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The President, members of Congress and consumer advocates are all demanding price transparency within the healthcare universe.  The major push of late is President Trump’s executive order that will be issued in June 2019; while critics hope this initiative will fade, the topic has been on the industry radar for many, many years. How did we get to today’s scenario? We have a robust perspective on this subject at Experian Health because we’ve been working with healthcare organizations offering various solutions that inform consumers about the costs of their care for more than 10 years. We brought to market the first iteration of our current Patient Estimates product back in 2008, responding, in part, to the growing issue of medical debt and inherent risk to providers not getting full payment for services. The challenges presented by medical debt are well documented, but the important point to focus on is that as long as Americans continue to lack the ability to pay for their care and health organizations struggle with collections, the push towards price transparency will continue. Perhaps this is much needed progress? Since 1957, nearly 75% of Americans have consistently reported being insured but unable to pay their medical bills, according to a study by the Centers for Disease Control. Now, more than 50 years later, many legislators hope mandated price transparency will alleviate the surprise factor of medical costs and spur a more competitive environment. In 2008, helping patients understand their costs was intended to improve providers’ collections success. The term ‘price transparency,’ with additional connotations (e.g. better experience for the patient, improved efficiencies), popped up about the same time as the introduction of very high deductible health plans. The phrase started gaining traction following passage of the Affordable Care Act, and as patients were responsible for more of their medical costs. Add in the rise of consumerism within healthcare and Americans’ digital lifestyles, and it’s no surprise there are calls for pricing to be as easy to understand as they are in the retail space. We harness the power of data and analytics to fulfill these needs in the marketplace. The healthcare industry was ripe for change more than a decade ago, as evidenced by the desire of organizations to leverage what we could offer. While there is continued debate on the transparency topic, the good news is today’s data-driven technology can create a patient financial experience that is friendly, understandable and accessible, delivering the good-faith estimates many consumers, legislators and the industry-at-large wish to see. Consumerism drives price transparency expectations Ultimately, the financial aspect to care is a key component to consumers’ satisfaction with a provider. This realization began to bubble to the surface over the last several years. In fact, Experian Health conducted research last year to understand consumer pain points during the healthcare journey. Consequently, it was no surprise when the study revealed consumers’ biggest frustrations and challenges – above clinical areas – is dealing with the financial aspects of healthcare: 90 percent of respondents ranked worrying about paying their medical bills as a very important to extremely important pain point. 30 percent acknowledged the challenges of determining what financial support options (e.g., payment plans, government grants, and hospital charity care programs) are available 90 percent reported significantly underestimating the costs associated with major medical procedures (e.g., knee replacement) The takeaway from this study is clear: consumers want a streamlined payment process that builds confidence and provides peace of mind. We know that healthcare providers want to increase the efficiency and success of their collections efforts. Ultimately, everyone benefits from clarity around pricing. So whether government-mandated or not, there is no denying that price transparency, in some form, is here to stay and a transformation in the industry is taking hold. Experian Health is leading the way to innovations that will help healthcare organizations thrive in this new era. By leveraging our expertise in data and analytics and our understanding of healthcare costs, we can help patients successfully navigate their financial obligations from primary care appointments through subsequent diagnostic procedures and surgeries. The potential is there for everyone to benefit from an evolved, modern system. Related Articles: How Blessing Health System personalized estimates to improve patient satisfaction

  The roll-out of patient portals has been a slow burn. While consumer finance, retail and other markets have given customers secure electronic access to their personal information for decades, healthcare has been playing catch-up. But thanks to regulatory pushes, such as the Promoting Interoperability and Meaningful Use programs and the Affordable Care Act, digitized health records are now the norm. Over half of healthcare consumers in the US use patient portals to access their health information at the click of a button – just as they do with their bank accounts or grocery deliveries. Aside from the convenience factor, research suggests that when patients have access to their health records through patient portals, they experience better health outcomes, greater satisfaction levels, and improved communication with their provider. There’s a higher chance of spotting errors. Adherence to medications is increased, and care becomes more accessible for some otherwise hard-to-reach patients. For providers, this sense of ownership, transparency and connection contributes to elevated consumer loyalty and engagement. As consumers embrace online portals to view their medical records and lab results, renew prescriptions, schedule appointments, and in some cases pay bills, they expect and assume their provider will keep that data secure. Providers must balance convenience and security. Unfortunately, some patients remain unconvinced of their providers’ ability to get this balance right. Patients worry about portal privacy and security Despite the upsides, a quarter of patients with access to online portals in 2017 chose not to access them because of worries about privacy and security. They’re right to be cautious: medical identities are said to be worth 20-50 times more than financial identities. It's no wonder identity thieves are increasingly targeting the healthcare industry. In 2018, the US Department of Health and Human Services’ Office for Civil Rights (OCR) reported 351 data breaches of 500 or more healthcare records, resulting in the exposure of more than 13 million patient records. Hackers are always on the lookout for vulnerabilities to exploit, with patient medical records, log-in credentials, passwords and other authentication credentials among their top five targets. Without adequate IT security, your prized patient engagement tools – like patient portals – can become an open door for hackers. As a provider, your job is to make it easy for patients to access and manage their own data, but hard for fraudsters to get their hands on sensitive data.​​​​​​​​​​​​​​ ​​​​​​​How to keep patient portals secure The good thing about being somewhat late to the party is that healthcare organizations can learn from other industries in how they have tackled online security challenges without creating too much of a burden for consumers. Think about how consumers authenticate their accounts for financial services or even social media profiles. Typically, there's an email to verify they are who they say they are, or a two-factor authentication process with a code sent to their cell phone. Most patient portals don't have these layers of security. At Experian Health, we recommend a multi-layered solution incorporating device recognition (especially important as more users access portals via cell phones and tablets), identity proofing and fraud management. Here are some examples: Sign-up screening When someone enrolls in the portal, use identity proofing to ensure they are who they say they are. It’s particularly important to ask out-of-wallet questions, such as their city of birth, first car model, or previous address to make sure they’re not an imposter.     Log-in monitoring Device intelligence will help you confirm the patient is using a cell phone or tablet your system recognizes, to minimize the risk of someone else accessing their account. This technology will tell you if the device is associated with previous fraudulent activities or potentially impersonating multiple patients. If a device fails to meet the risk threshold, identity proofing questions can be used to verify the user’s right to access the account. Additional checks on risky requests Some patient portal activities, like downloading medical records and editing a patient’s profile, increase the risk. You’d want to add an extra layer of control here, such as additional out-of-wallet questions, to safeguard your patient’s data. Rapid response and damage containment Given the sensitivity and richness of medical data, an attack on the portal can be devastating for patients and costly for providers. In the event of an attack, providers can put in place early warning systems to flag up which patients have been compromised and trigger rapid response measures to shut down the attack and prevent the damage from spreading. Promote interoperability Physicians and care providers need to share information on patients in the course of providing good care. But how are they doing this? To keep that data secure and ensure it’s only seen by the right people, you can set up your systems to share data across different platforms in a safe and secure way. Underlying all of this is the need to reassure your patients that you can be trusted with their data. Victoria Dames, Senior Director of Product Management, Experian Health, explains: “Healthcare breaches are nothing new, and neither is hackers’ and identity thieves’ penchant for medical records. What is new, however, is the broad range of tools that organizations can now utilize to stop them from accessing that personal data. Give patients the peace of mind they deserve by taking advantage of up-to-date solutions that actually work in our ever-evolving tech climate.” Learn more about how protect patient portals and encourage more patients to enjoy the full benefits of their patient portal, knowing that their sensitive personal details are safe.

Over the last twenty years, American hospitals have provided more than $620 billion of uncompensated care for cases where no payment was made by a patient or insurer. This includes financial assistance, where hospitals provide care at a reduced cost for those unable to cover their full bill, and bad debt, where patients have not applied for financial assistance and cannot or will not pay their bill. Despite extensions to Medicaid coverage under the Affordable Care Act, the number of uninsured people in the United States is still approaching 30 million. For these often-vulnerable populations, safety-net hospitals provide essential care regardless of the patient’s ability to pay. But safety-net hospitals are themselves under increasing financial pressure, experiencing more than double the uncompensated care costs of other acute hospitals. And when safety-net hospitals are closed down or struggle to meet demand, nearby hospitals must cover the shortfall in care. It’s a problem for everyone. A Kellogg Insight report found that when more people are uninsured, hospitals bear the cost by providing uncompensated care to the tune of $900 for each additional uninsured patient. Craig Garthwaite, Assistant Professor of Strategy, describes hospitals as “insurers of last resort”: “People are still going to the emergency room and they are still receiving treatment – so the cost is still there. When governments do not provide health insurance, hospitals must effectively provide it instead.” Hospitals might respond to the burden of uncompensated care in three ways: shifting the cost of care to other payers, cutting the cost of services to all patients and removing unprofitable services, or accepting lower total profit margins. All have the potential to damage quality of care as well as revenue and workflow. But beyond these major systemic responses, there are steps providers can take to reduce their risk of unpaid care and optimize their existing revenue framework. Protect your revenue by finding missing coverage quickly The new reimbursement landscape forces providers to manage more self-pay patients, with high-deductible health plans and health savings accounts. This puts a lot more responsibility and stress on patients themselves, who may not be able to afford their co-payments. Uncovering missed or undisclosed insurance coverage is also costly and time-consuming for providers. Regardless of ability to pay, if your patients are wrongly classified as uninsured or as having only one insurance option, you’re likely to lose revenue. As the financial risk of uncompensated care continues to grow, there are important questions for healthcare executives to consider: How do you decrease your accounts receivable balances and self-pay write-offs? How do you increase cash flow from re-billed claims? Are you missing any opportunities to bill additional payers for services? Are you identifying coverage for emergency department inpatients in time to meet your notice of admission requirements? The answers boil down to having the right processes in place to discover which patients can and cannot afford to pay, ideally before they go through the billing system. When you know this, you can move quickly to direct them to alternative sources of funding. How to find insurance coverage to avoid bad debt and charity write-offs An automated coverage discovery solution could help you identify patient accounts that don’t have sufficient insurance coverage, without the expense and hassle of engaging a collections agency. This proactive software integrates with your revenue cycle to search government and commercial payers automatically, so you can find insurance coverage that may have been missed or forgotten. It relies on multiple data sources and reliable demographic information to detect any inaccurate financial classifications and alternative coverage options. It can also shed light on product usage, productivity and financial results, which may help you fine tune your revenue cycle in other ways. Murry Ford, Director of Revenue at Grady Health System explains how Coverage Discovery allows his team to identify an accurate coverage match for patients without the patient having to share this information: “We use Coverage Discovery when the patient is admitted… the system automatically attaches the coverage to the patient’s account. No one has to get involved – it’s touchless, it’s seamless, and it’s worked really well for us. It’s brought in revenue that we would not have identified otherwise.” Every dollar found in this way is a dollar you’re not writing off to bad debt, or spending on unnecessary patient collections and admin. Mike Simms, Vice President of Revenue Cycle at Cone Health says: “Coverage Discovery is wonderful… After every admission, the next day we get a file which gives us insurance on those that we’ve missed. We can add that insurance to the patient account and bill the insurance company. In the end it helps us resolve accounts in a timely manner. Since we’ve been using Coverage Discovery, we’ve received over $3 million in payments, and that’s more than a 300% ROI.” An automated solution like this can be plugged in immediately to handle unresolved accounts for you, resulting in faster and more accurate collections, greater patient satisfaction, and improved staff workflow – ultimately reducing your organization’s risk of uncompensated care. Learn more about how Coverage Discovery Manager works.