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What if you could flag patients who are at risk of readmission? What if you could anticipate missed appointments or know ahead of time that someone is going to face challenges with their care plan? This knowledge could help you improve patient outcomes, streamline staff workflows and improve your bottom line. So how can you get this non-medical information and use it to improve treatment outcomes? A person’s circumstances can help us understand potential challenges in access to care to predict their behaviors More than 80% of health outcomes are unrelated to medical care. Instead, they are attributable to outside social and economic forces, such as housing, education, unemployment, low income, transportation, access to green space, loneliness, inequality and other non-medical factors. These social determinants of health (SDOH) are the living and working conditions that come together in just the right combination to either promote or a limit a person’s health and wellbeing. As a healthcare professional, you’re no doubt aware that people struggling with financial or life circumstances have a more difficult time focusing on their health and subsequently face more urgent hardships. And it isn’t just the patients who suffer. It has a negative impact on the entire healthcare ecosystem. Why providers should care about social determinants of health When patients struggle to access healthcare services, they’re less likely to follow treatment plans or adhere to follow-up visits. They’re more likely to need to come back with more serious conditions that could have been detected earlier, had they felt equipped to follow the care plan. Not only is this worrying for the patient, but it also leads to excessive service utilization that is costly for providers. Missed appointments are estimated to cost the US healthcare system a massive $150 billion, while each unused 60-minute slot costs an average of $200. And that’s not to mention the opportunity cost of equipment and rooms sitting idle, and all those wasted hours of billable physician time. The shift to value-based care puts more pressure on providers to improve outcomes. But how can they do that when those outcomes are partially determined by factors beyond their control? Considering that 68% of patients have at least one social determinant challenge, the only sensible move is to bring solving for SDOH to the forefront of care planning. “No patient wants to skip appointments and dial 911 as their only reliable means to get the care they need,” said Karly Rowe, Experian Health vice president of product management. “We want to level the playing field by helping providers identify and solve for these socio-economic challenges that make it hard for some patients to get the care they need. SDOH has the ability to improve outcomes, lower costs and increase patient satisfaction, removing the socio-economic obstacles hindering healthcare.” An example of providers and payers collaborating to solve for social determinants of health is the Aligning for Health coalition, which in 2016 referred 33,000 patients to community initiatives. Andy Friedell, a senior vice president at Maxim Healthcare Services said of the program: “We are prioritizing community-based care and social determinant solutions for our patients and clients. In fact, we have effectively used these tools to help reduce readmissions by over 65% for high-risk patients.” How can social determinant data improve outcomes? Let’s look at two examples of how healthcare providers might analyze social determinants to help improve care management. 1. Reducing appointment no-shows For many patients, a lack of transportation is the main barrier to compliance. How do they get to an appointment or procedure if they don’t have a car, don’t live in an area well served by public transport, and can’t afford a cab? Looking at vehicle registration data and public transport services in the area would be one way for a provider to gauge access to care. But does that give the full story? Even if they can find transport, are they juggling two jobs? Do they need childcare? By synthesizing data on transportation, family arrangements, average incomes, and more, providers can anticipate the propensity of someone being unable to access care, and offer solutions such as a free hospital bus service or crèche facility. 2. Preventing escalated health conditions Understanding social determinants is not about identifying unhealthy behavior. For example, a provider might see poor health and point to poor diet. But a patient’s poor diet may not simply result from poor choices. A provider who’s aware of the potential impact of social determinants might consider the propensity of food insecurity – maybe the patient doesn’t have access to healthy food? However, putting the patient at the center and truly understanding social determinants means thinking beyond the ‘food desert’ explanation. Even where healthy food is available, the ability to eat it might be limited by lack of time to cook it, or money to buy it. The provider must adjust their lens and understand how a stressful work schedule, chaotic household and readily available cheap food converge to make it virtually impossible for the patient to even think about putting their health first with a healthy meal. As a result, a patient who could have been identified early on with symptoms indicating the onset of diabetes, for example, instead has their diagnosis delayed because they can’t get to an appointment, while their condition worsens due to their unhealthy diet. Instead of offering dietary advice or signposting to a wholesome supermarket, the provider might choose to work with a registered dietician nutritionist, direct patients to community resources, participate in community partnerships, or even engage with local planning departments and commercial developers. When you understand what drives your patients and recognize the real barriers preventing them from prioritizing or accessing healthcare, you can proactively identify opportunities to solve them. 3. Using the right data to understand and solve for social determinants of health Better care management and improved health outcomes start with understanding the whole patient and the social determinants impacting their life, and then turning those insights into actions. For providers to be proactive, preventative and patient-friendly, they need to know the patient’s socioeconomic background before they enter the room. They must have an idea of what that conversation should look like before they even say hello, and know which SDOH-related programs might be relevant to this patient. Analytics platforms can help leverage wider consumer data sets to spot patterns that affect operational efficiencies so providers can offer more patient-centered care. Of course, if you’re using consumer data, you must have confidence both in its accuracy and in your ability to safeguard consumer privacy. Both can be achieved if you work with a data management partner who can collect data from consumers at scale, with solutions that check all the privacy boxes necessary to allow this data to be used in a healthcare setting. So if you weren’t already thinking about what social determinants of health mean for your organization, perhaps think about what you could do now to incorporate a solution that tells you what patients need, provides the right amount of context to understand what external factors might be causing or affecting that need, and then solve for it at the point of care. — The solution exists to help you. You could have the power to identify and solve for social determinants at your fingertips.

Whether it’s due to pressure from governing bodies or price-shopping health consumers, many healthcare organizations are being challenged with price transparency efforts. With so many moving parts to determine a patient’s financial liability, how can accurate patient estimates be provided in a timely manner? Giving patients the right pricing information at the right time Like many healthcare systems, Blessing Health relied on various printouts and spreadsheets of price lists from different departments of the hospital to provide patient estimates. Lists needed to be manually updated, and the staff often relied on outdated information. The process wasn’t standardized, and estimates were inconsistent across the enterprise. While Blessing wanted to make sure that patients were getting accurate information, the estimates didn’t consider a patient’s insurance information. Since patients weren’t understanding their true financial obligation, it caused frustration among patients and employees. In today’s competitive environment, it’s important to reduce instances in the patient journey that might cause irritation. A recent report from Trends in Healthcare Payments, notes that patients who are satisfied with billing are five times more likely to recommend the hospital. At a time when hospitals are being asked to do more with less and reduce the cost of care, manual processes and work must be reduced and automated with data to provide accurate information. Patient liability estimation is a complex process of calculating multiple components, not easily available to users, including insurance benefits, charges, contractual adjustments and provider discounts. If hospital staff are manually estimating the processes, they could be using outdated pricing lists which may not include application of insurance benefits, contract rates, and discounts. As consumers gain access to pricing information, health leaders should invest in data-driven technology that can provide consumers with accurate personalized estimates. Most healthcare organizations already have the basic data they need to use automated technology to construct estimates for basic services, including claims data, real-time eligibility and benefits information, payer contracts and charge description master (CDM) information. Blessing Health knew they needed to find a way to advise patients of their financial liability, as well as give staff a tool they could confidently use to request patient payments upfront to increase collections. They wanted real-time estimates that were personalized based on a patient’s insurance and contract information. To do this, Blessing Health reached out to Experian Health to integrate Patient Estimates into their Allscripts® workflow. What to look for in price estimator tools Healthcare organizations should implement price transparency and collection practices that are standardized across the enterprise. A pricing transparency tool eliminates the need for manually updating price lists, and removes the guesswork and tedious manual processes, which often result in outdated, inaccurate estimates. Price transparency software should also include reporting features that give greater control over the process and can be agile in managing transparency initiatives as well as track potential versus actual collections. A price transparency tool should highlight a patient’s financial situation, as well as their propensity to pay, allowing you to optimize your collection strategies from the start and get patients on the right programs. To help reduce traffic to call centers, a price transparency tool should be integrated into consumer-facing estimates that are personalized and available through a web portal or mobile app. Price estimation can help with patient collections Through an automated, data-driven process, Blessing Health is now able to provide personalized patient estimates that are 80 percent to 90 percent accurate. (Inaccuracies result from unexpected tests or procedures.) As a result, Blessing Health benefited from a 58 percent increase in point-of-service patient collections. Based on the cost to implement these services, Blessing Health experienced a 1,200% return on investment. After realizing success on the hospital side, Blessing Health implemented Patient Estimates for their physician group as well. — Learn more about how you can empower the patient financial experience.

A recent Black Book survey of more than 500 healthcare networks revealed that hospitals in the U.S. have been painstakingly slow in adopting healthcare revenue cycle management (RCM) solutions. At the start of 2018, nearly 26 percent of hospitals had no viable solution in place, and 82 percent of them planned to make value-based reimbursement decisions without one.   For most hospitals, one of the biggest challenges in implementing RCM solutions is finding talent with the right skill set to handle RCM software difficulties. It’s a problem that even the largest healthcare delivery networks face and one that UCLA Health hospitals had to overcome. UCLA Health System Faculty Practice Group (UCLA FPG) employs more than 2,500 physicians with more than 220 primary and specialty practices.   Keeping up with payer contracts   In 2007, more than $4 million in revenue went uncollected at UCLA FPG. The group’s RCM pain points were typical of those in the industry. For example, the group was unable to keep track of over- and underpayments, which made it difficult to adhere to payer contracts. It was also difficult to manage appeals and track recovery as the volume of payer contracts grew and became increasingly more complex.   The difficulty UCLA FPG had in gathering and exporting information, in addition to the complexity and volume of contracts, left it with little negotiating power when dealing with payers. UCLA FPG's numbers continued to fluctuate until implementing Epic alongside Experian Health's Contract Manager.   Using this web-based solution, UCLA FPG has been able to automate and improve its revenue cycle due to the solution’s ability to continually monitor and update every payer contract. This has also helped the healthcare group stay compliant with all payer agreements by making it possible to catch errors faster.   Director of Revenue Integrity Measha Ford states: “We are able to catch Medicare overpayments faster with the contract management system. We recently integrated all our Medicare contracts into the system to have a lower risk of compliance issues since we only have 60 days to refund Medicare back once we identify an overpayment. Having this system, having that ability to load the contracts into the system to catch these potential risks, is very helpful.”   The UCLA network now has fewer administrative write-offs every year, faster AR collections, and reduced denials.   Experian Health's team maintains contract terms, fee schedules, and payment policies and makes sure every claim processed follows UCLA's contract terms. Online dashboards and reports help monitor reimbursement and reduce payment discrepancies through interactive graphs that expose source claim data and practice management system-specific data attributes.   Analyzing contracts before signing up   In addition to tracking and managing contracts, the group also knows exactly how a new contract or redefined contract terms will affect its bottom line. It has intel on real-world “what if” scenarios to provide insight into how various contract terms affect cash flow for the precise mix of services the group provides. It's also able to avoid unfavorable contract terms, as they are easily spotted through analysis.   Are health plans complying with your contract terms? Learn more about how we can help you find lost revenue with data-driven insight.