Identity Management

The State of Patient Access surveys patients and providers to see how patient access has changed since COVID-19. See the results!

Learn how ACS worked with Experian Health and our Universal Identity Manager (UIM) platform to deliver the Experian Single Best Record (ESBR).

Knowing that clinical care accounts for only a portion of health outcomes, understanding how patients are affected by social determinants of health (SDOH) continues to gain attention as a critical factor in care delivery. COVID-19 has thrust the issue even further into the spotlight, with socially and economically vulnerable groups hardest hit by the pandemic. At the same time, the expansion of telehealth services over the last year has benefited some marginalized groups, who may feel uncomfortable visiting health facilities or may, for example, sometimes face challenges finding transportation to and from their visits. What’s clear is that when it comes to mitigating the impact of COVID-19’s lingering effects, patient identities based on clinical data alone simply won’t cut it. Providers need a holistic view of patients – both clinical and non-clinical.   Many providers do not have updated contact information for the patients they want to engage, in addition to missing patient-level insights such as housing, food, access to technology, transportation and financial stability data that could help better engage patients. Given the many complicated personal and structural barriers that may exist to accessing healthcare, providers lacking SDOH data in patients’ records are risking avoidable readmissions, unnecessary ED visits, poor care quality ratings and denied reimbursements.   Understanding patient needs and preferences via lifestyle factors – like occupation and technological knowledge – helps providers improve engagement, outreach and access. The results can be game-changing.   The benefits of an enriched, more robust patient record with SDOH Improved certainty of patient needs to achieve healthy outcomes Whether it’s missed appointments, lack of engagement, deferred treatment, or failure to comply with care instructions – if SDOH is the cause, providers need to know.  An enriched patient record that includes clearly defined SDOH risks and insights to those risks is invaluable.   For example, if a patient record includes recommended engagement strategies suggesting medication delivery, or ensuring medications are with the patient at discharge, due to the patient’s difficulty accessing a pharmacy, negative outcome risk is reduced. Significant provider blind spots that might otherwise interfere with desired health outcomes can be eliminated or extensively mitigated with access to this kind of data.   Consumer data gives additional insight useful in risk stratification efforts, allowing care teams to get granular and proactive if, for example, a patient’s lifestyle makes office-hour calls impossible, or if a lack of transportation requires the patient be informed that telehealth is available. Additionally, the data can flag if the patient prefers reminders by text, voice message or email. These considerations make a difference; 80-90% of modifiable contributors to healthy outcomes for a population are regularly attributed to the social, economic and environmental factors that comprise SDOH.   Connecting the dots can improve care coordination SDOH data doesn’t just help flag general access issues; it can also help providers dig into specific challenges that may warrant referrals to community programs or additional staffing support. SDOH data may lead to the discovery that a patient is struggling to access healthy, affordable food and prompt a conversation about getting referred to an in-network nutritionist or local food partnership.   Patient-specific information can be merged with consumer databases covering a range of socio-economic data, initiating proactive conversations with patients that can solve non-clinical gaps in care.   Clarity of the “why” behind patient insights, for better communication and engagement Someone experiencing financial instability as a result of pandemic-related unemployment will expect a different financial conversation than someone who has lived in poverty for their whole life. Further, two patients with high readmission risk can have completely different social determinants of health impacting that risk.  Knowing that patients are affected by SDOH is only one piece of the puzzle. Understanding the bigger picture helps create a whole picture and enables personalized, sensitive, and helpful communication.   A turn-key SDOH solution that helps define the “why” behind the score avoids analysis paralysis and enables a quick, effective engagement strategy based on what really matters to patients. Supplementing patient surveys with consumer data is also important, as it provides deeper insights and recommendations for engagement strategies.   Of course, a connected system only works when the patient identity is accurate and tracks them from service to service. With a universal identity manager, you can have confidence that your teams are all working from a complete, current and insights-rich view of each patient.   Find out more about how Experian Health can help your organization make sense of SDOH data for better patient identity management and a more personalized patient experience.  

    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?   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

See how patient portal automation ensures secure access for vaccine scheduling. Simplify enrollment, reduce admin burdens, and more.

Providers know they need to improve their digital front door to withstand the financial impact of COVID-19, but change can feel risky, especially with so much uncertainty. Experian Health’s recent patient access survey offers a glimpse of what patients hope the digital front door will look like in 2021 and beyond. But what do providers see for the future of patient access? And are those views aligned? Providers that offer the most accessible patient access solutions in a post-pandemic world will secure greater patient satisfaction and loyalty.

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.

How has the pandemic affected consumer attitudes around patient access? What do consumers want when it comes to accessing care? These are the questions providers must answer if they are to survive the pandemic and lay the groundwork for future financial success. Experian Health’s recent patient access survey offers a glimpse of what patients hope the digital front door will look like in 2021 and beyond. Wherever you are in the digital patient access journey, there's an opportunity to improve the experience for patients to one that will not only survive the tumult of the pandemic, but also thrive in the years ahead.

This article addresses what a unique patient identifier is, how it's used in healthcare, and ways they can improve the patient experience.