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It’s almost time to say goodbye to Health Insurance Claim Numbers (HICNS). Earlier this year, the Centers for Medicare and Medicaid Services (CMS) began the process of removing HICNs from Medicare cards, replacing them with a new Medicare Beneficiary Identifier (MBI). From January 1, 2020, CMS will only consider claims bearing the patient’s MBI number. With 150 million numbers issued to active and archived beneficiaries, the scale of the change could have a major impact on providers and their billing processes. Here, we look at how healthcare organizations can ensure they’re as prepared as possible. Why change to a Medicare Beneficiary Identifier? The shift to MBIs is an effort to protect patient information and address the vulnerabilities that come with relying on Social Security Numbers (SSN) to verify patient identities. HICNs are tied to an individual’s (or their spouse’s) SSN, which, according to cybersecurity experts, is an increasingly lucrative route to stealing someone’s identity. In 2018, over 1200 data breaches were reported, with over 400 million records exposed. Of these, SSNs were the most commonly exposed piece of data across all industries, with the exception of the healthcare and medical sector (which is affected nevertheless, given the industry’s widespread use of SSNs). Once a fraudster has their hands on someone’s SSN, it’s all too easy for them to create a fake identity and wreak havoc on that person’s life. What’s more, criminals can currently use SSNs in this way to access medical services or drugs under someone else’s name. Medical fraud is thought to cost between $80 and $230 billion annually in the U.S. If SSNs are no longer a means of confirming medical identities, the emotional and financial costs of medical fraud can be avoided. So, while plans for funding a national patient identifier may have been stalled for now, the MBI represents a significant step forward to protect patients from identity theft, keeping their information safe and reduce the likelihood of medical fraud. What does the transition to MBIs mean for your organization? Like the implementation of ICD-10, this is a huge transition for CMS and providers alike. Most providers are already using both numbers to manage patient claims, with 76% of fee-for-service claims submitted using the MBI for the week ending July 5, 2019. You can continue using the HICN for Medicare transactions such as billing, confirming eligibility status and checking claim status until the end of this year, but after that, Medicare will deny claims that don’t include the MBI. There are some exceptions, but the general rule is that claims must be submitted with the MBI, no matter when the service was provided. How should providers prepare for the MBI transition? The lower your denial rate, the healthier your revenue cycle will be. To avoid unnecessary denials as a result of the MBI transition, providers should consider the following strategies to ensure a smooth transition: Check systems and procedures Your software systems, automated processes and patient-facing procedures should already have been adapted to accept MBIs. Ensure your staff have processes in place to check and add new MBIs for existing and current Medicare patients. Remember, you’ll need to continue tracking HICNs alongside the new MBIs for the lifecycle of current claims. Appeals will use whichever identifier was used to submit the original claim. Reach out to existing patients The MBI won’t affect Medicare benefits, but recipients should all have received their new number and will need to use it to access services. Make sure existing patients are aware of the change and encourage members to update their details via their patient portal. Remind them to bring their new Medicare card to future appointments. Obtain an MBI for new patients When new patients register with you, ask for the new MBI. If they don’t have it, you should be able to look it up using your Medicare Administrative Contractor’s (MAC) web portal. Train staff so they know what to ask, how to use the MBI and how to answer patients’ questions. Alternatively, for about the past year, when a claim has been submitted to Medicare with a HICN, Medicare has returned the MBI on the remittance (835 file). This is something that can be used to create crosswalks. Optimize for cleaner claims One major effect of the change is that your existing method for carrying out Medicare scrubs, where SSNs could be used to check for Medicare eligibility based on demographic information, will no longer be possible. Consider a solution such as Claim Scrubber and Registration Quality Assurance to improve the accuracy of Medicare eligibility information. Encourage good data protection hygiene This is a chance to review your data protection practices. Consider whether there are additional steps you could take to safeguard your patient data and prevent medical theft. Are you ready? Experian Health’s Coverage Discovery tool already contains many patient MBIs through its historical repository, which grows every day. This historical repository contains a dataset of MBIs, which will allow us to continue searching for and presenting Medicare coverage to our clients when the transition period ends. Are you ready for this change to take place? Let’s schedule some time to review your coverage solutions and see if we can help improve your collection process.
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
They don’t make medical diagnoses. They would never prescribe clinical treatment. They may not ever be in the same room as your patients. Still, your healthcare organization’s marketing team are on the frontline when it comes to improving patient outcomes. The rise of healthcare consumerism means patients have come to expect the same frictionless experience they often receive in retail and financial services. For healthcare providers who want to deliver an outstanding patient experience, this means using data and insights about patients’ lifestyles, behaviors and preferences to personalize the content, timing and frequency of your communications. By connecting patients to the right information at the right time, consumer-driven marketing strategies lift engagement and help patients access care, in turn driving improvements in patient outcomes. The benefits of a consumer-focused marketing strategy According to Gartner’s 2017 Customer Experience in Marketing Survey, 67% of companies said they compete on the basis of customer experience. This goes to show the growing importance of understanding customer interactions and how those can result in greater customer satisfaction, loyalty and advocacy. Healthcare providers can learn from brands in other fields that are already using data-driven marketing to create a better consumer experience and drive business growth. For example: Amazon makes it easy for customers to purchase additional items, with the use of ‘one-click’ buy buttons and helpful recommendations based on previous buying behavior Walmart Online reminds you when you’ve forgotten to add one of your usual household staples to your cart Twitter suggests news articles that may be of interest, based on what you’ve liked and shared before Google knows you’re more likely to respond to a nudge to sign up for Google Pay when you already have a Google account, because you’re already part of their digital ecosystem These brands use consumer insights to tailor content at every opportunity. They segment audiences based on lifestyle and behavioral data, so specific consumers only see the most relevant messages. In the same way, a consumer-focused healthcare marketing strategy can help providers attract new customers, provide timely and relevant information to current members, and boost brand loyalty. How to use consumer data to give patients the right content at the right time Whether you want to reach a busy parent seeking the best pediatric care for their child, or an elderly patient looking for advice on how to stay active—data and analytics can help you identify the consumers your health system wants to attract AND give them the most useful content as they move through your system as consumers. It’ll tell you whether a text message as they leave work at 6 pm would be most likely to garner a quick response, or whether a weekend email guiding them to their patient portal would be a better way to help them make informed decisions about their care. The essential ingredient here is reliable consumer data. Data that’s outdated, lacking key customer attributes or of questionable integrity is going to be unhelpful as a marketing tool. You must also maintain compliance with consumer privacy best practice. But when you’re armed with the highest quality lifestyle, demographic, psychographic and behavioral data, you can start to understand what the patient is thinking, feeling and doing at each point in their patient journey. What does daily life look like for your consumers? How much can they afford? Would they be likely to compare prices and shop around for services, or would they prioritize ease of use or quality? Do they prefer to handle ‘life admin’ on a mobile device or by phone? What time of day will they be most receptive to information from a service provider? When you know what information will be most helpful to your patients, you can create relevant content and segment your marketing campaign to deliver the right information, at the right time, in the right format. Once you’ve done that, analytics can also allow you to monitor and track the response to this tailored content, to evaluate and refine the strategies that are working best. Working with a data partner to leverage consumer insights Leveraging consumer insights is somewhat uncharted territory for many healthcare providers, but you don’t have to go it alone. Partnering with a reliable third-party vendor can help you navigate the world of data security and compliance and become nimbler in your communications with patients. Karly Rowe, Vice President of New Product Development, Identity and Care Management Products at Experian Health explains: “Understanding how the right data can transform your patient experience will continue to grow in importance for healthcare providers who want to make a successful play for market share. As the sheer volume of healthcare data grows at an astronomical rate, it’s essential to know how to draw out the most useful insights. You need to know where to source the highest quality data and how to deploy it effectively within your organization to drive proactive engagement with patients.” For organizations looking to improve patient retention and engagement, Experian Health offers access to datasets encompassing the most comprehensive resources for building strong relationships with your customers. By showing your patients you understand their health aspirations and offering the personalized experience they’re seeking, they’re more likely to continue logging in to their portals, showing up for appointments, and engaging with the services they really need to improve their health.
Last week, I attended the ONC Symposium on Patient Matching for Prescription Drug Monitoring Programs (PDMPs) and conversations with pharmacy stakeholders confirmed that momentum is growing for an industry-wide solution to the patient matching challenge. Recent legislative movements could see a removal of the ban on federal funding for a universal patient identifier (UPI), while within the industry, we now have a range of exciting collaborations and innovative solutions on the table to help improve patient identity management. As someone who works closely with pharmacy leaders, PDMP administrators, health IT experts and standards organizations, I’m optimistic about what patient matching technology could mean for the pharmacy world. Here’s why. When life doesn’t match health events In today’s healthcare system, patients move through several facilities and services, seeing multiple doctors, pharmacists, nurses and other clinicians. In between those interactions, life happens. A patient might move to a new house. Get married. Have kids. Relocate to a different state. Maybe they visited Pharmacy A for their medications while living in San Francisco, but delivered their first child in Hospital B, after moving to Los Angeles with a new surname and different address. How does the health service know this is the same person? Who is keeping track? Patients with similar names can have their records combined, while data entry errors lead to the same patient having multiple unmatched records. The ONC itself has found that 10-20% of patients may not be correctly matched to their entire medical record within an organization, rising to 50-60% when data is shared between organizations. For pharmacists, the fact that nearly 80% of prescriptions are delivered electronically means the opportunities for data entry errors to creep in is worryingly high. How can they be sure that the prescription they’re holding is for the patient across the counter? A prescription in the wrong hands could be fatal. PDMP facilitators face the same problem when trying to improve patient match rates for the proper tracking of opioids. Since the data comes from various sources, often formatted differently and not always including required fields, PDMPS are forced to do the best they can with what they have. To further complicate the issue, states across the U.S. do not have a common, underlying method of uniquely identifying patients to be able to exchange information across state PDMPs. While PDMPs establish central repositories of prescribing and dispensing records of medications classified as controlled substances that can be accessed online by authorized individuals and agencies—individual state PDMPs vary in required prescribing information and in data submission time, usually with a week or more of delay. An additional challenge exists since not all programs share their data with other state PDMPs, preventing information exchange and reducing the effectiveness of the programs. The answer is to have a single, complete picture of each patient that can be accessed by all relevant organizations in the healthcare ecosystem – but how close are we to achieving true interoperability? Why EMPIs aren’t the answer The common solution historically has been to use an enterprise master patient index (EMPI) to link all versions of a patient’s record within a health eco-system (such as in a pharmacy, a physician’s office, or a PDMP). The problem is these usually rely on limited historical and demographic information, which may have gaps or errors that end up being replicated in any service using the EMPI. A universal patient identifier that integrates patient information from reliable health, credit and consumer data sources can give pharmacies and other providers a much more comprehensive view of their patients than traditional matching approaches. Referential matching technology, as recommended by Pew researchers, uses unique identifiers and third-party data to provide continuous updates to the master patient index, so you know you’re giving the right prescription to the right person. Collaborating for better patient matching solutions One example of how this is already being used to link patient prescription data at scale is in Experian Health’s collaboration with the National Council for Prescription Drug Programs (NCPDP), which sets the standards for the digital exchange of pharmacy-related healthcare information. Lee Ann Stember, President of the NCPDP, says: “We needed a single, unified and accurate view of the patient that could address the patient safety and business issues that plague our healthcare system.” To this end, we’ve teamed up to create a patient matching solution that provides a framework for establishing a unique patient identifier across the entire US healthcare network. This is a vendor-neutral, cost-effective solution that lets providers exchange information efficiently and accurately. There’s less chance of a prescription being given to the wrong patient and causing unwanted and even fatal interactions. In August 2018, NCPDP working groups approved the UPI as a standard field. This means the UPI may be used by other partners to improve the accuracy of patient data exchange. The PDMP Reporting Standard was among those identified as suitable for communicating the UPI. With this standard, pharmacies will be able to submit the UPI directly to PDMPs so that patients can be matched using the UPI instead of probabilistic or manual processes. A UPI can help states who share data improve their matching because it is a real-time solution that will feed into the management of controlled substance prescriptions across state lines, creating better visibility into interstate prescriptions and more importantly improving patient safety. The current lack of transparency into controlled substances—who is filling, when they are filling, how often they are filling, etc.—is feeding the national opioid epidemic which is taking a significant human and capital toll. Working towards an industry-wide solution Our strategic alliance with NCPDP was inspired by a shared desire to leverage data for the common good. We want to give more providers the opportunity to benefit from this UPI solution, to help address some of the patient safety challenges facing the healthcare industry. That’s why Experian Health is offering access to our Universal Identity Manager (UIM) Batch product for no charge. This tool strips out duplicates in your patient data and gives you a UPI that can be used across different health entities, enabling secure information exchange. It can even provide updated demographic information using the United States Postal Service CASS address standardization. Given the advances already made in trialling innovative solutions for the secure and accurate exchange of prescription data, the pharmacy industry is well-placed to lead the way in adopting more comprehensive and reliable patient matching frameworks. As we know, better data means better care. More accurate patient matching not only improves patient safety, but allows for better care coordination, financial savings and greater operational efficiency. — Find out more about how the Universal Identity Manager and other identity management solutions can help pharmacies improve patient matching. Matt McGrath is Vice President of Pharmacy Strategy and Solutions at Experian Health.
For many patients, the unknown cost of unexpected care is a source of anxiety: two-thirds of Americans are “very worried” or “somewhat worried” about being able to cover unexpected medical bills. No wonder, when around 56% say they wouldn’t be able to afford an unexpected bill over $1,000. In cases where insurance doesn’t cover the entirety of the bill, responsibility for paying the balance falls to the patient. The lack of price transparency leads to confusion and stress for patients, and unnecessary administrative costs for providers, who are left to chase payments from growing numbers of self-pay patients. Moving towards more transparent pricing Traditionally, patient billing has been calculated at the end of the revenue cycle, after insurance adjustments have been made. In recent months, a push for meaningful price transparency is emerging as a result of consumer demands about the cost of care, pressure from governing bodies, and bipartisan support for a legislative solution to surprise billing. In response, healthcare organizations are increasingly looking to move patient billing to the front of the revenue cycle, to give consumers greater clarity about what to expect when their bill arrives. Estimating patient liability is far from simple. It calls on front office staff to make complicated calculations based on insurance benefits, charges, contractual adjustments and provider discounts. If staff are doing this manually, they may find themselves using outdated pricing lists that don’t include current insurance information, rates and discounts. So how should providers ensure their front office staff have the right tools in place to give accurate, personalized estimates for each patient? Data-driven technology can help reduce surprise billing Data-driven technology that automates, simplifies, and unifies the revenue cycle can ensure timely communication on billing between healthcare providers and insurers. This means your front-office team can base estimates on accurate, up-to-date information. To reduce the risk of errors creeping in, price transparency and collection practices should be standardized across the enterprise. A pricing transparency tool eliminates the need for manually updated price lists and removes the guesswork that often leads to mistakes. It can also include reporting features that let you track potential and actual collections, so you have greater insight into the opportunities for revenue cycle optimization. Helping patients navigate the cost of care As patients bear more out of pocket payment responsibility, they expect a better consumer experience. Creating an optimal patient collections strategy and frictionless experience is ever more important. Full transparency calls for accurate and up to date pricing to be available to patients before they receive care, along with a detailed breakdown of what their insurer will cover. When they know what the difference is, they’ll know upfront how much they’re likely to need to pay. Additionally, clear and proactive communication around the billing process can help eliminate the shock factor, improve the patient collections process, and create a better patient financial experience all round. You could provide a text-to-mobile experience that delivers a text message with a secure link to the patient’s estimated bill. Or you might integrate a price transparency tool into your patient portal or mobile app, that lets patients see a personalized cost breakdown based on real-time pricing and benefit information, alongside methods for secure payment. A price transparency tool can also help you gather insights into a patient’s financial situation and propensity to pay, so you can optimize your collection strategies from the start and get them onto the right program. El Camino Hospital in California set an organizational objective to improve price transparency. Terri Manifesto, Senior Director (Revenue Cycle) says: “We decided to do a soft launch of a patient estimator tool, and the very next day, even without advertising it yet, our patients found the tool on the website and started using it. The feedback was excellent. We’re providing a lot more estimates than we could before because it’s 24/7 and patients can use it on their mobile device, their laptop or their desktop. Some advice I’d give other hospitals is to think of the patient when you’re deciding what to do to best communicate your prices. What would the patient want?” Working with a partner such as Experian Health lets you combine industry-leading technical expertise and payment tools with your own knowledge of your patients, so you can create the best payment experience for your consumers. Using data-driven technology, you can work to eliminate the pain of surprise bills and promote price transparency, resulting in greater revenue opportunities and customer loyalty.
Most healthcare consumers spend only a tiny fraction of their lives in the clinical world of medical appointments and procedures. Where and how they spend the rest of their time has a far bigger impact on their health and well-being. So why are some providers still relying primarily on clinical data to devise their care plans? Clinical data is crucial when it comes to a patient’s diagnosis and treatment options, but it tells you nothing about their ability to stick to a care plan when they get home. How do their living situation and lifestyle habits play into the physician’s treatment recommendations? Consumer data is the missing piece of the healthcare jigsaw. When providers have insights into their patients’ social and economic circumstances, they’re better placed to spot the factors that might hinder access to care, and offer a more holistic, tailored and effective support plan. The predictive power of consumer data Let’s imagine a single mom of two small kids, working two jobs. Her daily life is a race to get everything done on time, give her children what they need and still make ends meet within her weekly budget. When a reminder for her annual wellness appointment flashes up on her phone, she adds it to her mental to-do list. But by the time the appointment comes around, the stress of taking time off work and scraping together the cash for gas or bus fare means she puts it off. She doesn’t go. Six months later, she ends up in the emergency room with symptoms of a serious illness. Had her provider known about the barriers in advance, they could have supported her to get to her appointment and discover her illness sooner. As Dr. David Berg, co-founder of Redirect Health says, “the most important part of getting good results is not the knowledge of the doctors, not the treatment, not the drug. It’s the logistics, the social support, the ability to arrange babysitting.” Consumer data, such as car ownership, employment status, income level and family information can give you these insights early enough to take action. You’ll know whether your patients can get to their appointments easily, whether they can afford childcare, and a whole host of other factors that might affect their ability to stick to a care plan. And once you know those things, you can offer tailored support to give them the best chance of success. How to gather non-clinical insights According to PwC, around 78% of providers lack the data to identify patients’ social needs. Many have basic demographic information on their patient populations, but are missing the more sophisticated insights that could help them better support patients. It doesn’t have to be complicated, but there are a few considerations healthcare providers should vet as they gather and use consumer data to help drive care plan compliance: Evaluate the pros and cons of patient surveys The obvious way to find out more about your patients’ needs is to ask them directly. A survey at the point of registration can help you understand what barriers may prevent them from attending appointments, taking prescriptions or following other medical advice. However, surveys can be time-consuming and expensive to administer, and recording answers by hand can lead to errors. How a patient interprets the questions and how your team interprets the answers may affect the usefulness of the survey data. And a patient’s circumstances may change between completing the survey and trying to follow the care plan. This approach also only includes patients who manage to attend an appointment in the first place. Those without access to care such as the mom in the example above, would be omitted from the survey, so you would miss out on discovering how to help them. Tap data vendors to deepen your consumer insights A third-party data vendor can give you access to data on your patient population’s income, occupations, length of residence and other social and economic circumstances. When this data is packaged up for your care managers, it can be used to inform proactive, preventative conversations with your patients, to solve any non-clinical gaps in care. It’s more cost-effective than patient surveys and removes the risk of personal bias and interpretation. Ensuring the reliability and integrity of your data vendor can be a challenge. Data brokers often use consumer data collected in retail and other industries, which may not be completely relevant to your activities or collected in a way that meets the requirements for use in healthcare settings. It’s crucial to be able to verify the source of the data and confirm that individuals were told how their data would be used and given the choice to opt out. Always ask your vendor if they are an “original source compiler.\" Working with a data vendor in the health space, such as Experian Health, can help avoid these pitfalls, as they will have expertise in the appropriate use of consumer data in healthcare. Understand permissible use of consumer data to stay compliant To use consumer data successfully, you must have confidence in both its accuracy and your ability to safeguard patient privacy. For example, are your data collection processes compliant with the General Data Protection Regulation (GDPR) and the California Consumer Privacy Act 2018 (CCPA)? Working with a data management partner who collects data directly from consumers means you can verify that all privacy requirements and opt-outs are in place. They’ll also help you scrutinize hundreds of public and proprietary data sources, so you use only the most relevant, up-to-date data to inform your decision-making. By evaluating and understanding these three areas, you’ll be able to leverage consumer data to tailor your patient engagement and support and make it easier for your patients to comply with their care plan. The more you are able to see and treat each patient as a whole, individual person, the better their health outcomes are likely to be. Consumer data lets you do that.
Medical identity theft is a growing concern for healthcare organizations in the digital age. In 2017, healthcare data breaches accounted for 24% of all data breaches, rising to 29% in 2018. In just 12 months, the total number of personal medical records exposed jumped from 5.3 million to 9.9 million. In fact, healthcare data breaches tend to expose many more individual records than other industries. For example, according to the Identity Theft Resource Center, 43.9% of breaches in the first half of 2019 were in business, while only 36.9% were in healthcare. But for healthcare, this meant exposing a staggering 77.4% of all records left vulnerable to identity theft, compared to just 9.5% by business breaches. The potential impact of a healthcare data breach seems to be further-reaching than in other fields. At the same time, healthcare is slightly behind other industries when it comes to data security. Financial services have a two-decade head start to refine their anti-fraud strategies. This, coupled with the fact that medical identities are worth 20 to 50 times more to fraudsters than financial identities, means medical identity theft is increasingly appealing to criminals. It’s a big concern, but healthcare organizations can use data to fight data theft. When you’re armed with the right information, you can put in place the right strategy to protect your patients. What is medical identity theft? Medical identity theft is when someone uses another person’s health-related identifying information without them knowing. This could include their name and address, Social Security number, health records, or insurance information. Fraudsters can use this information to access medical services without paying, submit false insurance claims, or buy drugs. They pretend to be someone else to access services illegally. In addition, that personal information could be used for other kinds of identity fraud or blackmail. What are the consequences of medical identity theft? Karly Rowe, Vice President New Product Development, Identity & Care Management Product at Experian Health, says: “For patients, the impact of having their personal information stolen, and then possibly used to make false claims in their name, can be hugely violating. When someone’s record becomes overlaid with a thief’s record, this can have massive consequences for that person’s future treatment. It’s a major stress to sort out – both administratively and financially. And for organizations, there’s obviously the reputational hit. The relationship between provider and patient is based on trust. When you fail to secure your patients’ most personal information, you risk losing that trust for good.” It’s also a major cost. Medical fraud in the U.S. is estimated to cost somewhere between $80 billion and $230 billion, with the cost to individual providers and payers coming in at around $2 million per breach. To tackle the problem, healthcare organizations are stepping up their security practices across the board. A HIMSS survey, in partnership with Experian Data Breach Resolution, reported that data security strategies have improved. Ninety-two percent of those asked had performed a formal risk analysis, and more than half had increased their patient data security budget. A number of organizations also teamed up to form the Medical Identity Fraud Alliance, to mobilize the industry to tackle the problem. Still, there’s a ways to go. 3 ways to leverage data insights to prevent medical identity theft Protecting patient data calls for a data-based solution. Here are three ways to leverage consumer data and technology to protect your patients and keep their information safe: Resolve patient identities. Accurate patient data is the cornerstone of data management. If your records aren’t entirely reliable to begin with, keeping them safe and secure will be much harder. Put preventative measures in place to minimize the risk of duplicates and errors. Assigning a Universal Patient Identifier (UPI) will let you follow the entire patient journey, so you have a complete, accurate and secure picture of each patient. Protect patient identities. Patient portals allow people to access their health information from their personal devices. It’s convenient and can improve engagement and health outcomes. Unfortunately, they can also become vulnerable to breaches by data thieves. You have to make it easy for patients to use portals, but difficult for fraudsters to get their hands on that personal data. As patient portals gain popularity, you must have the right technology in place to validate and protect patient identities. Automating patient enrollment with a tool like Precise ID® can help authenticate patient identities from the start using identity-proofing, fraud management and device recognition. Enrich patient identities. With data insights, you can check that your patient is who they say they are the moment they arrive in reception. Using the broadest and most trustworthy datasets, identity verification solutions make constant checks, so you have a single, accurate and 360° view of each patient. Not only is this ‘golden record’ the cornerstone of patient care and experience, it’ll let your staff update patient data during intake without manual corrections. Medical records contain some of the most sensitive personal information, so it’s vital to safeguard it with the strongest security that exists. — Download this free eBook to learn how to evolve today\'s patient matching technologies or find out more about how to protect your patient data and prevent medical identity theft.
