First Pst after migration to Cloud in Health care Blog

Nearly 40% of patients postponed medical care for themselves or a family member in 2022 due to cost. The percentage jumped 12 percentage points in a year, from 26% in 2021 to 38% in 2022, according to Gallup's annual Health and Healthcare poll. While this trend has clear ramifications for healthcare, it's also bound to affect revenue and collections for healthcare providers. Providers need to stay ahead of the curve when it comes to navigating staff shortages, decreased patient volume, and the range of financial problems patients are currently facing. Matt Hanas, Lead Product Manager at Experian Health, shared how providers can improve collections as patients postpone care. Q1: New studies show that many patients are putting off care due to costs. What does this mean for collections? “We're hearing about this very exact concern directly from our clients,” says Hanas, “and it's unfortunate to see patients put off medical care due to rising costs. Patients across our nation are struggling to balance where to allocate their hard-earned dollars, and they're having to make difficult decisions about whether to seek medical care or use that money on their everyday necessities. Meanwhile, healthcare providers are once again adapting to a shifting climate: “Clients are meeting this trend head-on with adaptable plans of action that allow for customizable contact strategies driven by automation and powerful data sources, using Experian solutions like Collections Optimization Manager,” says Hanas. “[Postponed care] doesn't have to be a heavily felt impact in collections if health organizations can quickly and easily adjust their collections strategies according to economic shifts, such as reduced patient volumes.” When volume is down, efficiency is key. “Experian's suite of products allows clients to utilize the tools and data we can provide to pivot on some of their outreach approaches,” Hanas says. “Segmentation results allow them to consider, for example, focusing on lower balance accounts with a consistent pattern of good payment history, or increasing collections efforts on higher balance accounts that may be harder to collect on. Having access to this data and following it is very key in preventing significant revenue interruptions during these patient volume shifts that we are seeing right now.” Q2: How can providers improve collections amid staffing shortages? “Automate as much of your workflow as possible,” Hanas advises. Automation not only reduces the need for staff intervention but also helps manage the complexity that comes with postponed care. Patients who have put off getting medical treatment may require more extensive (and expensive) treatment. If they've postponed care because of cost, it could be a sign that their finances are stretched. A complicated collections environment needs more than additional staff hours; it calls for data-driven insights and automation. “Visibility, powered by data, drives actionable workflows,” says Hanas, who points out that using solutions from Experian Health allows healthcare providers to accomplish more with fewer staff, including: Automatically pushing updates into an EHR system without manual intervention Setting up automated, prescheduled dialing and texting campaigns Prioritizing collections based on propensity to pay Adjusting scrubs and screens on AR files to remove accounts that are unlikely or unable to pay Sending text-to-pay message alerts Giving patients self-service payment options through online portals and mobile apps “I'm not saying you can completely replace the human touch throughout collections,” says Hanas. “But automation, data-driven insights, and user-friendly, self-sufficient payment collection tools can minimize the impact felt from staffing shortages by ensuring that staff collections efforts are efficient, and by offering patients that power, that freedom to use the self-service payment tools they are very eager and willing to use.” The return on investment speaks for itself. “Our collections solutions have a 9:1 return on investment ratio, based on clients' 2022 data,” says Hanas. “We think that's a pretty remarkable ROI.” Find out how University of California San Diego Health used Collections Optimization Manager and Coverage Discovery to increase collections from $6 million to $21 million. Q3: How does access to multiple sources of data improve collections success in the current environment? “Data gives our clients a compass that guides them very precisely, so they know which patients to focus on and what strategies to deploy,” says Hanas. “Experian is one of the largest data aggregators in the world, which benefits products like Collections Optimization Manager heavily—but it doesn't stop there. Experian Health doesn't rely solely on credit data; it also includes non-credit consumer data. We continually partner to grow our arsenal of data sources, so clients have a laundry list of solutions and products powered by this accumulated portfolio of data sources.” Here's how providers are using Experian's suite of collections solutions to help patients and improve collections efforts: Qualifying patients for Medicaid – “Data sources may show coverage that's been simply overlooked or forgotten by the patient,” says Hanas. “For example, Coverage Discovery has found a ton of Medicaid coverage for patients who simply didn't know they had it—or who failed to report it.” Recently, the expiration of the COVID-19 public health emergency caused millions of patients to lose their Medicaid coverage overnight.  In these cases, providing information to patients who are confused about coverage benefits both providers and patients. Hanas notes: “When we find patients are eligible for Medicaid coverage, they're really pleased to find out that their self-pay balances will be covered.” Filtering out difficult-to-collect accounts can improve collections – Screening can save providers valuable time and resources they might otherwise spend trying to collect from patients who are unable to pay. Hanas says, “Simply being able to identify that someone's address is not current or deliverable saves providers money on statement processing and postage—and saves them the trouble of attempting to send a bill that cannot be delivered.” Gaining insight into financial circumstances – “Our data gives our clients visibility into consumers' financial status changes—paying off a car loan or securing a new mortgage, for example, are things that our clients really need to know. By monitoring these financial status changes, our clients can increase or decrease their collections efforts based on what they see,” Hanas explains. Q4: How can providers support their patients who may need extra financial assistance? “Identifying patients who are eligible for charity care and other forms of assistance is probably the most rewarding use of our data, models, and algorithms,” says Hanas. “Patient Financial Clearance, which falls under the Collections Optimization suite of products, shows which patients may automatically qualify for charity. For those who do, clients can set up automation rules on the back end to automatically write off balances. This happens through a seamless integration, so it's virtually effortless. “Providers can also use the propensity to pay tool in Patient Financial Clearance to identify patients with a low likelihood of paying and offer payment plans that may help them meet their obligations. By having these conversations early in the process, healthcare organizations can keep more accounts out of collections and patients can receive medical care without having to worry about what's going to come after their visit.” The bottom line “Clients want to centralize their business operations around their patients and their care, to find the best approaches to looking after patients' health as well as their financial health,” Hanas says. “We don't want to send everyone who has a balance to collections: We want to use the different tools we have to assist them up front so they can get the medical care they need without feeling stressed and thinking about possible bills down the line. Learn more about how Collections Optimization Manager and Experian Health's full suite of collections solutions can help providers protect profits and drive revenue.

The digitization of healthcare hasn't necessarily translated to better patient access, according to recent findings. Shockingly, almost half of healthcare providers and a fifth of patients have reported that gaining access to care has actually become more challenging in the past two years. Despite significant technological investment, it appears there is still room for improvement when it comes to ensuring patients receive the care they need in a timely, efficient manner. Experian Health’s latest investigation into the state of patient access reveals that patients and providers are enthusiastic about maintaining the digital momentum, but still see room for improvement. The State of Patient Access 2023 – the Digital Front Door is the third in a series of reports that began in 2020. This survey looks at trends, challenges and priorities when it comes to patient access. The new report reveals findings from a survey carried out in December 2022 – which involved more than 1,000 patients and more than 200 healthcare providers across the U.S. As patients become increasingly tech-savvy, their expectations for a streamlined healthcare experience are evolving. It's no longer enough for healthcare providers to offer traditional services – patients now expect digital patient access services to be standard. Providers recognize the advantages of digitalization but remain sensitive to the operational challenges. This article highlights three areas of opportunity for providers to not only open their digital front door, but also secure a competitive advantage for years to come. 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. Opportunity 1: continue to expand digital options in patient access 56% of patients want more digital options for managing their care 69% of providers agree that mobile access is important to patients Both patients and providers want access to be streamlined and efficient. Providers recognize that patients are looking for more digital options, though some are concerned about their current technology’s ability to meet demand. This perhaps explains why nearly half intend to invest in digital technology in the next six months. Providers that leverage technology to reduce friction at patient intake will secure a competitive edge. Beyond delivering a better patient experience, providers see digitalization as a route to operational efficiency, increased capacity and better resource management. 36% of respondents are more optimistic about the state of patient access in 2023, thanks to technology offsetting ongoing staffing shortages. Opportunity 2: implement online self-scheduling to remove barriers to care 78% of patients who think patient access has worsened say the biggest challenge is seeing a doctor quickly 40% of providers have implemented self-scheduling within the past year Speed is the greatest access challenge for patients. In fact, “Seeing a practitioner quickly” has stayed at No. 1 on the patients’ “most challenging” list for the past three years, trending up every year. Patients that think access is worse blame slow scheduling processes, while those that think access is better attribute this to faster scheduling. Meanwhile, providers say that getting patients to engage with digital services so they can see a doctor quickly is their top priority. This points to a huge opportunity for providers to implement scheduling technology that closes this gap, since 56% of patients who think access is worse would switch providers because of this issue. Online self-scheduling gives patients the freedom to book and cancel appointments at their convenience, eliminating the hassle of picking up the phone or waiting on hold. Providers benefit from reduced administration errors, no-shows, and denied claims. With smart integration into scheduling protocols, every timeslot can be filled so patients can see their doctor sooner. Opportunity 3: simplify the financial experience for patients 26% of patients say paying for healthcare is worse than previous years 63% of providers believe patients frequently postpone care due to the cost of care A third opportunity encompasses the patient’s financial journey. Giving patients more power over their payment options is becoming increasingly vital. This is particularly true for younger generations who prioritize digital payment solutions. As these demographics continue to seek more convenient, flexible, and varied payment methods, it will be critical for healthcare providers to address these concerns in order to foster long-term patient satisfaction. Simplifying the experience with accurate pre-care estimates, early payment plans, digital payment options and patient portals means patients will find it easier to pay their bills. Price estimates, in particular, have become increasingly important to nearly 90% of patients; however, the survey reveals that less than a third of patients are actually receiving it before their appointment. This highlights the urgent need for healthcare providers to prioritize transparency and provide clear pricing well in advance. By adopting frictionless payments, healthcare providers can reap many benefits. One major perk is that patients are less likely to put off medical care when the payment process is simple and smooth. Not only that, but providers can expect to see faster collections and a boost in their bottom line. Plus, leveraging digital technology can streamline mundane back-office tasks, leaving staff with more time to focus on other important work. Embrace digital patient access to secure long-term patient loyalty Navigating the pandemic, staffing shortages, and economic volatility has been a bumpy ride for healthcare providers. But amidst the turbulence, one silver lining has emerged: the power of digital technology to enhance patient access. Experian Health’s three surveys show that providers have worked hard since 2020 to reduce friction in patient access, and are seeing the pay-off in higher patient satisfaction. But there’s still work to do. Providers that leverage technology to deliver convenience, transparency and potentially reduced costs to patients will be rewarded with loyalty, and better financial performance in the long run. Download The State of Patient Access 2023 – the Digital Front Door to see the full results.

Healthcare claims management is getting a much-needed infusion of technology. Artificial intelligence (AI) is the key player, utilizing vast amounts of data related to human behavior and health to forecast patterns in disease outcomes with greater precision than ever before. The same analytical power can be applied to claims data to predict and prevent denials. Using artificial intelligence for claims management is now more crucial than ever. By rooting out errors, evaluating trends and predicting payer behavior, AI helps reduce the likelihood of denied claims and maximize revenue opportunities. Staff can spend less time “treating” the effects of denied claims. But even when denials occur, AI still plays a role, quickly triaging high-value denials so staff uses their time efficiently. This two-pronged, proactive and reactive approach is captured in Experian Health's AI Advantage solution™. Using AI-powered analytics and automation, this technology helps providers predict, prevent and process denials to improve claims management and increase revenue. It's time to update claims management systems In Experian Health's State of Claims survey, nearly 3 out of 4 healthcare executives said reducing denials was their top priority. Denials are increasing in number, taking longer to process and taking a bigger bite out of provider profits. Traditional claims management strategies are no longer fit for purpose. The volume and complexity are too much for manual processes to handle, resulting in errors, time-consuming rework and lost revenue. Many providers are using automated claims management platforms to code and edit claims before they are submitted. Automation is ideal for these highly repetitive processes. Faster and more efficient claims processing increases clean claim rates and speeds up reimbursement. Experian Health's automated claims management solutions are designed with these outcomes in mind, with ClaimSource® and Contract Manager named among the best-performing claims management products in 2023, according to a KLAS report. Artificial intelligence builds on the benefits of automation, providing insights and recommendations to drive better decision-making. While automation frees staff from time-consuming, process-driven tasks, artificial intelligence allows them to perform remaining tasks at a higher level. For example, when it comes to processing denials, staff will often “guesstimate” each claim's potential for payment. They'll usually focus on reworking the highest-value denials first. AI removes the guesswork so staff can prioritize denials based on monetary value and likelihood of reimbursement, so time isn't wasted chasing higher payments that may never materialize. Using artificial intelligence for claims management can predict and prevent denials A successful denial reduction strategy starts upstream, to proactively prevent denials before they occur. AI Advantage ­– Predictive Denials uses AI to review claims before they're submitted and flag any that are likely to be denied, based on historical payment data and payer adjudication rules. The tool detects changes to the way payers handle denials, even if those aren't explicitly documented. If a claim exceeds the (customizable) threshold for probability of denial, Predictive Denials alerts the appropriate biller, who can then intervene and make corrections prior to claim submission. The benefits of this “early detection” approach include: Reducing the number of denials to be processed (and staff time spent processing them) Reducing AR days by flagging high-risk claims Improving patient satisfaction by avoiding lengthy appeals processes. After using AI Advantage – Predictive Denials for six months, Schneck Medical Center reduced average monthly denials by 4.6%. Reworking claims flagged with a predictive alert took 3–5 minutes, which was significantly quicker than before. By frontloading staff time to get claims right the first time, less effort was spent on denials. Implementation was straightforward, with no disruption to the existing claims workflow. Triaging denials for faster, more effective rework The second piece of the AI Advantage solution addresses denials that haven't been prevented. AI Advantage – Denial Triage uses advanced algorithms to identify and segment denials so staff can focus on the most profitable resubmissions. Denials are automatically triaged into five customizable categories based on likelihood of approval. Staff can rework the claims in their work queue without wondering if they're putting their effort in the right place. By automating decisions about which claims to prioritize for rework in real time, Denials Triage eliminates time spent on low-value denials and increases revenue by prioritizing high-value claims. As with Predictive Denials, this reduces the administrative burden on staff, expedites AR days, and increases patient satisfaction by reducing time to decision. Extending the automation advantage To maximize reimbursements, providers need to look at opportunities to leverage automation and artificial intelligence across the entire claims ecosystem. AI Advantage integrates with existing systems and workflows to leverage the impact of tools such as ClaimSource®. ClaimSource manages the whole claims cycle from a single online application. AI Advantage uses real-time insights generated by ClaimSource to detect patterns and predict future payer behavior. Other ways to use automation to improve claims management include: Automated claim scrubbing – Claim Scrubber uses machine learning to assess which claims have been denied in the past and why. Claims can be tagged for extra checks before being prepared for processing, to ensure likely errors have been avoided. This helps eliminate undercharges, reduce errors and minimize rework. Enhanced claim status monitoring – This helps providers keep track of existing claims. Automated status requests based on each payer's adjudication timeframe reduce manual follow-up work and allow staff to respond promptly to issues. Gathering insights into potential problems before the electronic remittance advice and explanation of benefits are processed creates time to make corrections. Using a denials workflow manager – This system automates and optimizes the denial management portion of the claims cycle, so staff can improve productivity and speed up reimbursement. With a single vendor, these tools and systems are designed to work cohesively, so there are no issues with interoperability. Data is reliable, accessible and integrated, so automation can pull from the most up-to-date and complete sources. This data can feed into proprietary machine-learning algorithms to predict and shape future performance. Experian Health's suite of automated claims management software solutions also comes with support from experienced claims-specific experts, who can help staff optimize their set-up and workflows. With the rise of AI, the healthcare industry is turning towards a more proactive approach to claim denials. Leveraging artificial intelligence for claims management can improve the overall efficiency and accuracy of healthcare claims processing, leading to fewer denials and a more seamless patient experience. Instead of waiting for denials to occur before taking remedial action, providers can use AI and automation to proactively detect errors and diagnose weaknesses in the claims process for a healthier revenue cycle. Discover how AI Advantage can help healthcare organizations predict and prevent claim denials.