First Pst after migration to Cloud in Health care Blog

Editor's note: This blog post was updated on October 2, 2023.  In today's rapidly evolving healthcare landscape, the need for a standardized approach to patient matching and identification has become crucial. Not having a unique patient identifier (UPI) not only poses challenges to managing patient data but also hampers interoperability between healthcare organizations. A unique patient identifier (UPI) is a method for standardizing patient identification. Individuals are assigned a unique code, and that code, rather than a Social Security Number, name, or address, is what is used by healthcare organizations to identify and manage patient information. A standardized code like this not only protects sensitive health information but supports the exchange of data between healthcare organizations and states as it is a number and format easily read and recognized by all. Advocates for a coordinated approach to patient matching are continuing to make the case for a national unique patient identifier (UPI). In April 2023, healthcare organizations wrote to legislators urging them to reject language in the 2024 Health and Human Services appropriations bill that prohibits the use of federal funding for a national UPI standard. More than 150 healthcare and medical organizations signed the letter, including Experian Health. The coalition argues that a standardized approach to patient matching could save lives, avoid medical errors, reduce unnecessary costs and greatly improve operational efficiency. While federal funding currently remains off-limits, the industry is poised to move forward to develop a national patient identity solution that is cost-effective, scalable, secure and one that protects patient privacy. Let's explore how a UPI can revolutionize the healthcare industry and create a truly connected ecosystem. How a unique patient identifier is used in healthcare UPIs give providers and payers a way to link records for the same patient or member, so they have one complete record. Without a UPI, a provider may inadvertently create a duplicate patient record because a slight variation in the patient's name or address means their original record isn't accurately matched to them. A 2022 survey by Patient ID Now found that 6 in 10 healthcare organizations had estimated duplication rates of 4-8%, while 16% of organizations had more than 15 patients with the same name.  If there's more than one record for a patient, providers may miss important medical information that's not carried through to the version of the record they're looking at. Unreliable records can also lead to misidentification, where patients with a similar name may have their records incorrectly matched. According to the ECRI Institute, misidentification is one of the top ten threats to patient safety. Patients could be given the wrong treatment or medication, with life-altering or fatal consequences.  While patient safety is the top concern for providers, efficiency is another driver of attempts to improve records management. Organizations report spending $1.3 million per year on patient identity resolution, as resources must be redirected to figuring out who patients are and fixing errors. Being able to correctly link records for a complete view of an individual's identity can help circumvent these challenges.  A unique patient identifier is the key to interoperability Managing patient data across the entire healthcare ecosystem is a long-standing challenge. Many organizations rely on master patient indexes to match patients using demographic data. But these single-source databases are rife with gaps, overlaps, and outdated patient information. They can't keep up with simple name and address changes or easily identify and fix data entry errors.   A more effective solution involves combining data sets to create complete identities and profiles, where every piece of new data is instantly updated and verified. Experian Health uses referential matching technology to achieve a fuller picture of each patient's identity. The UPI then acts as a golden thread, linking each patient record correctly within and between systems.  For example, if a provider has a patient in their EHR twice under two spellings of the patient's name, a UPI would link those two profiles, creating a singular view of the patient. If a pharmacy has a patient listed under a birth name but the doctor has them listed under their married name, a UPI can ensure both systems match the patient correctly.  When combined with other patient engagement solutions, data and identity management tools  create the infrastructure needed for healthcare to truly become one cohesive, patient- and member-centric network.  It is important to note that the UPI is not a patient-facing number and is not known to the patient or provider. It does not collect or share any clinical claims or diagnostic information; its purpose is simply to link records together giving providers and payers a complete view of someone's identity.  Improving the patient experience with a unique patient identifier  Healthcare consumers are increasingly seeking digital-first, efficient processes, and they're sensitive to the need for robust data security. Healthcare organizations must demonstrate their ability to manage patient data properly from the patient's first interaction. If data management is inefficient, patients will find themselves being forced to fill out forms they've already filled out multiple times or undergo duplicate tests as they travel between facilities. Patients with similar names may be confused if they're shown someone else's details during the identification process.  In an ecosystem built around a strong healthcare network, these discrepancies can be avoided. The patient's unique identifier remains consistent across every healthcare facility they visit – including physicians' offices, hospitals, pharmacies, specialists and long-term care facilities – so all providers know exactly who they are.   While patients welcome a more convenient, coordinated experience, they'll also be reassured by the reduced risk of medical errors that comes with a well-connected healthcare network.   Efforts to improve patient identity resolution in healthcare  While there may not be a national UPI yet, the industry is trying to find workaround solutions. The Centers for Medicare & Medicaid replaced Social Security Numbers with Medicare Beneficiary Numbers as the primary means of identifying Medicare beneficiaries. But while this addresses the risk of data breaches, it doesn't resolve the interoperability challenge.   Another initiative is Project US@ (Project USA), run by the Office of the National Coordinator for Health Information Technology (ONC). This aims to create a consistent healthcare industry-wide specification for representing patient addresses, to improve address accuracy. This would ensure that, for example, the same street name written as “road” and “Rd.” is not mistakenly viewed as two different addresses by the software.   To support efforts to integrate disparate software solutions, Experian Health announced in 2019 that every person in the United States had successfully been assigned a unique UPI, powered by Experian Health Universal Identity Manager (UIM) and NCPDP Standards™ (the “UPI”).  Combining Experian's expansive data assets and innovative UIM technology along with NCPDP standards, each person who has received medical care or used a pharmacy has been assigned a UPI. As new patients enter the healthcare ecosystem, this number will continue to grow.  Dave Roberts, VP of Platform Products at Experian Health, says that “the technological foundation is already in place for data interoperability through the creation of UPIs that are maintained in a master person index. These solutions are vendor-neutral, meaning data can flow freely between disparate electronic health systems, regardless of size or location.” Utilizing Experian Health's Patient Identity Solutions The implementation of unique patient identifiers holds immense potential for creating a connected healthcare ecosystem. By standardizing patient identification and enhancing data management, a unique patient identifier can improve patient safety, reduce costs, and streamline processes across the entire healthcare industry. Find out more about how Experian Health's patient identity solutions serve as stepping stones towards a more efficient and patient-centric healthcare network.

Health plans have been fighting against inaccurate member data, incomplete member profiles and duplicate records for years. Without a watertight way to keep track of patient identities so health data is reliably linked and accessible across multiple services, payers can’t always be confident that the record in front of them matches the member they have in mind. The pandemic has brought this into sharp focus: positive COVID-19 test results aren’t always following members from service to service, and as the vaccination program rolls out, knowing who has had the disease and who has been vaccinated could be difficult to monitor. As health data expands exponentially and the need to share and connect member records becomes more urgent and complicated, the challenges facing health plans will only grow. Could a unique patient identifier (UPI) be the answer? 4 member matching challenges that health plans could solve with a UPI 1. The healthcare ecosystem lacks 21st Century Cures Act data coordination The lack of integrated systems to transfer member data securely contributes to safety issues, payment delays and potential audits and fines. Over a third of denied claims for health systems result from inaccurate patient information, costing them  at least $6 billion per year. While this would seem not to impact the payer, the inability to properly link claims to members could lead to an inability to understand the risk represented by the members being covered. Or worse, an inability to anticipate and monitor trends in members health and provide proactive healthcare options. A unique patient identifier can connect the dots between different parts of the healthcare ecosystem so duplicate and incomplete member data can be detected and eliminated. With a more complete picture of who a member is, health plans can make decisions based on accurate information and exchange data safely and securely. There’s a far lower risk of acting without knowing about recent treatment or test results, or communicating using the wrong address (or even to the wrong member). 2. Healthcare providers have outgrown traditional matching tools With the volume and variability of health data to be matched, traditional matching tools are no longer fit for purpose. For example, an enterprise master patient index (EMPI), which links all versions of a patient’s record across several facilities, may seem reliable. However, by relying on a single source of demographic data, EMPIs likely replicate errors and outdated information, and may combine records for patients who share certain demographic information (for example, if two patients have similar names and the same date of birth). Instead, payers should consider a matching solution that combines member roster information with comprehensive third-party reference data. Member records are matched using referential and probabilistic matching, and connected using a UPI. This gives health plans a more complete picture of their members, built on reliable health, credit, and consumer data sources, and allows all parties to understand the person at the center of it all. 3. Discrepancies in member data make care coordination impossible Members may use different names or nicknames, their address may change, and they may even share a Social Security Number (SSN) with someone else. How can health plans help to coordinate care if they’re not sure they’re tracking the right member? A single electronic health record (EHR) can follow the member throughout their healthcare journey with a UPI, so health plans can be confident that the person on the phone or in the office matches the record on screen. They can monitor and respond to gaps in care, allowing them to better coordinate care for better patient health, improved member engagement and money-saving operational efficiencies. 4. Members present to multiple facilities, inhibiting care plan tracking How can health plans reliably track medication adherence, especially when members present to multiple locations? Is there really a gap in care, or did the member just attend a different facility? And if members go to different pharmacies, how can a pharmacist be sure the prescription is going to the right person? All of this can create risks to patient safety and increased costs for payers. A UPI can help. Experian Health has teamed up with the National Council for Prescription Drug Programs (NCPDP), which sets standards for pharmacy services to exchange electronic healthcare data. A framework has been built for a UPI-based patient matching solution that the entire US healthcare network can use. Not only will this improve patient safety, it’ll minimize staff time spent on reconciling incorrect records, thus boosting financial performance too. When it comes to mismatched records, prevention is better than cure. With a Universal Identity Manager, health plans can have confidence in the accuracy and security of the data they’re using and sharing, promote patient safety, and improve staff productivity. Contact us to learn more.

Experian Health products referenced in this blog post: Patient Engagement Solutions Patient Scheduling Precise ID Patient Payment Estimates Patient Payment Solutions To access more insights and trends, download the entire white paper:  How has the pandemic affected consumer attitudes toward patient access? What kind of digital experience do consumers expect from their healthcare provider in 2021? Are patients and providers on the same page when it comes to self-service in the healthcare journey? Providers must answer these questions if they are to improve their digital front door, boost patient loyalty and withstand the financial impact of COVID-19. While we know that a satisfying patient access experience translates to a stronger revenue cycle, change can feel risky without knowing what consumers really want. Experian Health surveyed hundreds of healthcare consumers and providers to find out what each expects from patient access in 2021, and uncovered opportunities for providers to lay the groundwork for future financial success. Survey findings: 4 revenue-boosting opportunities for patient access in 2021 1. More control and convenience for consumers Nearly eight in ten consumer survey respondents want to be able to schedule their own appointments, at any time of day or night, from their home or mobile device. They can already order groceries and view their bank accounts this way – and they want the same level of control and convenience when managing the non-clinical aspects of their healthcare. Digital patient engagement solutions allow providers to offer consumers the flexibility and accessibility they crave. Patients can schedule appointments online, complete registration from home and pay bills from a mobile device. Convenience also delivers health benefits: no-shows are less likely, and patients find it easier to adhere to care plans. And while COVID-19 remains a concern, self-service options minimize face-to-face contact, keeping staff and patients safe. Automating patient access even contributes to better collection rates, for example, by reducing errors that can lead to denied claims. 2. But don’t deliver convenience at the expense of safety and security Patients want convenience, but they also want their data to be kept safe. More than half of consumers surveyed, particularly the younger age groups, say they worry about security when accessing their personal details online. Security can be challenging for providers: they need multi-layered solutions that can adapt to security threats that evolve with ever-increasing complexity, without creating cumbersome log-in processes for patients. But with the right technology, providers can  safeguard patient data with confidence. Experian Health’s patient portal security tools use leading-edge identity proofing, risk-based authentication and knowledge-based questions to reliably verify patient identities. Patients can book appointments, register for care or view their health information. Calls to IT support are likely to drop too, saving staff and patients valuable time. 3. Contactless care requirements are driving long term, systemic change While many of these changes were already simmering in the background, the pandemic has turned up the heat and accelerated the need for contactless care. Will this be a long-term trend? Both patients and providers believe self-service technology is here to stay and seven in ten providers surveyed say they don’t expect patients to feel comfortable in waiting rooms until at least summer 2021. While face-to-face care will always be important, it seems likely that a digital front door will become the default to make the non-clinical portion of the healthcare journey easier and quicker for everyone. “As providers expand the use of patient portals, there is a huge opportunity to demonstrate the true value of virtual care – and transform healthcare for the long-term." – Tom Cox, general manager, head of product, Experian Health 4. The financial conversation between consumers and providers must be based on trust, transparency and empathy When the final bill bears no resemblance to initial estimates, patients feel frustrated and misled. With deductibles and out-of-pocket expenses on the rise, patients are demanding simple and clear pricing information so they can plan accordingly. Providers that offer consumers transparency, understanding, control and convenience when managing their financial responsibilities are going to have the competitive edge. Providers can achieve this with clear, upfront and accurate pricing estimates to help patients understand their financial obligations before their visit. Next, support to check coverage and advice on tailored payment plans will provide patients with as many tools as possible as they plan to meet those obligations. Experian Health’s Patient Payment Solutions can check for patient coverage, identify a payment plan(s) that suits a patient’s individual situation, and then make it easy to pay via a mobile device. Future provider revenue hinges on investment in digital healthcare. A welcoming, convenient and secure digital front door translates to patient loyalty, which in turn can mitigate losses in challenging times. Wherever are in digital patient access journey, there’s an opportunity to improve the experience for patients and build a revenue cycle that not only survives the tumult of the pandemic, but also thrives in the years ahead.