First Pst after migration to Cloud in Health care Blog

Several major healthcare operators reported major losses for 2022, as revenue growth failed to outpace increasing expenses. McKinsey’s projections for provider profit pools suggest a more promising outlook over the next few years, with the fastest growth expected in virtual and non-acute care segments. As labor costs rise, organizations are looking for ways to cut spending and increase cash flow. Healthcare contract management is a key area to focus on, as underpayments and denied claims can significantly impact revenue. A third of providers report up to 15% of claims being denied, and underpayments continue to remain a significant concern. Securing reimbursements at already-agreed rates can help healthcare organizations significantly benefit financial performance. Unfortunately, managing payer contracts is not a straightforward process. Payer regulations and policies are in constant flux, and providers often lack the insights to negotiate and monitor payer performance effectively. Implementing a contract management solution can help providers negotiate favorable terms, check payer compliance, and reduce the risk of denials and underpayments. Why is healthcare contract management so challenging? Multiply thousands of vendors by thousands of service providers and again by thousands of patient encounters – and the scale of the healthcare contract management challenge becomes apparent. An average health system deals with hundreds of different payers, each with its own policies, processes, and paperwork. This lack of standardization makes it difficult to process claims efficiently and ensure payer compliance with agreed terms, not helped by soaring patient volumes and increasingly complex claims. The growing resource burden means the payer-provider relationship is coming under strain. But the challenge begins even before the contract is signed. Providers split their focus between numerous clinical and financial objectives. In contrast, payers can concentrate their attention more fully on fee negotiations. There’s an inherent imbalance in the resources each party brings to the negotiating table. As a result, providers are often on the back foot and can end up signing up for less favorable terms. Without a robust approach to negotiating and managing payer contracts, providers will struggle to achieve full reimbursement for services rendered. They may submit claims that do not adhere to payer policies, and find claims are being denied or not paid in full. More accounts will end up going to collections, and patients may be exposed to the threat of balance billing. At the extreme, providers may be forced to undergo lengthy appeals processes or even resort to legal action. The challenge of underpayment is especially fraught in emergency care, where disputes around reimbursement for services provided by out-of-network physicians at in-network facilities are common. It pays to invest in provider-payer relationships The solution lies in improving payer-provider relationships.. Smooth contract negotiations, clean claims and fair reimbursement rates are only possible when each party is clear about what they need from the other and delivers what they have agreed. By promoting better communication, transparency and accountability, providers can catch more underpayments and ensure more claims are clean the first time, leading to better financial performance. With a reliable contract management solution, providers can monitor payer compliance with contract terms and clarify what’s expected to ensure clean claims every time. Contract Manager and Contract Analysis: best in KLAS for healthcare contract management The 2023 Best in KLAS report identified Experian Health’s Contract Manager and Contract Analysis products as #1 in Revenue Cycle, Contract Management. This solution leverages Experian’s data, analytics, and technology to help hospitals and health systems improve contract management and financial performance in three ways: 1. Validating reimbursement accuracy Contract Manager helps providers find inconsistencies between amounts claimed and amounts paid. It accurately adjudicates each claim and compares expected payments to actual reimbursements. By continuously monitoring payer compliance with agreed contract terms, the tool identifies patterns of non-reimbursement to improve denial prevention and avoid missed revenue opportunities. Administrators can monitor reimbursement using online dashboards and real-time variance reports, which make it easy to manage multiple payer contracts and reimbursement methodologies. The tool also defines specific contract terms and fee schedules and can adapt to changing payer policies, to ensure that claims are processed and valued in line with current payment rules. 2. Preventing and recovering underpayments One of the biggest advantages of automation is the ability to find patterns that a human eye might miss (or take longer to spot). Manual processes (often based on a patchwork of Excel spreadsheets) are not only labor-intensive and costly, but do not consistently identify payment errors. Contract Manager offers a standardized approach to underpayment analysis, identifying sources and patterns of errors so recurring issues can be avoided in the future. Administrators can also use Contract Manager to generate data to support contract-based appeals, so they know which claims to appeal and can communicate more effectively with payers. 3. Negotiating favorable terms with payers Contract Manager’s automated system enables better management of collections data, payer performance and under-or over-payments. This puts providers in a stronger negotiating position when modeling new and amended contracts – a process that can be further improved with Contract Analysis. Contract Analysis assesses the potential financial impact of proposed contract terms down to individual service lines so providers can tailor their negotiation strategy to maximize reimbursement. It arms providers with real-world “what if” scenarios to provide insight into how contract terms could affect cash flow before they sign on the dotted line. Using real claims data to evaluate payer proposals gives providers insight into the true impact of proposed terms on reimbursement. It accelerates the negotiation process and gives providers leverage with payers that they might not otherwise have. Since the responsibility for proving that a claim has been wrongly denied or underpaid lies with the provider, it is on providers to make sure that agreed terms are favorable and to understand how they will ensure compliance. With Contract Analysis, they can reduce contract risks and prevent issues before they arise to drive down denials and underpayments. Using a healthcare contract management solution As the healthcare industry evolves, providers need to find ways to maintain resiliency and financial success. Healthcare contract management is an area where providers can make a significant impact on their financial performance. Unfortunately, managing payer contracts is a complex system with fluctuating regulations and policies. A dedicated contract management solution can help reimbursements maximize reimbursements and can provide the data insights providers need to efficiently negotiate better payment terms. Learn more about how Experian Health’s healthcare contract management solutions help providers improve contract negotiations, monitor payer compliance and recover more revenue.

According to the State of Patient Access 2023, speeding up patient access is the fastest route to patient satisfaction. “Seeing a practitioner quickly” tops the list of patients' pain points based on the survey, which was carried out in December 2022. The number of patients citing this as their biggest access challenge has almost doubled over the last three years, up from 15% in 2020 to 27% in 2022. There is a clear correlation between efficient scheduling processes and patient satisfaction when it comes to access to healthcare. Those who believe that access has improved in the past two years credit faster scheduling, while those who believe it has worsened point to lengthy appointment wait times. Enhancements in speedy and streamlined mobile patient appointment scheduling have translated directly to improved patient access experiences. Beyond the frustration factor, delays can result in longer recovery times, higher medical expenses, and even life-threatening situations. Providers are highly motivated to expedite care for these reasons. Despite significant advancements in the industry, staffing shortages continue to hinder patient access and care. The lack of available staff to schedule appointments and provide necessary clinical services can result in frustrating bottlenecks that leave patients waiting and in limbo. This article examines 5 ways in which mobile patient appointment scheduling can mitigate manual labor for staff while simultaneously providing enhanced care services to patients, enabling faster and more efficient healthcare. How mobile scheduling benefits healthcare staff and patients 1. Reduce paperwork associated with appointments Four in ten patients who think patient access has worsened specifically blame the scheduling process. Outdated methods of appointment scheduling and registration can hinder the seamless digital experience that patients desire. Not only that, but they also consume staff time and can be cumbersome to maintain. Mobile patient scheduling reduces paperwork by allowing patients to book appointments through a mobile app or patient portal, directly from their device. The patient can book at their convenience, without needing to wait for a phone call. They can check appointment confirmations on the go and get real-time updates, reducing the risk of misunderstandings or missed appointments. 2. Streamline operations with real-time scheduling information Mobile patient scheduling is more than a simple switch from paper to digital processes. It leverages automation to reduce staff workload, eliminate data entry errors and make better use of clinician time. Traditionally, schedulers would need to work through a list of questions with patients to match them to the right provider and appointment time. A mobile scheduling solution allows the patient to answer these questions online, then offer appointment times that fit with the providers' scheduling protocols. Patient Schedule automates scheduling protocols with customized business rules to give clinical staff control over the calendars. Real-time information means gaps can be filled quickly, so patients get earlier appointments and no available slots are wasted. John Mercer, Executive Director of Online Scheduling at HCA Healthcare, says Patient Schedule has been convenient for both patients and providers, with 35% of appointments booked outside of working hours: “Experian Health's Patient Schedule has been well received by our provider population, both employed and affiliated. They can receive new patients from a digital domain even when the office is closed. We can also specify certain appointment types and dedicated inventory for patients with acute needs.” 3. Reduce no-shows with appointment reminders Easy online scheduling is only the first step. How can providers ensure patients turn up? Even the most organized patients can forget about an appointment. Proactive measures must be taken to ensure patient attendance after scheduling has been accomplished. Even the most responsible patients can accidentally overlook an appointment, causing longer wait times for both patients and doctors due to missed appointments. Fortunately, providers can mitigate the risk of no-shows by utilizing a mobile scheduling solution that integrates the option to add appointments directly to patients' digital calendars, followed up with automated reminders via text or email as the scheduled date nears. Mobile scheduling also makes it easy for patients to cancel or reschedule appointments. With the click of a button, patients can avoid being a no-show and free up their appointment time for someone else. Same- and next-day appointment scheduling means patients can see if any cancellations have led to new slots opening up, so they can see their doctor sooner. 4. Improve communication between medical teams By reducing no-shows and enabling patients to see their doctor quickly, digital scheduling also helps close gaps in care. Care teams can see a patient's recent and upcoming visits to specialists and view the patient's real-time information, facilitating more informed decisions about care. Mobile scheduling improves communication between medical teams, allowing them to respond quickly to referral requests and coordinate care across multiple providers and settings, all through a single platform. Automated patient outreach can take this a step further, by prompting patients to self-schedule appointments via targeted interactive voice response (IVR), text message or email. 5. Reduce time-consuming administrative tasks with automation Ensuring efficiency has become increasingly important amidst staffing challenges. Automated and self-service scheduling tools are key for reducing the amount of unnecessary administrative work.  Clients that use Experian Health's Patient Schedule solution reduce call times by 50%, as patients are able to manage their own bookings online and through text and IVR campaigns. Analytics can help providers further optimize capacity, outcomes and practice performance by drawing out trends and opportunities for efficiency. Opting for mobile scheduling can help healthcare providers save valuable time and resources, elevating the effectiveness and profitability of their operations. Opening the digital front door with mobile scheduling Mobile patient scheduling has gained traction, with 40% of providers implementing self-scheduling solutions in the last year. For those that haven't yet adopted this technology, there's a huge opportunity to help patients navigate their healthcare journey with ease. Patient satisfaction is heavily dependent on how much friction processes add or remove to the patient access experience. Integrating mobile scheduling tools with automated registration, payment systems and patient outreach solutions can amplify these benefits and help providers streamline their operations. Find out more about how Experian Health's mobile patient appointment scheduling software is helping providers improve the patient experience and operational efficiency.

The COVID-19 pandemic and economic volatility cast a spotlight on America's healthcare system, revealing many complications with patient access. Most patients and providers agree: patient access along with financial strain, are major contributors to patient burnout and delayed or lapsed healthcare. Healthcare providers can help ease the burden for patients by taking steps to implement digital solutions that make access to care easier. What's causing patient burnout? Today, there are many contributing factors causing patient burnout and most have to do with patient access, according to the latest Experian Health data. In fact, 21% of patients feel that patient access today is much worse than in previous years. And 80% of patients feel that the biggest challenge they face is seeing a doctor quickly. Frustrating experiences with registration and inaccurate estimating – all parts of patient access – are burning patients out, too. Nearly half of patients (49%) have trouble finding appointments that fit their schedule and 40% say the process to schedule an appointment is one of their top issues. And when they're finally able to be seen by a provider, patients are often met with understaffed offices, overworked physicians, long waits and rushed appointments. As a final blow, patients are also finding themselves faced with higher-than-expected medical bills thanks to inaccurate pre-treatment estimates. In fact, only 29% of patients say they received a cost estimate before care, and of those who didn't receive an estimate, 41% said the final costs for care were more than expected. Today's patients are seriously fed up, and providers agree. Nearly half (47%) say that patient access is worse than in the previous two years. Close to 90% of providers (87%) also feel that staffing shortages are contributing heavily to poor patient experiences along with outdated technology (21%). The State of Patient Access 2023 report is based on a new survey, fielded in December 2022, that gathered responses from 202 healthcare professionals responsible for patient access and 1,001 patients who engaged in care for themselves or a dependent in 2022. It is the third survey in a series fielded by Experian Health since 2020. Building a better patient experience A positive patient experience begins with simplifying patient access. In fact, according to a recent Experian Health report, more than half of patients want more digital options to manage their care (56%) and have even considered changing to a provider that offers better access. To retain existing patients and attract new patients, healthcare providers need to have digital patient access solutions in place. From the ability to register for appointments online to mobile payments, a digital front door can help providers create more satisfactory patient experiences. Not only can digital tools improve the patient experience, but it's also the starting point of the revenue cycle and accounts for registration, scheduling, gathering insurance information and collecting co-pays or deductibles. And it's where 30% to 50% of denied claims initiate, thanks to inaccurate patient information, lack of real-time insurance verification and manual processes, among other factors. Alex Harwitz, Experian Health's VP of Product, Digital Front Door, says, “When we think about how digital front door solutions can solve for patient burnout, the answer is simple. What's good for the patient is good for the provider. Our latest Experian Health study has shown us that patients want more access. They're looking for functions that are easy to use and don't take up a lot of time. When providers provide streamlined digital solutions, it leads to better patient access experiences that directly result in better business outcomes for the practice.” Introducing automated patient access solutions can help healthcare practices give patients more control over their healthcare, reduce claim denials and alleviate some of the issues caused by short staffing. Recent data from Experian Health and PYMNTS also found that a third of patients opted to fill out registration forms for their most recent healthcare visit using digital methods, while 61% of patients said they'd consider changing healthcare providers to one that offers a patient portal. Automated patient access solutions can offer high-quality service without limiting care options, providing an ideal win-win situation for both patient and provider alike. Automate patient access with digital solutions According to recent Experian Health data, over 46% of providers are planning to invest in digital front door capabilities in the next six months. This shows a growing recognition of the importance of digital patient access solutions among healthcare providers. Automated digital patient access solutions can help healthcare providers improve patient access, reduce waiting times, and increase operational efficiency, among other benefits. Some of the automated digital patient access solutions that providers can consider investing in include: 1. Patient registration and scheduling Using integrated registration and scheduling solutions, such as Experian Health's Registration Accelerator, Patient Scheduling software, and Patient Outreach, can help providers create a better patient experience before they even see a provider. Automating intake online can simplify registration processes, while reducing administrative costs and boosting revenue. When patients have easy access to schedule appointments online 24/7, there are fewer gaps in care and providers have reduced staff call times and more time to collect billing. Plus, providers can automate patient outreach messages and offer the ability to self-schedule via IVR or text – giving patients even more access. 2. Patient payment tools 26% of patients say that paying for healthcare is harder than ever, and 77% of healthcare consumers say it's important to understand the cost of their care before getting treatment. But it's still the norm for patients to go into procedures without knowing what they'll ultimately owe. A tool like Experian Health's Patient Financial Advisor can send patients accurate cost estimates and easy payment options ahead of time. Estimates using the Patient Financial Advisor are based on real-time patient benefit information, the provider's payer contracted rates and provider pricing. By giving individuals a clear understanding of their costs and payment prior to a medical procedure, providers can help their patients feel more financially confident. A built-in payment portal also offers methods to make a secure payment, resulting in fewer billing delays. 3. Patient estimates According to recent Experian Health and PYMTNS data, 4 in 10 patients said they spent more on healthcare than they could afford, but when they know the costs upfront, they feel empowered to make better decisions about their healthcare. Although there are measures in place to help ensure self-pay and uninsured patients receive a good-faith estimate up front, such as the Price Transparency Final Rule and the No Surprises Act, inaccurate estimates can still be an issue. Using a digital solution such as Experian Health's Patient Estimates, can help providers meet regulatory requirements, create a positive patient experience and bring in faster payments. Plus, estimates are more accurate as they account for payment plans, prompt-pay discounts, state-mandated discounts as well as other types of financial assistance policies for self-pay patients. Reduce patient burnout with digital front door solutions To reduce patients' financial strain and ease their frustration with access to care, providers must make it a priority to adopt digital solutions that better serve patient needs. These digital front door capabilities not only help increase access to care but also provide a personalized experience for each individual. Digital patient portals, online appointment scheduling, patient estimates – all of these can help deliver better outcomes and drive efficiency for both patients and providers. By implementing these digital patient access solutions, healthcare providers can create a more efficient and convenient patient experience, reduce administrative burdens, and streamline their revenue cycle management processes. Learn how Experian Health can help healthcare organizations implement digital front door capabilities that can improve patient access and minimize patient burnout.