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Experian Health will be at HFMA ANI again this year–booth 1025–at the Venetian-Palazzo Sands Expo in Las Vegas, Nevada. Kristen Simmons, Senior Vice President, Strategy, Innovation, Consumer Experience, and Marketing, with Experian Health, chatted with Joe Lavelle of IntrepidNOW to provide her insights on this year’s HFMA ANI conference, consumerism in healthcare and much more! Excerpt below: Experian Health booth activities  "[In our booth this year at HFMA ANI, we want to focus] around peer to peer learning and exchanges, so we are doing less selling and more engaging and more understanding. Understanding folks problems and helping to collectively arrive at solutions. We are doing a lot this year in terms of hands on demos of our solutions. We'll be showing some of our patient engagement products which include, self-service portals and mobile options for getting price estimates for applying for charity care, and setting up payment plans. Likewise, on the revenue cycle management side to automate orders with patient access functionality, contract management claims and collections, all those types of things that we do to improve efficiency and increase reimbursement for our clients. We'll also be showing off some of our identity management capabilities to match, manage, and protect patient identities so we can safe guard medical information and reduce risks for our clients. And on the care management side, our early support and sharing of post acute patient care information to help providers succeed as we all move forward into a value based paradigm." How Experian Health is addressing the need for consumerism in healthcare  "When it comes to consumerism, it's interesting when you're a company that has a lot of data and a lot of capabilities to say, 'Hey what can we do for people?' One of the things we really wanted to look at for our consumer approach, was to say, 'What is it that needs to be done?' We had some great hypotheses coming in and a lot of those were borne out but we actually undertook a big national study to take a look at what consumers biggest pain points were. It has a qualitative and a quantitative component. But, we basically looked at the entire healthcare journey so we weren't just asking them about the administrative and financial aspects of care, but also the clinical aspects. As we walked through the journey and were able to get a lot of quantitative data about all these different aspects of their healthcare journey, what actually turned out to be the most painful for the most people, were all the things around the financial equation. And, so clearly there can be pain in a clinical side, especially if you're unhealthy, you've got something chronic, you've got something terminal. There's all kinds of awful situations there but, really affecting almost everyone is a lot of the pain around the financial aspect of healthcare. So, we were able to look closely at some of those pain points and decide on some of the biggest ones that we wanted to tackle." How Experian Health is helping providers address financial pain points for patients and providers "Some of the big pain points for people is just the fact that you don't know what you're going to owe and as the patient portion of responsibility increases, understanding what you're going to be paying becomes more and more important to a consumer. So, understanding what I owe earlier, being transparent, and then helping me pay, those are some of the areas. And there are others but those are some of the absolute biggest pain points. And as you pointed out with some of our propensity to pay analytics, and some of the other capabilities that we have, we're able to help providers understand the financial situation patients are in much earlier in the process so they can get them to the right kind of funding sources. They can give them peace of mind so that they know what they're paying upfront, which may impact when they choose to go in for a major procedure or how they might want to save up for it or how they might want to access different funding sources." Listen to the full podcast

There's no question that portals increase patient engagement. According to the Office of the National Coordinator for Health IT, almost eight in 10 patients appreciate the improved access to healthcare information afforded to them by self-service systems. Unfortunately, portal systems also offer an obvious target for healthcare hackers. Within a patient portal, criminals can steal medical identity data, which is worth somewhere between 20 and 50 times as much as financial data, such as credit card numbers. They then use the stolen information to submit fraudulent claims, fill prescriptions, and resell medical equipment. What's more, because many healthcare organizations lack proper detection tools and some patients neglect to check their explanation of benefits (EOB) statements, health data breaches tend to go undetected longer than those in other sectors. No wonder healthcare data security incidents rose 211 percent in 2017, according to the 2018 "McAfee Labs Threats Report." Protecting patients' data with technology Patient portals engender patient engagement and loyalty, but if a data breach occurs, that loyalty is quickly lost. Besides losing patients’ trust, healthcare organizations that experience a data breach face potentially severe HIPAA penalties. Healthcare firms can learn a great deal from how other industries have met similar security challenges without overburdening consumers. Providers can use best-in-class technologies, data and analytics systems, and their deep understanding of patient needs to manage risks and protect patient identities. To arm providers against breaches, Experian Health offers Precise ID® with Digital Risk Score to protect portal users’ identities from their first sign-in to their last. By automating the portal signup process, it stops false enrollments at the source. Then, using multilayer verification, it provides access protection for future sessions. Because Precise ID takes less than a second to evaluate access risks, patients don't need to sit through loading screens. On the provider side, Precise ID satisfies the Centers of Medicare and Medicaid Services' Promoting Interoperability standards, minimizing compliance risks. At a time when one in five patients withhold information from physicians because of data breach concerns, Precise ID builds trust between patients and providers by protecting patients' data from unauthorized access. Giving patients the power to access their medical information through portal technology has been one of the past decade's biggest steps forward in improving patient-provider relationships. But with that reward comes responsibility: Providers must protect portals from unauthorized access and theft of medical records. With Precise ID with Digital Risk Score, providers get the security they need, and patients get the seamless access they've come to expect.

As a healthcare organization, if you're not already focused on decreasing claim denials, time is of the essence. According to one industry estimate, healthcare personnel spend a little more than 20 hours per week solely dealing with insurance claims. Altogether, that equates to about $83,000 worth of time per year per physician on claims-related administrative tasks. Most of those expenses come from needing to rework and resubmit denied claims. For example, the average U.S.-based health plan with 100 million patients processes about 1 billion medical claims annually. Up to 20 percent of these are denied due to poor claims management, and each denied claim costs approximately $25 to rework. It’s obvious, then, that cutting costs and improving productivity means learning to cut down on claim denials, too. This is exactly why Northwell Health turned to Experian Health's Claim Scrubber to accommodate its claims management needs. Cutting claim denials in half The Northwell Health network is intimately familiar with the high costs of dealing with claims denials. The nonprofit healthcare system consists of 22 hospitals and more than 550 outpatient facilities throughout New York state. In 2013, it partnered with Experian Health to cut down the rate of denied claims for all of its providers. With the help of Experian’s Claim Scrubber solution, Northwell Health cut that rate by 50 percent within just a few years. The network now also enjoys significantly shorter times between claim submissions and reimbursement, and staff can more easily stay up-to-date on regulatory and coding changes. By 2017, Northwell Health was a different, much more efficient healthcare network than it was four years before. The change was due mostly to the dramatically reduced time and costs related to denied medical claims, which Claim Scrubber made possible. The key to Northwell Health’s success Simple human error is the main reason why medical claims are denied so often. The smallest typo or discrepancy can lead to an immediate denial, and reworking a claim rarely increases its chances of being more accurate. Claim Scrubber eliminates that error by automatically quality-checking each claim line by line according to general, patient, and payer-specific information. The software solution streamlines claims management by checking that every claim is clean and error-free before the provider submits it, eliminating the costly, time-consuming need to redo them. Fewer denials (and, therefore, fewer reworked claims) mean a faster and more predictable revenue cycle, as well as lower administrative costs and more time for staff to focus on patient care. In turn, by 2017, Northwell Health providers' investment in patient care paid off. They were ranked the Best Children’s Hospitals across nine specialties by U.S. News and World Report. This is an amazing accomplishment, especially when Northwell Health's work with Claim Scrubber began as a small pilot program implemented for a single specialty. At first, the network chose 10 distinct edits to implement in claims related to a single specialty. Through direct communications with the Experian Health team, including weekly invoice audits to ensure the edits were working, Northwell Health providers quickly began seeing results. For that single specialty, claim denials in several categories started decreasing rapidly. After just one year, providers throughout the Northwell Health network saw the difference compared to their own claim denial rates. Before long, every provider wanted the edits enabled for their categories. Today, Claim Scrubber is activated for more than 25 specialties throughout the network, and leadership is confident that denial rates will continue to drop. Take your small step with Claim Scrubber The reason why the Northwell Health network is such a great example of Claim Scrubber’s potential is that it implemented the change in small steps. When it comes to claim submissions, every detail matters, and together with Experian Health’s experts, the solution allows you to examine every detail and the success of each edit before moving on. Change is challenging, especially in healthcare, but the exorbitant amount of time and money that providers lose every year to denied claims is becoming unsustainable. By following Northwell Health’s example and taking small steps toward better solutions, every healthcare provider can overcome that challenge and eliminate the burden of claim denials.