely new set of issues has arrived: how to properly administer and manage the vaccine. Now that a COVID-19 vaccine is approved and underway, providers need to execute a medical billing and coding strategy to sustain vaccination efforts. We interviewed J. Scott Milne, senior director of product management at Experian Health, about what’s changed and what providers can do to prepare. How can providers ensure that vaccine administration codes are billed correctly? The ICD-10 and CPT codes for the COVID-19 vaccine haven’t existed until now, which means providers have a new set of codes to learn and unfortunately, those codes seem to change or update almost daily. As more vaccines are introduced, more codes are also introduced, and not just for the vaccine as a whole, but for each specific dose of the vaccine. For example, dose one of the Pfizer vaccine will have a code that differs entirely from dose two of the Moderna vaccine. Keeping up with these changes isn’t only difficult for provider staff, who are likely already stretched thin, but they certainly don’t want to run the risk of submitting a claim with incorrect information. The errors are what result in denials or undercharges. A solution like Claim Scrubber ensures code sets are current on a daily basis – a necessity for times like these – but applies an extensive set of general and payer-specific edits before preparing the claim for processing. That means claims for vaccine administration are error-free before submission to the payer or clearinghouse. Providers can eliminate undercharges, boost first-time pass through rates and do away with costly, time-consuming rework. But proper coding is only the first piece of the billing puzzle. The second piece is to verify the accuracy of payment received from third-party payers. How can providers ensure that third party payers will reimburse at the contracted rates? Providers can certainly get reimbursed for administering the vaccine, but there are a lot of moving parts to keep up with. For example, both Medicaid and Medicare will reimburse providers for administering COVID-19 vaccines, but the percentage of what is covered will differ by carrier and the reimbursement rates can vary both by state and type of arrangement. Reimbursement rates will also vary amongst private payers. Then there is the variation in reimbursement based on vaccine type and dosage -- vaccines that require a single dose may be reimbursed at a rate different than those that require two doses. Even without the vaccine rollout underway it can be a headache for hospitals and health systems to manage multiple payer contracts and reimbursement methodologies. A solution like Contract Manager will pinpoint variance in reimbursement quickly and easily, accurately pricing claims and comparing actual allowed amounts to expected amounts. It is a tool built to adapt to changes within the industry, so providers can capitalize on emerging reimbursement schemes and changes in payer payment policies. It can also help identify sources and patterns of errors so recurring issues can be promptly resolved. The end result: the provider organization can the payer revenue that is due for vaccine administration. Interested in learning more about how providers can optimize vaccine-related reimbursements? Contact us. Other blog posts in this series: Segmenting your patient population for the COVID-19 vaccine Engaging patient segments with convenient, secure scheduling solutions Authenticating portal access with automation Optimizing reimbursements by capturing missing coverage
The urgency to move quickly and vaccinate the population has introduced an entirely new set of challenges for providers regarding patient identity. Many continue to leverage existing processes and solutions already in place, manually handling the pain points that come with them, but now at scale and at an unprecedented rate. As the rollout moves forward, the strain on provider resources will only deepen, as will the risks associated with patient misidentification. The data mess behind the scenes Many patients are registering for the vaccine through a patient portal. While the self-service nature of signing up for the vaccine via a portal is beneficial, patients are unfortunately able to register for a portal account more than once. In fact, some of our clients have reported seeing as many as 1,800 duplicate records created per day. Those duplicate records are generated from some individuals who forgot their log-in account information and opted to create a new account, and others who simply forgot they had an account. With the sense of urgency to secure a vaccination appointment, consumers are moving at a rapid speed and simply want to grab a spot with the quickest credentials available. Regardless, multiple registrations for a single patient will create duplicate patient information. Duplicate records are not only costly (the estimated cost of remediation is $96 per duplicate pair), but they are an incredible drain on staff productivity, and ultimately, they are detrimental to patient safety. Multiple records of a single individual pose a risk for potential allergies, reactions, medical history and more. Even more, it is detrimental specifically to the efficacy of the vaccine as it will be harder to gauge in real time how many patients have been vaccinated, and at what stage, and make it more difficult to truly understand what percentage of the patient population has actually been vaccinated. UIM: not another stop-gap solution Experian’s Universal Identity Manager (UIM) platform is tailor-made for a situation like this as it was developed to create a single view of the same patient with their most current information. The matching technology accurately identifies patients and matches records within and across disparate healthcare organizations, providing a more complete understanding of who a patient is, despite the data gaps or errors that may exist in patient rosters. With it, providers are not only preventing duplicate and overlaid patient records but UIM can also minimize errors and fraud in patient records. It additionally improves staff productivity by decreasing the need for record reconciliation—a benefit likely welcomed by many if they are continuing to see anywhere near 1,800 duplicate records per day. When integrated with a solution like Precise ID, providers can both reconcile duplicate records, and effectively stop them from being created in the first place. By automating the patient portal enrollment process, healthcare organizations can remove the manual processes associated with portal enrollment, optimize critical IT staff resources while securing patient information and support a positive patient experience. State-of-the-art identity proofing, risk-based authentication and knowledge-based questions help providers securely verify each patient’s identity as they enroll for the patient portal. Explore how Experian Health can help resolve and enhance identities as part of the vaccine management process and beyond, not only by resolving duplicate records, but also by enhancing records with the best demographic and social determinants of health data available.
While the various waves of vaccine priority may be largely defined, the ability for many providers to segment their patient populations based on those designations isn\'t always simple. Without accurate data, there’s a risk that some vulnerable patients will be missed out. We interviewed Mindy Pankoke, senior product manager at Experian Health, about the challenges in segmenting patient populations for the COVID vaccine and how providers can best overcome those challenges. How does addressing patients’ barriers to care increase vaccination rates? The early versions of this vaccination have two doses which comes with its own set of challenges. Getting a vaccination is one thing but getting people to follow up for a second dose in a certain time frame is another. It’s the non-clinical factors that will prevent patients from getting the vaccine. So, things like inflexible work schedules, lack of transportation or even the access or comfort levels with technology required to schedule an appointment online can prevent patients from receiving or prioritizing the first and/or second dose. It can be an uneven playing field with those patients that do not have more flexible schedules, a vehicle or even access to the proper technology to schedule and register for both doses. It’s much easier for patients to prioritize getting the vaccine when those non-clinical factors are a non-issue. What challenges may providers face when trying to segment patient populations for vaccine administration? There are a lot of gaps in patient demographics which can make it difficult for providers to accurately identify and segment patients. Think information like date of birth or occupation. If providers want to segment by age, which many will likely do for the first wave of vaccinations, that would require a complete record of every patient with an accurate birth date. Providers may also want to segment by occupation, knowing essential workers are also eligible for the vaccine. But how can you understand who is an essential worker? Especially when that definition may vary by state or local government? Including non-clinical insights and enhancing demographic data as part of the patient record can help providers fill in the gaps and better segment patient populations for vaccine administration. By combining the power of Experian’s consumer demographic information with more than 40 years of experience compiling consumer data from self-reported and state license boards, Experian Health is able to drill down into occupation data to view different types of employment (construction, utility, etc.) for you to use to outreach, verify and streamline the scheduling (and automated scheduling) or the COVID vaccination. What are some best practices to move from identifying at risk or priority populations and operationalizing that information into actually administering the vaccine to those groups? This is really where it all comes together, and really where providers need to act fast. Once a group is identified, providers can automate the process as much as possible. First, it is imperative that providers clean up their data. Recent processing of Experian’s Universal Identity Manager solution has identified 1,800 duplicate records in COVID vaccination registrations, for individual facilities. Providers can remove the duplicates, enhance the demographics where they may be out of date or missing, and put in place a proactive system to call out and prevent duplicates moving forward. And the vaccine has a shelf life, correct? So even after segmenting the right patients, how can providers act fast to ensure it is administered? So another best practice is to automate the scheduling for as many vaccination appointments possible. With a tool like Patient Schedule, providers can leverage the demographic data to programmatically push out a notification to a patient’s cell phone via IVR or text message, have them verify their eligibility based on the age or occupation data from Experian, and then allow the patient to book their appointment on the spot for a time that works best with their schedule. On the back end, the Patient Schedule solution syncs with the clinic or mobile vaccination site’s calendar to confirm the appointment, allowing staff the opportunity to tackle other pieces of the COVID vaccination strategy. Anything else you\'d like to add? Providers will also want to risk stratify using social determinants of health insight on the individual level. Patients in every wave of vaccine priority present an opportunity for better patient engagement (68% of the US is impacted by at least one social determinant of health hindering them from accessing or prioritizing their care). Many patients will need help adhering to that second dose and knowing that information and those circumstances on the individual level can help providers engage in the best way possible to ensure the vaccine is administered correctly. Interested in learning more about how Experian Health can help supercharge the COVID-19 vaccine management process?
If President Biden’s two trillion-dollar stimulus package is approved by Congress, support will include funding for a national vaccination program. While the arrival of the vaccine is an immense relief, the logistics for rolling it out across the country present a major challenge. Even at a rate of one million shots administered per day, it could still take 18 months to vaccinate 80% of the population. There are numerous supply, distribution and communication challenges to overcome, both at national and state levels. And for individual healthcare providers, mass vaccine administration calls for a holistic approach, to make sure the right patients get the right dose at the right time and place. Could data analytics and digital automation tools be the key to identifying, engaging and supporting patients as the vaccine program is rolled out? Here are 6 ways digital technology could help your organization improve vaccine management. 6 digital tools to include in your vaccine management plan Segment patient groups with consumer data Deciding who gets the vaccine first is only hurdle number one. Providers must then segment patient populations according to risk categories (such as age or occupation), so they know who should be at the top of the list. Without accurate consumer data, there’s a risk that some vulnerable patients will be missed out. The answer lies in data analytics. By synthesizing thousands of data points for more than 300 million Americans, ConsumerView gives providers the detailed insights needed to segment and target patient populations. At the tap of a button, providers can find out which patients are essential workers or in high-risk groups, so they can be channeled into the vaccine program without delay. Improve patient access and engagement with data insights According to the Kaiser Family Foundation, six in ten older adults say they don’t know when and where to get the vaccine. Many patients also face access barriers such as lack of transportation or childcare, or poor digital literacy. If providers don’t account for these in their outreach and engagement efforts, their vaccine program will fall flat. Consumer data can again help providers understand who their patients are, to identify those who might have trouble getting the vaccine. Insights on the social determinants of health can point to the best communication channels and support services to offer. Keep track of patient identities with secure patient portals If providers are reaching out to patients and encouraging them to schedule vaccine appointments through their patient portal, they must have confidence that the person signing up and logging in is who they say they are. The right security protocols can help validate and protect patient information. One example of identity proofing technology is Precise ID®, which uses knowledge-based authentication (questions only the real person would be able to answer) and device recognition to verify patient identities. Prompt patients to book a vaccine appointment with automated outreach Imagine if patients could receive a text or voice message notifying them that it’s time to schedule their vaccine, with a link and simple instructions on how to book. With automated outreach, providers can proactively text or call a segment of patients with self-scheduling options and specific messages about the vaccine and its safety. Not only will this help to increase vaccination rates, it’ll reduce call center volumes at a time when staff are already under pressure. Make it easy for patients to schedule appointments with online self-scheduling In order to meet daily goals for vaccine administration, it has to be easy for patients to book appointments. The last thing any provider wants is no-shows. By deploying scheduling software that ties vaccination qualification rules into the booking process, providers can match patients to a convenient slot, ensure they meet the correct segmentation criteria prior to booking, and confirm whether the appointment is for the first or second dose. And of course, an online self-service scheduling tool such as Patient Schedule allows this part of the patient journey to be completed with minimal face-to-face contact, minimizing risk of infection. Speed up reimbursement with automated coverage discovery Finally, providers must make sure that vaccine-related reimbursements run smoothly. CMS has ruled that every American should have access to the vaccine without incurring any out-of-pocket costs. But although the government may be footing the final bill, providers still need to seek reimbursement by payers, which means they still need a reliable way to check a patient’s coverage status. With Coverage Discovery, providers can run quick, comprehensive checks of commercial and government coverage, and identify the right payer for administrative services. Digital software and analytics can provide efficient, secure and convenient ways for providers to guide patients through the vaccine management process, without delay. Contact us for more information on how Experian Health can support your organization to deliver a vaccine management plan.
Consumers today want more flexible and convenient access to care, preferably through the self-service experience they are accustomed to in other areas of their lives. To answer this call, providers are turning to online self-scheduling, which allows patients to book an appointment with the provider of their choice any time of day or night via the comfort of their own home and on a mobile device. Incorporating a self-scheduling solution that reaps long-term success takes a specific strategy, and with the number self-scheduling vendors growing every day, it can be hard to know what to look for in a self-scheduling solution. How can providers be sure that their solution is scheduling patients effectively? Implement patient self-scheduling the right way. Online self-scheduling that automates scheduling protocols with customized business rules drives efficiency while ensuring bookings are accurate. If calling to schedule an appointment, schedulers will walk patients through a series of questions to determine the best possible provider and appointment time for their specific care need. The right scheduling solution should be able to seamlessly facilitate that question and answer process online. It not only ensures that patients are being matched with the right provider but keeps providers’ scheduling rules in mind throughout the entire process. For example, some providers may only designate certain days and appointment slots throughout the week for new patients. With those protocols included as part of the scheduling solution, providers can maintain control of their calendars while filling existing gaps.This is particularly vital during a pandemic like COVID-19 where to avoid further exposure and spread of the virus providers may only want to see patients experiencing those symptoms at certain times of day. The benefits are three-fold: schedulers, including call center agents and patients, see only appropriate appointment availability for a provider in real-time allowing them to book on the spot, providers can experience a more predictable schedule as they know their rules are being maintained, and patients can be assured that their health and safety is a top priority for in-office visits. Integrate with your EMR/PM system. Direct integration with any EMR/PM system is a key component for any successful scheduling solution as it provides everyone (patients, providers, health plans, and call center agents) with a continually up-to-date, real-time view of appointment availability. These integrations improve workflows behind the scenes while enabling the patient-centered aspect of the technology, which is the ability to book an appointment from a computer, phone, or tablet. Additionally, being able to provide a non-integrated scheduling experience for affiliated providers and other services is a vital additional offering that needs to be available outside the integration so that systems can open scheduling to all services. Having a solution that can do both is ideal. Offer a white-labeled experience. Customers remember and go back to brands they love, and that couldn’t be truer in healthcare. That is why it is important for organizations to deliver a consistent brand experience across the board—even with a self-scheduling solution hosted by an outside vendor. Leveraging a white-labeled scheduling solution promotes a strong brand experience and builds trust while saving patients the hassle and confusion of leaving the organization’s website to schedule via another. Moreover, many scheduling vendors require logins to their system in order to schedule, this is an unnecessary barrier to patient access. While useful for current or existing patients, a log-in may actually be a detriment to acquiring new patients or those who don’t yet have a relationship with your organization. Provide real-time scheduling (not just request an appointment). Unfortunately, many organizations claim to offer online self-scheduling, but the reality couldn’t be further from the truth. So many times, patients go through the entire online scheduling process to find out that they’ve only requested an appointment, and still have to wait for the provider to confirm and book, more often than not with a phone call which is what the patient was trying to avoid all along. Real-time scheduling means patients have the ability to view and actually choose their preferred appointment day and time and book right there on the spot. This also means that patients can book an appointment any time of day or night, outside of the provider’s business hours. Allow same and next day appointment scheduling. Many providers set aside appointment slots for their patients to schedule same- and next-day appointments for more urgent needs. These slots can be made available to patients online with a scheduling solution’s ability to automate business rules. Offering same- and next-day appointments online holds a few advantages: it’s certainly a competitive advantage against the growing number of standalone urgent care offices, but it also helps mitigate gaps in care as patients are less likely to present elsewhere for care. Send calendar reminders. The act of booking an appointment isn’t always enough to make a patient show up for scheduled care. Automated calendar reminders, specifically, ones that include .ics calendar files, sent to patients immediately after the booking process increase the chances that patients will show for their scheduled appointments. It’s a feature that dramatically reduces patient no-shows, which are often detrimental to the bottom line. Complement with automated outreach. Many health systems send automated phone and text campaigns to patients about their healthcare needs, but all of them still require a patient to call in to schedule an actual appointment. Minimizing the burden on patients could close more gaps in care, improve the patient experience and reduce call center workload at the same time. Automated, targeted outreach campaigns can help you do exactly this. With a simple text message or voice message, providers can prompt patients to book their next appointment right then and there, on the spot, as part of the text message or voice call.With automation, providers can contact and schedule more patients versus leveraging a call center to contact each person individually. And, when automated patient outreach is paired with digital scheduling, patients are far more likely to show up to appointments. Make referral scheduling easy. Providers can arm referral partners with dedicated scheduling links, making it easier for them to schedule certain services. These links can include a customizable Q&A that walks the scheduler through the booking process and allows them to schedule the referral appointment effortlessly and without a phone call. Internal referrals within a provider organization can be similarly managed with a digital scheduling interface. Where patients traditionally would have left the office with a list of providers to call for a follow-up, provider staff can now locate and book follow-up appointments for patients at the point of care before leaving. This not only improves referral capture rate but offers a better, more connected experience for patients as they can more easily navigate the continuum of care and, ultimately, achieve better health outcomes. Include availability on third-party scheduling sites. As providers open the digital front door to their practice, they will want to meet patients wherever they are online, outside of just the provider’s website. A sophisticated online scheduling solution will enable providers the ability to add scheduling links on third-party websites so that patients searching online for local providers or specialists can immediately see appointment availability down to specific days and times.Also, to ensure accurate bookings, the scheduling solution must be able to ask patients questions to ensure they qualify to book, ensuring that the provider’s calendar is protected while making access easier. Leverage analytics to understand your users. Where are patients dropping off during the scheduling process? What is the conversion rate? How many patients are actually showing up for their scheduled appointments? These are all important questions for providers to ask when gauging the effectiveness of their scheduling solution. The answers to each of these questions can refine and improve the scheduling process, and a sophisticated self-scheduling solution will come with real-time analytics dashboards and data science capabilities to help determine opportunities for improvement.Analytics and reporting can also be used to track capacity and utilization rates to help providers optimize their calendars and referral pathways. Analytics can provide insight into where referrals are being sent so that bottlenecks can be quickly and easily identified, and the behavior modified to better spread referrals across the network. The rise of consumerism in the healthcare industry is no doubt influencing the creation and adoption of self-scheduling solutions, among other digital technologies that improve patient access. As these technologies are more seriously considered, providers need to be aware of what to look for in a self-scheduling solution. Smart technology that incorporates the components above will stand out from the crowd, ready to fit the unique needs of any provider organization. Download our free guide to learn more about online self-scheduling and how it fits within an omni-channel access strategy.
There is no shortage of data in the healthcare industry. Unfortunately, more data doesn’t always mean better data – especially when it comes to patient information. A unique patient identifier (UPI) is a method for standardizing patient identification. Individuals are assigned a unique code, and that code, rather than a Social Security Number, name, or address, is what is used by healthcare organizations to identify and manage patient information. A standardized code like this not only protects sensitive health information but supports the exchange of data between healthcare organizations and states as it is a number and format easily read and recognized by all. While a UPI has yet to be nationally recognized and implemented, a foundation has certainly been made and the industry is perfectly poised to move forward. How a unique patient identifier is used in healthcare The UPI helps healthcare organizations link the right records together, preventing duplicate records from being created. There are many ways duplicate accounts or variances can occur: address differences, name variations, maiden names and even user entry error. With UPIs, providers and payers can link records together and have one complete record and view of the patient or member, ultimately leading to a better experience and increased patient safety. Without reliable records, patient safety takes a hit. Misidentification can contribute to incorrect treatments and adverse medication interactions that have had life-altering or fatal consequences. The UPI’s ability to achieve accurate record match rates for every patient and member also improves efficient, patient-centered care coordination, as well as population health management strategies, prescription drug monitoring programs (PDMPs), social determinants of health and more. It is important to note that the UPI is not a patient-facing number and is not known to the patient or provider. It does not collect or share any clinical claims or diagnostic information; its purpose is simply to link records together giving providers and payers a complete view of someone’s identity. The patient experience within a real network A healthcare organization’s ability to manage patient data is apparent from the beginning. An inadequate system can force patients to fill out forms they’ve already filled out multiple times or undergo duplicate tests as they travel between facilities. It can also confuse patients who have similar information, such as first and last names, during the identification process. In an ecosystem built around a strong healthcare network, these discrepancies can be avoided. Patients are given a unique identifier that remains consistent across every healthcare facility they visit, from physicians’ offices to hospitals, pharmacies, specialists, long-term care facilities, and more. All providers that patients visit know exactly who they are. And it isn’t just greater comfort and convenience that patients gain from a well-connected healthcare network. Managing patients and their data is vital for reducing medical errors. One Johns Hopkins study found that medical errors account for more than 250,000 deaths annually in the United States. Healthcare efficiency within a real network The challenge of managing patient data across the entire healthcare ecosystem isn’t new — interoperability has been a hot button issue for years now. While there are several master patient indexes that organizations can use to match patients with appropriate demographic data, these still include gaps, overlaps, and outdated patient information. These indexes can’t keep up with simple things such as name and address changes or data entry errors. Therefore, providers and payers who rely on them have trouble matching their patients and members accurately. A more effective solution involves combining these data sets to create complete identities and profiles, where every piece of new data is instantly updated and verified. For example, if a provider has a patient in their EHR twice under two spellings of the patient’s name in error, a UPI would link those two profiles, creating a singular view of the patient in that provider’s system. Similarly, a UPI can help facilitate interoperability between healthcare providers. For example, if a pharmacy has a patient listed under a maiden name but the doctor has that same patient under a married name, the prescription during the ePrescribing process might not get associated with the right profile. If both organizations have the UPI on record and submit it during the transaction, the systems will match the patient using the UPI. Every authorized care team member can immediately access the updated data related to a patient or member’s identity, which offers benefits far beyond treatment. For providers, this could mean increased collections. For payers, it could look like improved medication adherence. For example, ValleyCare Health System in northern California was struggling with hundreds of bills being returned each month because of wrong patient addresses. When the health system implemented an identity verification program, it decreased the amount of returned mail by 90 percent. The network effect in a nutshell Sorting through clinical data issues takes up a great deal of time. The administrative costs of healthcare account for nearly 8 percent of U.S. healthcare expenditures. By identifying patients through unique socioeconomic factors, healthcare organizations can more efficiently and accurately manage data and put it to good use. A healthcare network tied together by streamlined data management provides an environment where duplicate or inaccurate information is detected and corrected almost immediately. Both patients and members are accurately identified, and their data retains its quality at every stage of care. When combined with other patient engagement solutions, such as patient portals, data and identity management tools create the infrastructure needed for healthcare to truly become one cohesive, patient- and member-centric network. Unique patient identifiers in the news Until recently, the use of federal funds for the adoption of a national patient identifier (NPI) was prohibited. The ban has limited the Department of Health and Human Services (HHS) from interacting with healthcare organizations to develop and implement an NPI strategy. In the years since the funding ban put the brakes on a universal approach, many disparate software solutions have been created which don’t talk or share information with each other. Integrating these systems in an industry of this scale will take a concerted effort. The ban was lifted in July of 2020, giving HHS the ability to evaluate a full range of patient matching solutions and enable it to work with the private sector to identify a solution that is cost-effective, scalable, secure and one that protects patient privacy. Karly Rowe, Vice President, Patient Access, Identity, and Care Management Products at Experian Health believes that “private-sector entities have already developed the technological foundation for data interoperability through the creation of UPIs that are maintained in a master person index.” These solutions are vendor neutral, meaning data can flow freely between disparate electronic health systems, regardless of size or location. With federal funding back on the table, “UPIs could be adopted with government oversight of private sector offerings and the creation of national standards to ensure quality patient matching and identification.” At the end of 2019, Experian Health announced that every person in the United States (about 328 million Americans) had successfully been assigned a unique UPI, powered by Experian Health Universal Identity Manager (UIM) and NCPDP Standards™ (the “UPI”). Combining Experian’s expansive data assets and innovative UIM technology along with the unique ability NCPDP brings to share the UPI throughout the healthcare ecosystem using the NCPDP Telecommunication Standard and its SCRIPT Standard, each individual in the U.S. that has received medical care or utilized a pharmacy has been processed through the solution and assigned a UPI. As new patients enter the healthcare ecosystem, this number will continue to grow. Learn more about unique patient identifiers Having a single, unified and accurate view of patients and members is a challenge that plagues the healthcare system. Now, there is promise of a comprehensive solution that reduces the barriers to make healthcare safer. Interested in learning more about unique patient identifiers and how Experian Health can help?
Experian Health products referenced in this blog post: Patient Financial Clearance Coverage Discovery Collections Optimization Manager Healthcare may be historically more recession-resistant that other industries, but the COVID-19 pandemic has left many providers hurting financially, as many patients struggle to pay their bills. Patient collections were already a challenge, with declining Medicaid coverage and rising co-pay obligations putting patients on the hook for more of their healthcare expenses. Now, with millions of Americans out of work and missing out on employer-sponsored insurance, providers are being forced to adapt their collections processes to fit this unstable insurance landscape, or risk losing more dollars to bad debt. Four key strategies can help providers seal the cracks in patient collections and stem the surge in uncompensated care. With compassionate processes that treat each patient as an individual, providers can use data and automation for more efficient healthcare charity screening, find missing coverage and identify both propensity to pay and the best financial pathway to minimize the chances of bills going unpaid. 1. Screen for charity eligibility early and often Nearly 4 in 10 unemployed Americans have been without work for more than 27 weeks – the most since November 2013. As unemployment persists and benefits dwindle for many, more patients may be eligible for charitable support to cover their healthcare costs. Running presumptive healthcare charity screening as part of the collections workflow can help providers identify those who should be getting extra support. Patient Financial Clearance runs automated checks when a patient registers, so individuals can be automatically enrolled as soon as eligibility is confirmed. Checks are repeated throughout the patient journey, should their financial situation changes. Caye Mauney, Patient Access Director for Palo Pinto General Hospital, says the automated checks can confirm eligibility within just three seconds. This saves a huge amount of time for her team, while giving patients financial clarity without worrying waits: “All the information we need is now at our fingertips. The patient no longer needs to bring in check stubs or go back to a former employer to ask for information. It’s been a game changer.” 2. Find forgotten coverage quickly Automation can help providers cut uncompensated care by finding missing and forgotten coverage, even when patient case mix and payer rules are constantly changing. Healthcare organizations that quickly uncover previously unidentified coverage are often are paid sooner and avoid the collections challenges of self-pay receivables. Experian Health’s Coverage Discovery uses best practices around search, historical information, multiple proprietary data sources and demographic validation to find previously unknown coverage. It continuously scans for insurance coverage to maximize reimbursements and minimize accounts sent to collections and to charity. Learn from Banner Health how Coverage Discovery has helped the organization find 30+% unidentified coverage earlier in the revenue cycle. 3. Improve the collections experience with compassionate billing Speedy coverage checks are just one way to give patients peace of mind when it comes to medical expenses. The collections process is often opaque and intimidating, hitting patients when they’re already stressed and vulnerable. The more compassion that can be built in, the better the patient financial experience will be. Unpaid bills go down, while patient loyalty goes up. Transparent pricing, data-driven payment plans, personalized communications, and easy ways to pay all contribute to a positive patient financial experience. A good place to start is with Collections Optimization Manager, which allows providers to segment, support and monitor patients throughout the entire collections cycle. By connecting to a host of other patient-facing tools, this helps members feel taken care of from start to finish. 4. Use data to put patients on best payment pathway None of these strategies will work without reliable, accurate data. Healthcare organizations traditionally rely on demographic and behavioral datasets, but this leaves gaps in how much is known about patients’ financial situations. Incorporating credit data can add a layer of valuable insights about a patient’s propensity to pay, so collections resources can be directed to the appropriate accounts. If it is clear a patient has a missed mortgage payment or delinquent loans, providers can help them find alternative coverage and redirect them to a better payment pathway. Experian Health combines demographic, behavioral and credit data so providers can help patients navigate their health expenses with confidence. The result? Better financial health for all. Find out more about how to optimize patient collections, whatever 2021 has in store, in our recent eBook, Recession-proof your revenue cycle.
There is no question that providers’ bottom line has been hit hard this year, and a new surge in COVID-19 is bound to threaten hospital finances once again. As healthcare providers look to supercharge their payment velocity during these uncertain times, it’s worth taking a step back to examine the revenue cycle management process as a whole: what it is, how it works, and the clear actions providers can take to improve the process overall. Below is an overview of healthcare revenue cycle management and how specifically providers can improve their bottom line now and after the pandemic subsides. What is revenue cycle management? Any business, regardless of industry, needs to develop successful processes and strategies for remaining financially healthy. For hospitals and health systems, that process is revenue cycle management. To run a successful healthcare organization, providers must employ and manage accurate and efficient billing processes. Without it, these organizations will likely have to close their doors and will, as a result, no longer be able to provide quality care for their patient population. How revenue cycle management works in healthcare To put it simply, in order to generate revenue for their organization, providers need to collect payments for services rendered. The process of doing this, however, isn’t always as straightforward and simple as it seems. Think of healthcare revenue cycle management like a journey. It starts when a patient schedules an appointment and ends when all patient payments for medical service(s) received have been collected. As we move through the journey, providers have a lot to manage, starting first with front-end intake process, moving all the way through the back-office operations to ensure payment is ultimately secured. Phases of the revenue cycle management life cycle The revenue cycle management life cycle spans several phases: Schedule visit and secure estimate. To kickstart the process, a patient will book an appointment with a provider or specialist and administrative staff will handle insurance eligibility verification and ultimately establish a patient account for that organization. This is also an opportunity for providers to offer price transparency and provide an estimate for services to be rendered. Registration and check-in. An early and vital step for optimizing the entire revenue cycle management process, this is where providers capture details like medical history, insurance coverage and other patient demographics. Ensuring correct patient information on the front end reduces the errors that cause rework in the back office. Ensure care is authorized by the payer. Still on the front end, this is where provider staff checks whether prior authorization is required for a particular procedure or service. Not securing authorization in advance of service can lead to costly denials, rework, operational inefficiencies, and a poor patient experience. Receive treatment and discharge. Once the patient is discharged, the services provided will be translated into billable charges and a medical billing code will be assigned to the claim. It is crucial to the revenue cycle that these claims be accurately coded, as the re-work for incorrect codes and subsequent claim rejections can be costly and a drain for productivity. Medical claims submitted. The claim must then be submitted to the payer. Submitting accurate and timely claims maximizes the revenue collected and prevents delays in reimbursement. Rejected claims directly affect an organization’s revenue cycle, making it all the more important to get the claim right before it makes its way to the payer. Even if a claim is denied, is important it be resubmitted as quick as possible. Patient payments and collections. Once insurance reviews the claim and provides their reimbursement, patients are presented with their out-of-pocket costs for services rendered. On-time payments made in full are preferable for a healthy revenue cycle, but that isn’t always feasible for patients, especially now given the current environment with COVID-19. This is where quality collections practices can really help to optimize patient payments and reduce bad debt. Challenges in revenue cycle management Any process with this number of touch points is bound to come with challenges, but two major challenges seem to stand out: claims and collections. Navigating healthcare claims is complex and costly. Providers and facilities often get stuck in a cycle of inaccurate claim submissions, denials, corrections and rebilling that delays reimbursement and negatively impacts financial performance. A lot of denials can be traced back to errors within the claim submission: improper coding, issues with insurance eligibility, missing or inaccurate patient information, or duplicate claim submission. Errors like this on the front-end are a major cause of the headaches experienced by providers further down the line. After claims are submitted, provider staff will monitor and keep track of claim status. Surprisingly, many still use a manual process not only for this, but for managing any claims that are ultimately denied. Without any kind of automation, this is a drain on productivity, time and resources and it becomes more difficult for providers to respond to denied, pending or returned claims in a timely manner for reimbursement. Another prominent challenge in the revenue cycle is collections, notably collecting from patients before or at the point of service. Providers would prefer to collect from patients prior to them leaving the office, but it’s not always possible, and for a few reasons. Patients are increasingly unable to pay their medical bills, more are presenting as self-pay (maybe now more than ever during the pandemic), and some may not be aware of subsequent coverage or that they qualify for charity assistance, all which directly impact providers’ abilities to collect. A lack of price transparency for services can make it even more difficult for patients to prepare financially. Benefits of revenue cycle management Despite its challenges, when done right, there are many benefits of revenue cycle management in healthcare. Effective revenue cycle management not only improves the patient experience but improves staff satisfaction as well. Automating the process (billing, coding, claims management, etc.) reduces a lot of the associated administrative burden, which allows providers to focus on the delivery of quality care. An optimized revenue cycle will also lower the rate of denials. As errors and redundancies are addressed and prevented on the front end, fewer claims will be denied. Maybe one of the most obvious benefits of a healthy revenue cycle is maximized collections and revenue, and faster collection processes, especially when the process is automized. The entire collections process can be expedited, lowering administrative burden while also improving accuracy. How to improve your revenue cycle management We recommend providers take a holistic approach to improving revenue cycle management, focusing largely on automating the process and within the following four areas: Automate access Patient access is the starting point for the entire revenue cycle process. Ensuring correct patient information on the front end reduces the errors that cause rework in the back office. patient access. With an automated, data-driven workflow, providers can reduce the errors that lead to claim denials while simultaneously improving access to care for patients through capabilities like online scheduling. Access is further improved by reducing the friction around patient billing by leveraging real-time eligibility verification to deliver accurate patient estimates at registration. Increase collections There is a definitely a delicate balance between ensuring that debts are collected and fostering a positive patient financial experience. It is imperative providers find a way to maximize patient collections while also increasing patient satisfaction. Patient access staff must be the patient’s advocate while also improving the organization’s ability to collect from the patient and payer. By leveraging a data-driven approach, staff can verify patient identity and insurance coverage as well as provide an accurate estimate of payment responsibility ahead of service. Staff even can review data to assess ability to pay and evaluate various payment plan and/or financial assistance options. The further upstream the revenue cycle can be managed the more effective the process will be to ensure the patients are informed prior to service, so they can make their portion of their payment responsibilities as early as possible to accelerate the cash collections for providers and to reduce the need to put significant effort into late stage collections. Streamline claims Providers can improve financial performance with automated, clean and data-driven medical claims management. By integrating claims management software with customized edits into the workflow system, providers can thoroughly review every line of every encounter and verify that each claim is coded properly and contains the correct information before the claim is invoiced and submitted for reimbursement. Encounters can be processed in real time with automatic alerts for incorrect codes or other potential issues before the claims submission. Responses include a detailed explanation of why a claim was flagged, so any necessary modifications can be made prior to submission. Increase reimbursement Healthcare organizations that don’t stay current on payer policy and procedure changes risk payment delays and lost revenue. It can also be difficult for providers to verify the accuracy of payment received from third-party payers. With automated access to the right data, providers can be reimbursed more accurately and quickly, while also strengthening their relationships with payers. Providers can avoid payment delays and lost revenue with automated payer policy and procedure change notifications. Solutions that continuously audit payer contract performance can assure that collections align with negotiated terms. The key for successful revenue cycle management Technology, specifically data and automation, is key to the success of the healthcare revenue cycle. Automation ensures problems don’t continue to effect productivity, and data can be matched precisely to predict, model and optimize financial results. Both can also be used to highlight a patient’s financial situation, as well as their propensity to pay, allowing providers to optimize collection strategies from the start and get patients on the right programs.
