Patient Access
Verify critical patient information and collect patient payments prior to service
The manual process for fielding scheduling calls isn\'t an easy one. Calls can take up to 20 minutes, and call center agents may have to comb through binders or spreadsheets of provider calendars and scheduling rules to book a single appointment. As a result, call center staff may only be able to place a handful of patients per day, despite receiving hundreds of scheduling calls. This not only contributes to a poor patient experience but can cause care delays and potentially push patients to seek care from surrounding competitors. Prior to working with Experian Health, call center agents at Heritage Medical Associates were manually scheduling patients with the process described above, and only able to place three to five patients per day with calls lasting several minutes. With Experian Health’s call center scheduling solution in place, call center agents now have access to all of the organization’s 135+ providers in a single digital platform. With an integration with Allscripts, call center agents can see all available appointments in real-time, identify the best provider and appointment for a patient’s specific care need and then book the appointment on the spot. Heritage Medical Associates has seen several improvements since working with Experian Health. Increased call center efficiency. The time spent on the phone for scheduling an appointment has been nearly cut in half — from seven minutes down to just four. With more time, call center agents can now place between 40 and 50 patients per day. Improved patient experience. Patients who called in to book an appointment, reported higher levels of satisfaction as they were able to navigate to the right provider and appointment more quickly. Enhanced physician satisfaction. By automating their scheduling rules, providers can ensure that any open appointment slots are booked according to their personal preferences. They can better predict their schedules and maintain control over their calendars with the new solution. Improvements to the bottom line. As each individual provider and separate location becomes more efficient, Heritage Medical Associates as a whole has been able to control overhead and has seen quantifiable improvement to its bottom line. “The physicians that I’ve talked with so far find that they have a more efficient and planned day, and it’s more relaxing. Their productivity is increased, and, at the same time, they’ve been able to reduce some of the stresses of their schedule.” — Jim Browne, Chief Executive Officer, Heritage Medical Associates Learn more about how you can improve call center efficiency and the patient experience with guided search and scheduling.
Visits to emergency departments (ED) dropped by 42% in the early months of COVID-19, according to the CDC. In pre-pandemic times, this might have been a positive sign. Two-thirds of ED visits are thought to be avoidable, with emergency care used as a safety net in the absence of access to more appropriate services. Excessive emergency care also comes with a high price, often resulting in a poor patient experience. UnitedHealth Group estimates that the 18 million preventable visits per year cost the health system up to $32 billion annually. Unfortunately, the rapid decrease in ED use during the pandemic isn’t a signal that care management and access challenges have been resolved. Social distancing, stay-at-home orders and fear of being exposed to COVID-19 have prompted patients to avoid seeking care in person altogether. Inevitably, as more individuals either postpone or forego the care they need, ED use will start to creep back up again. For health plans, the worry is a sudden influx of their members returning to emergency departments with more complex care needs arising from delayed treatment. Medical costs could sky-rocket, while gaps in care could reach critical levels as health plans and providers struggle to keep track of ED admissions and readmissions. As health plans look to curb ED utilization in the aftermath of COVID-19, digital tools can provide a valuable lifeline. 4 ways health plans can use digital tools to reduce unnecessary ED visits 1. Take action to engage members before acute episodes occur Proactively involving members in their own care management can help head off unnecessary ED visits before they’re even a possibility. Understanding how the social determinants of health affect a member and how they access care can help health plans tailor their engagement strategies and close gaps in care. Experian Health’s Member Engagement Solutions draw together all the insights needed to connect the dots between emergency visits, social and economic risk factors, and digital care coordination, so health plans can communicate with members in the most effective way. 2. Make it easier for members to access care when they need it Part of the ED visit volume is based on members’ frustration of not being able to access care when they want or need it. Health plans can prevent unnecessary ED visits by sending automated outreach prompts to encourage members to schedule appointments, via interactive voice response or text. A digital scheduling platform can give the member an easy way to book their appointment, without needing to call during office hours. With digital scheduling, health plan member engagement teams and call centers can facilitate member appointment scheduling with the right providers without the cumbersome three-way call. 3. Implement a real-time tracking strategy for ED admissions One of the biggest challenges for health plans is not knowing when members are admitted to the emergency department. A tool such as MemberMatch® can alert health plans of their members’ real-time ED encounters, so they can rally around active episodes of care – potentially avoiding unnecessary, out-of-network admissions and readmissions – and optimize the cost and quality of encounters across the continuum of care post-discharge. Using Experian Health’s leading referential matching system, a member’s care team can be notified via text, portal or email for quick insights that enable better care coordination. 4. Ensure better management of post-discharge follow-up care Every health plan’s checklist for reducing readmissions should include a follow-up strategy when patients have visited the ED. Given that post-ED follow-up for members with chronic conditions is likely to be a STAR measure in the future, plans should prepare their proactive intervention strategy now. USMD WellMed Health System used Experian Health’s Member Utilization Management Solutions for better care coordination for patients within 30 or 90 days of leaving hospital, significantly reducing their readmissions rate. Within just four months, the ROI trends gave them confidence to roll out Care Coordination Manager from USMD clinics to WellMed clinics too. Reducing admissions and readmissions is not about making access to the ED more difficult, but making access to other services, care options, and care management solutions easier. With the right digital solutions, health plans can take action to make this unprecedented transition of care from the ED to other, more cost-effective arenas the ‘new normal’ and put the old model of ED over-utilization in the past. Contact us to learn more about how Experian Health can help health plan reduce unnecessary ED visits.
A consumer-first healthcare revolution has been simmering for years. Despite efforts to create more human-friendly services, the industry still lags behind other consumer-centric sectors. Patients want healthcare to be simple, convenient and on-demand, but a persistent lack of coordination, accessibility and affordability leaves many struggling to navigate the healthcare landscape with ease. Is this about to change? Has COVID-19 flipped the switch? The pandemic has prompted people to engage with their own care in a way the industry hasn’t seen before, with a surge in telehealth and virtual care. Infection-control forced much of the patient journey online, while providers were pushed to find new ways to communicate quickly and clearly. Now, those with an eye on the road to post COVID-19 financial recovery are optimizing these digital strategies to meet new consumer expectations and improve patient loyalty. Embracing digital technology and automation throughout the entire patient journey will be key to patient acquisition and retention. Where should providers focus first? 4 consumer-led strategies to keep patients loyal 1. Prioritize convenience across the entire consumer experience Eighty percent of patients would switch providers for convenience factors alone – ranking ‘convenient, easy access’ ahead of insurance coverage and quality of care. Creating a digital experience that gives patients the flexibility and simplicity they desire should be priority number one in any patient loyalty plan. Providers can start by reviewing their digital platforms. Encourage patients to use their patient portal to access information, book appointments and manage their healthcare when appropriate. Telehealth and virtual care solutions can be future-proofed with reliable identity protection, so patients can safely access care from home and not worry about cumbersome log-in procedures. 2. Make patient access…accessible The patient experience shouldn’t begin with time-consuming forms, long waits and error-prone manual intake processes. Rather, providers can make it easy for patients to complete as many tasks as possible BEFORE they set foot in the office by automating patient access. Online patient scheduling lets patients book, cancel and change appointments online – which 77% of patients say is very important. It has the potential to reduce delays and no-shows, and can minimize the administrative burden for provider staff. While patients remain concerned about the risk of infection during COVID-19, providers can ease their concerns by reducing face-to-face contact with online pre-registration. 3. Respond to affordability and pricing pain points One Experian Health study found that the top pain points in the consumer journey center on the financial experience, from shopping for health insurance to understanding medical bills. Patients may be unsure what their insurance covers, whether their deductible has been met and whether they can afford the out-of-pocket costs. By providing clear, upfront pricing information about coverage and financial responsibility, providers can protect their patients from unnecessary surprises and reduce the risk of missed payments. Self-service patient payment tools can simplify the payment process too: patients can settle their bills anytime, anywhere, and get advice on financial assistance and best-fit payment plans. 4. Personalize the patient experience from end to end A one-size-fits-all approach doesn’t cut it anymore. Patients are looking for communications and services tailored to their individual needs. That used to be both technically and logistically impossible, but not anymore. Providers today can use comprehensive data and analytics to personalize the entire healthcare journey, from customer relationship management to patient collections. By combining automation, self-service tools and accurate insights into the patient’s circumstances, providers can help consumers make better decisions about their care and how to pay for it. To ensure data reliability and integrity, providers should consider partnering with a trusted data vendor, who can translate robust, multi-source consumer and financial data into a competitive consumer experience. There is no question that COVID-19 has changed the way we do healthcare, but the industry is perfectly posed to harness the change in consumer behavior and shift towards greater patient engagement. By bringing together a myriad of digital tools, providers can create a healthcare experience that’s convenient, compassionate and in line with consumer expectations. Interested in learning more about how we can help your organization welcome new patients through its digital door, and boost loyalty among existing patients?
“It’s important to provide our patients with the absolute best access channels to quickly and seamlessly connect with the care they need. Experian Health’s solution guides our patients to the right care and digitally connects them with a confirmed appointment.” - Kaci Husted, Vice President, Benefis Health System It’s shouldn’t come as a surprise that patients today want their healthcare experience to mirror the flexibility and convenience that they are now accustomed to with other industries. Notably, patients want easier and faster access to care, and preferably without having to pick up the phone to call and make an appointment. Benefis Health System knew it needed to provide patients with a new and improved access experience. Patients were required to call the office during business hours to book an appointment, and while some may have been immediately connected with a scheduler, others would have to leave a voicemail or be placed on hold. The process was not only taking valuable time out of patients’ days but carried the risk of delaying care. With online self-scheduling in place, patients can schedule an appointment online with any of Benefis Health System’s 300+ providers, regardless of time of day. The solution leverages powerful decision support, which guides patients directly into the appointment type and provider necessary for the treatment they need. It’s good for patients and providers, as the solution’s accuracy prevents any misplacement of patients to the wrong provider or appointment type. Patients started using the self-scheduling solution almost immediately after it was available. Benefis Health System has since experienced the following results: Improved access to care. Patients of Benefis Health System have used the system to book many appointments outside of office hours, with 50% of its patient base booking after hours. Better access to urgent care. One of Benefis Health System’s urgent care centers has seen a large uptick in online self-scheduling. In fact, 52% of patients are scheduling appointments online for that location. Ongoing improvements with analytics. Benefis Health System is leveraging analytics to track how many patients use online self-scheduling and can identify when and where they might fall out. They can see the pitfalls and where improvements may be necessary and make those changes in real time to drive better conversion rates. Currently, 23.6% of patients who start the process are converting to a booked appointment. Interested to see how online self-scheduling can help your organization improve access to care?
In previous winters, anyone struck by a sore throat or fever might assume they had flu, and head to bed with a hot drink and some painkillers. This year, the looming specter of COVID-19 could prompt those with flu-like symptoms to seek medical care instead. Combined with a likely second wave of COVID-19 cases as lockdown requirements relax, healthcare organizations anticipate a surge in patients seeking tests and treatment this winter. To protect against a possible “twindemic”, where COVID-19 and winter flu season collide, providers will want to ensure the patient intake and access process is as easy and efficient as possible—and not just for regular appointments with a primary care physician or specialist, but for pandemic- and flu-related services like COVID tests, flu shots, and more. Online scheduling has been a game-changer during the pandemic: could it be the key to surviving a twindemic? With the right digital tools in place, providers can screen patients for their COVID-19 or flu risk before attending an in-person appointment, helping separate healthy patients from those suspected of having either illness. Providers can also leverage those same digital tools to streamline activity like flu shots, or even drive-through testing for COVID-19. Four ways to leverage digital scheduling for a twindemic These four steps could be key to protecting patients, streamlining workflows and reducing pressures on call centers during flu season as it collides with COVID-19: 1. Create screening questionnaires during patient scheduling As soon as the patient logs on to book an appointment, they are asked to answer a few short questions about their symptoms. A screening questionnaire can triage people wanting to get tested, while the answers inform providers of the likelihood of a patient having COVID-19 and if that individual needs to quarantine. After being screened, the system can direct patients through the correct channel of care based on the information provided. A similar questionnaire could be adapted during flu season for providers to assess and compare symptoms and risks ahead of time. Providers can even designate day and time slots available to patients for flu vaccinations, making it easy for patients to schedule on their own time and further minimizing the risk of unnecessary contact with other patients in office. 2. Direct patients to drive-through testing to minimize in-person tests Depending on the answers given during screening, patients may be directed to virtual and disease-specific care, such as drive-through COVID-testing. An online scheduling platform can easily be used to book appointments for tests, presenting patients with any available time slots, either same-day or a few days out. The platform can also record information about the patient’s vehicle to quickly identify patients and avoid bottlenecks in the drive-through. With so many patients hesitant to show for in-person visits today, a similar system for flu shots could serve providers well. 3. Use guided search to direct patients to the right virtual services Virtual care has proven both necessary and valuable during the current pandemic. Not only has it kept patients in close contact with providers and specialists, but it has helped providers capture revenue lost from the cancellation or delay of in-person appointments. Virtual care will be increasingly critical during a dual COVID-19/flu season. By asking the right questions during online scheduling, patients can be connected to the correct provider, whether virtual or in-person, for their needs and book an appointment quickly and easily. 4. Eliminate walk-through traffic at urgent care centers Urgent care centers are already known to be the ‘doctor of choice’ for many patients, but this could pose a few challenges for both patients and providers during a dual pandemic. Rather than be a gathering spot for patients with both illnesses, urgent care centers may want to consider switching to an appointment-only system, where appointments must be scheduled online or by phone. This can help reduce the number of in-person visits and walk-in traffic, which will not only help keep everyone safe and healthy but contribute to a far better patient experience as patients wouldn’t have to sit and wait to be seen by a provider. Interested in hearing more about how online scheduling could help your organization manage flu season as it collies with COVID-19?
Before working with Experian Health, call center operations at Sanford Health were disparate and disjointed, with each call center operating on a different phone system with different carriers. While some centers saw high abandonment rates, others were waiting around for calls. Although Sanford attempted to create balance by placing accounts in a work queue, the process for managing outbound collection calls remained manual and it was impossible to identify and strategically contact patients based on ability to pay. Sanford took steps to improve collections with a patient-focused, hybrid approach that combines employee incentives with segmentation strategies. Since working with Experian Health, Sanford now has a focused approach to managing accounts receivable (AR) by identifying patients with a certain propensity to pay. Collections Optimization Manager allows Sanford to quickly identify a pathway and delivery to resolution of the patient’s balance. The analytical segmentation models within Collections Optimization Manager use precise algorithms that reveal those patients who likely are eligible for charity services, those who might prefer to pay in full at a discount, or those who might benefit from a payment plan. The solution then feeds segmentation data to PatientDial, which Sanford uses to route calls to 70 patient account representatives. Sanford also implemented a re-designed, more user-friendly patient statement format. The improved cover page offers easy-to-understand information about the bill including the available options for payment. In a larger effort to improve the patient experience, Sanford implemented an employee incentive program that appropriately rewards staff based on their collections’ performance. Since working with Experian Health, Sanford has seen the following improvements: Streamlined call center operations. With PatientDial in place, Sanford was able to consolidate its call center team members in 4 regions and seamlessly operate on centralized toll free and direct dial numbers. Where it used to take on average 56 seconds for a call to be answered, calls are now answered in 20 seconds or less. The system now comfortably manages an average of 12,000 inbound calls weekly. Increased collections. The model in place has allowed Sanford to improve collections in a myriad of ways. In addition to increased collections from calls made through PatientDial, Sanford was able to see an additional $2.5M in patient payments by ensuring patient statements were sent to the new or correct address. The system found an additional $60K by identifying new guarantors for accounts of deceased patients. The segmentation capabilities from Experian Health also enabled Sanford to identify patients struggling with bankruptcy, allowing staff to focus their efforts on collectible accounts and more efficiently direct individuals to charity options. Learn more about Sanford Health’s journey and how a similar approach could help your organization improve collections and employee satisfaction.
Finding previously unidentified insurance coverage can feel a little like a game of hide and seek. Patients may not always be aware of their insurance or eligibility for Medicare and Medicaid, and, in an effort to both improve the patient financial experience and simultaneously improve collections, providers are often tasked with finding this information on the spot. Historically, providers have used demographic information like Social Security Numbers (SSN) as a means to verify patient identities and locate this information, but that tactic is increasingly unreliable as it is possible for more than one person to use the same SSN and SSNs are a lucrative route to stealing someone’s identity. With this in mind, many health plans are no longer using SSNs as an identifying number for insurance coverage. In fact, the Centers for Medicare & Medicaid Services recently removed SSN-based Health Insurance Claim Numbers (HICNs) from Medicare cards and are now using Medicare Beneficiary Identifiers (MBIs) for Medicare transactions like billing, eligibility status, and claim status. The latest health plans to remove this piece of demographic information is Health Net Medi-Cal and Health Net National. Effective September 25, 2020, the search options for eligibility for this plan have changed. Providers will ONLY be able to find and verify coverage with a subscriber ID. \"Providers are often tasked with finding this information on the spot.\" While Health Net Medi-Cal and Health Net National are the latest health plans to do away with demographic searches, it’s certainly not a surprising trend and more will likely follow suit. Bridging the gap with historical data Uncovering previously unidentified coverage is critical for providers as it helps to eliminate costly self-pay situations, bad debt write-offs and unwarranted charity designations. And, without the proper insurance information, patients also risk delayed access to care and other financial hardships. With demographic searches on the decline, providers will need a more efficient and reliable way to search for coverage. As a data-driven company with a historical repository of claims data, Experian Health is uniquely positioned to help providers search for coverage. Combining search best practices, multiple proprietary databases and historical information, Experian Health’s Coverage Discovery locates patients\' billable commercial insurances that were unknown or forgotten, and combs through Medicare and Medicaid coverage. This flags accounts that may have been destined as a write-off or charity and maximizes reimbursement revenue by identifying primary, secondary and tertiary coverage. Not only do fewer accounts go to bad-debt collections, but providers can automate the self-pay scrubbing process. A tool like Coverage Discovery is even more beneficial for providers during COVID-19, where limitations of face-to-face contact make it more difficult to complete the usual coverage checks. Coverage Discovery empowers providers to facilitate coverage checks remotely, avoiding delayed reimbursements during a time when revenue streams are already feeling pressure. \"As a data-driven company with a historical repository of data, Experian Health is uniquely positioned to help providers search for coverage.\" Want to learn more? Contact us to see how Coverage Discovery can help find previously unidentified coverage and reduce bad debt.
Four in ten Americans live with multiple chronic conditions. For these individuals, life is punctuated with physician appointments, visits to the pharmacy and referrals to different specialists. Their care should be coordinated with orchestral precision, but the reality is somewhat less harmonious. Snail-paced scheduling systems, poor communication and mismatched patient records can lead to a lack of proper support for patients, confusion about how the care plan is managed, and potentially dangerous (and costly) gaps in care. For health plans, quality markers are missed and incentive payments start to dwindle. To help close these gaps, health plans must embrace a more innovative, consumer-focused approach to care coordination. Digital scheduling platforms make it easy for call center agents to help members find and book appointments, eliminating the need for a three-way call between the member and provider. Members are much more likely to be placed with the right clinician, at the right time and for the right appointment, while health plan call centers can operate far more efficiently. The automation and data integrity of digital systems makes it much easier to track and book appropriate post-discharge appointments and routine care management. Digital scheduling has the potential to improve health outcomes, drive up operational efficiency and yield big savings down the line. It’s about more than just matching consumer expectations, though a great member experience is certainly a competitive advantage for health plans. Better coordinated care could be life-changing for patients with chronic conditions. And with more members switching plans and seeking call center support in light of COVID-19, there’s a short-term urgency to tighten up communications and direct members to the care they need. Could a digital scheduling platform help your health plan close gaps in care and create a better member experience?
Products referenced in this article: Social Determinants of Health Patient Schedule Member Match Coverage Discovery Patient Financial Advisor Patient Payment Solutions With just a few clicks, patients can book appointments, speak to their doctor, access billing information and pay for care, all without leaving their homes. Online health services have been a lifesaver for many during the pandemic, and the reliance on digital tools has sky-rocketed over the last few months. But for some older consumers who may be less comfortable using digital devices, this shift towards “healthcare from home” feels daunting and isolating. Many seniors are not immersed in the digital culture and navigate life just fine without a touchscreen. The sudden shift in healthcare delivery channels has demanded many to venture into unfamiliar technology in a rushed and urgent manner. Others face barriers related to things like dementia, hearing loss and vision loss. Closing the digital divide Whatever their age, those left out of the digital loop face a higher risk of missed appointments, delayed care and anxiety about how to get tests and treatment. Providers will want to ensure that all of their digital offerings are designed to help patients of every age access care in a way that works for them. That means creating a consumer experience with pathways and channels to suit different patient needs and expectations, including “analog” options for those who aren’t inclined to learn new technologies. 4 ways to make digital health technology more senior-friendly 1. Use data to determine what’s working and what’s not The starting point for providers who want to improve seniors’ digital engagement is to understand how they’re actually using it (or not) right now. Non-clinical data can give insights on technology engagement, lifestyle and socioeconomic circumstances across all ages in a patient population. When providers know what patients are looking for, and where the gaps are, they can tailor their services to meet their patients’ needs. For example, let’s say a proportion of an organization’s older members have smartphones or tablets, but aren’t using them to access their patient portals. It’s likely they have the skills so but may not be aware of the service. This can be solved with a simple omnichannel outreach campaign to provide step-by-step instructions explaining how to get started. One way for providers to capture useful data is with “Z codes” -- the ICD-10-CM codes included in categories Z55-Z65. These identify non-medical factors that may influence a patient’s health status. Utilizing Z codes will enable better tracking of seniors’ needs and identify solutions to improve their health and wellbeing. Providers can also leverage data to better understand seniors’ activity in the continuum of care. Are older patients continually presenting for care at a facility that is out of network? A tool like MemberMatch can deliver these insights in real time, alerting care teams as early as possible so that they can rally around active episodes of care proactively and efficiently. This helps risk-bearing organizations optimize the quality and cost of member activity in the continuum of care, leading to better outcomes for patients and a better bottom line for organizations responsible for their health. 2. Give patients choices about how they access services Adoption of healthcare technology is increasing among older adults: 76% of over 50 say they welcome services to help them “age in place”, or live in one\'s own home and community safely, independently, and comfortably, regardless of age, income, or ability level. At CareMount Medical, 27% of primary care appointments made using Experian Health’s online scheduling tool are initiated by those aged 60 and over. The demand is there; support should follow. That said, an omnichannel approach is still important. Given a choice, more than half of people aged 50 and over prefer their health be managed by a mix of medical professionals and technology. This means giving patients the option to easily schedule appointments by phone. Automated outreach and integration, combined with practice management systems, will ultimately make patient scheduling easier. 3. Make virtual care easier to use More than half of seniors cancelled or delayed appointments due to COVID-19. Despite the promise of safety measures, many are hesitant to return. Virtual care may be the answer. Providers are quick to learn that telehealth is not a panacea, in particular for the senior population. As some patients may not have the technology and skills to access telehealth, providers may want to consider a hybrid “facilitated telehealth” model where medical professionals visit patients’ homes to help them get set up for telehealth visits. 4. Create a smoother patient financial experience As older patients become newly eligible for Medicare, many are unclear about their coverage status. To take the burden off the patient, providers should consider a tool such as Coverage Discovery, which allows staff to find MBI numbers quickly. This often proves helpful, particularly for new Medicare beneficiaries who may not have received their MBI card yet. A way to ease the stress of payments is to offer more transparent pricing so patients know what to expect as they start their healthcare journey. Experian Health’s Patient Financial Advisor gives a breakdown of their bill and payment options, helping them feel financially confident and more in control of their ability to pay – resulting in fewer collections issues. As older patients become more accustomed to paying for other everyday items through their smartphones or laptops, online patient payment solutions will become less foreign and more convenient, allowing them to manage medical payments in a time and place that suits them. It’s never been more important to help older patients stay connected, access care and feel supported during their healthcare journey. Contact us to explore how Experian Health’s solutions can help you close the digital divide.
