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As retail and technology companies make moves in healthcare, existing providers must find new ways to attract and retain patients. Offering personalized patient payment plans is one way to meet evolving consumer demands and hold on to the competitive edge. The best part of this strategy? Providers can use data they already hold to deliver convenient and compassionate collections. Digital disruptors are driving a consumer-centric approach to healthcare payments Having transformed consumer expectations over the last decade, digital technology giants – along with a new generation of start-ups – are now actively pursuing a share of the multi-billion-dollar US healthcare market. Concierge medicine, on-demand virtual health and other personalized services are solidifying consumer expectations of flexibility, convenience and control. While consumers have more choice, they're also paying more for healthcare. Inflation-weary consumers are apprehensive about rising costs, and many report frustrations with healthcare billing and payment processes. According to a 2022 Gallup poll, nearly four in ten patients postponed medical care because of cost concerns. This tension between demand for choice and concerns about affordability leaves the sector vulnerable to disruption by players that offer alternative payment models that make healthcare more affordable for consumers, while making it easier to pay for care. Creating a more consumer-friendly approach to patient collections is essential for profitability. 1 in 10 patients use payment plans to manage the cost of care Research by Experian Health and PYMNTs shows that patients welcome payment plans to spread out the cost of care. One in ten patients had used a payment plan to pay for their most recent doctor's visit. Nearly three in ten older patients used a payment plan after receiving an unexpected bill. Unsurprisingly, those on lower incomes were most likely to need payment plans. Experian Health's State of Patient Access survey 2023 emphasized patients' desire for more flexible and transparent payment options, including pre-service estimates, payment plans and digital payment methods. Providers see the benefits too: around two-thirds of providers said their organization understands patients' unique financial situations and offers payment plans and financial assistance where appropriate. Using data to tailor patient payment plans For payment plans to work effectively, personalization is non-negotiable. Too often, payment plans apply a generic “one size fits all” formula to patient accounts, regardless of payment history, financial situation or other key indicators of the patient's ability to pay. This runs the risk of delivering a poor consumer experience while doing little to reduce patient bad debt. With a data-driven approach, healthcare organizations can identify the optimal plan for each patient. For example, PatientSimple® uses Experian Health's proprietary data and analytics to assess each patient's propensity to pay and guide them to the most appropriate financial pathway. A self-service portal gives patients a convenient way to generate estimates and consider different pricing plans, so they can make a more informed and confident decision about how to pay their bills. It also supports staff to have more compassionate financial conversations with patients. Similarly, Patient Financial Advisor and Patient Estimates give patients upfront, accurate estimates of what they're likely to owe, drawing on current chargemaster lists, payer contracts and the patient's insurance data. Together with payment plans, these estimates help patients avoid unexpected bills, so they have a more positive payment experience and are less likely to miss payments. A third tactic is to make it as easy as possible for patients to pay. Self-service and contactless payment options remove friction from the payment process, so patients are more inclined to pay promptly where they can. The patient's account data can be securely auto-populated into payment tools so they can pay and go with minimal fuss. Stay ahead of competitors by creating patient-friendly experiences As healthcare evolves, healthcare organizations need to develop strategies to remain competitive while still delivering compassionate care. Personalized patient payment plans are one way to strike that balance. Not only do they give patients the flexibility and convenience they’re looking for, but providers can also use existing data to tailor plans that benefit both company and customers alike. Alex Harwitz, VP of Product, Digital Front Door, at Experian Health, says these tools can help providers stay competitive as patients are exposed to a growing range of consumer-friendly healthcare services: “The move towards more patient friendly online experiences is a catalyst for improved price transparency. The challenge for providers is to adapt to shifting consumer needs while managing their resources wisely. But there's a major opportunity for providers to use data they already hold to help patients figure out the best financial pathway. Putting patients first is a sure-fire strategy to see patient satisfaction and patient collections rise in parallel.” Find out how healthcare organizations can remain profitable in an increasingly competitive market with personalized patient payment plans and patient payment solutions.

With artificial intelligence (AI) continuing to dominate conversations among healthcare's strategic thinkers, it's clear that recent innovations in this field could herald a step-change in healthcare delivery. AI's ability to mimic human intelligence and machine learning (ML)'s capacity to learn from vast amounts of data means these technologies are fast becoming indispensable tools for healthcare leaders who want to optimize operations. Understanding how they work – and where to apply them for maximum impact – will be crucial to stay ahead of the competition as the revenue cycle landscape evolves. This article breaks down the what, why and how of AI technology in healthcare, and includes a look at Experian Health's new AI-based claims denial solution, AI Advantage™. Understanding machine learning and AI in healthcare The terms “machine learning” and “artificial intelligence” are often used indiscriminately, but what do they mean in a healthcare context? Generally speaking, AI is a machine's ability to perform cognitive functions that would normally be associated with humans, such as interacting with an environment, perceiving information, and solving problems. It can spot patterns, learn from experience and choose the right course of action to achieve a desired outcome. This includes natural language processing, robotics and machine learning. In healthcare, AI might be used to transform diagnosis through the analysis of medical images, expedite drug discovery by monitoring side effects, improve the safety and efficiency of surgery through robotics, and support patients to take ownership of their own health through health monitoring and wearables. Machine learning is a broad term that covers the processes used to extract meaning from (usually large) datasets to create and train a predictive model. It will look for historical patterns in input and output that a human eye might miss, and generate recommendations based on outcome parameters defined by the user. For example, it can look at patients' electronic health records to identify those who may be at risk of specific medical conditions so they can be offered appropriate advice. Another useful application is in predicting service demand, for more efficient appointment scheduling and resource allocation. Further subsets of machine learning include supervised learning, where training data is labelled with the desired outcomes that the algorithm should aim to detect, and unsupervised learning, which has no predefined targets and is useful for discovering patterns, insights and anomalies. Unlocking the AI Advantage™: how AI can reduce claim denials and improve financial performance The transformative potential of ML and AI technology in healthcare isn't limited to clinical decision-making and patient engagement: optimizing revenue cycle operations is a particularly attractive place to leverage the technology. It can be used to identify and reduce billing errors, enhance coding accuracy, and predict revenue leakage. This results in faster payments, better use of staff time and fewer claim denials. However, Experian Health's State of Claims 2022 survey revealed that while 51% of providers were using automation, only 11% of providers had integrated AI technology into their claims processes. Experian Health's new AI-based claims solution is specifically designed for those looking to take the next step to leverage AI to predict and prevent denials. AI Advantage takes a two-pronged approach to reduce the risk of denials and expedite any rework that may be needed. AI Advantage – Predictive Denials examines claims before they are submitted and calculates the probability of denial, based on thresholds set by the provider. It incorporates historical payment data and undocumented payer claim processing behavior to evaluate individual claims in real-time, with a level of speed and accuracy that would be unachievable using manual processes alone. High-risk claims can be edited before submission to reduce the risk of denial. AI Advantage – Denial Triage evaluates and segments denials based the likelihood of reimbursement following resubmission and prioritizes the work queue based on financial impact. It learns from payers' past decisions to formulate recommendations with increasing accuracy. This means staff can eliminate guesswork and focus their attention on the denials that will be most likely to yield results. See how Experian Health's AI-powered solution works to reduce and prevent denials. Challenges to watch out for when implementing AI While the benefits are clear, the rise of AI in healthcare applications also brings some challenges. Here are some key questions to consider for smooth implementation: How reliable is the data underpinning AI technology? AI tools are only as good as the data they're analyzing. Without high-quality, structured data, they will be unable to make accurate predictions. Providers need to ensure that data is available in a usable format and free from errors. Partnering with a reliable third-party vendor can help ensure all the relevant boxes are ticked. Does the technology integrate easily with existing workflows and software systems? Integrating new tools with the existing RCM infrastructure can be complex. Organizations often have legacy systems that may trigger interoperability issues, limiting effective data exchange and requiring staff to log in to multiple interfaces. A single vendor solution can mitigate for this. For example, AI Advantage fits together seamlessly with the industry-leading claims processing tool, ClaimSource®. Experian Health's consultancy team are also on hand to ensure smooth implementation. Does the software protect data privacy and security? Healthcare data is subject to multiple privacy and security regulations, such as HIPAA. Any new technology that processes data must comply with regulations and industry best practice. Being able to reassure patients that their data is safe is also an important driver of patient loyalty. What does the future hold for AI technology in healthcare? Looking ahead, the role of ML and AI in both patient-facing healthcare processes and revenue cycle operations is only going to grow. Predictive analytics will give staff increasingly powerful insights and recommendations to maximize reimbursement, while minimizing the burden on the workforce. Emerging technologies such as robotic process automation and natural language processing will offer more sophisticated and comprehensive workflow solutions, while AI's ability to continually learn and improve means providers that leverage AI will be better placed to make full use of their data and adapt to evolving trends and challenges. Discover how AI Advantage™ is helping Experian Health's clients transform their healthcare operations.

Staffing shortages are the new normal in healthcare. Most news headlines focus on gaps between the supply of providers and the growing demand for care. However, a recent survey by Experian Health, released in November 2023. shows the massive impact staffing shortages have on back office revenue cycle where these functions intersect with front-of-house patient engagement. Strikingly, the healthcare staffing shortage statistics in the survey show revenue cycle executives are 100% in agreement—staffing shortages significantly affect reimbursement workflows to the detriment of patients and healthcare employees. Experian Health's report, Short-staffed for the long term, surveyed 200 healthcare executives responsible for revenue cycle functions. The goal was to gauge the impact of worker shortages on revenue cycle management and patient engagement. While the pandemic brought these shortages into the public purview, this new data shows most providers believe healthcare staffing gaps are chronic and here to stay. These results reinforce The State of Patient Access 2023 survey, where 87% of providers blamed staffing shortages for declining access to care. As the healthcare industry continues to struggle with an ever-increasing staffing shortage, it has become increasingly evident that if left unresolved, this situation can wreak havoc on revenue cycle management (RCM). The latest survey illustrates the need for new strategies to alleviate healthcare worker shortfalls. This article explores the most recent healthcare staffing shortage statistics and some key findings from the study to help determine how healthcare providers can turn these challenges into opportunities. Experian Health surveyed 200 revenue cycle executives to determine the impact of staffing shortages on reimbursement and patient engagement. Download the report to get the full results. Finding 1: Most revenue cycle leaders believe staffing shortfalls negatively affect payer reimbursements and collections. 96% of survey respondents indicated a lack of qualified workers has a detrimental impact on organizational revenue channels. 80% say turnover in their department ranges from 11 to 40%, much higher than the national average of 3.8%. When healthcare organizations lack revenue cycle talent, they risk missing performance goals. High turnover and the departure of experienced staff create information deserts within healthcare organizations. It forces new team members to train faster, handle bigger caseloads before they're ready, and potentially burnout from stress. The pressure to do more faster creates a higher volume of preventable claims errors that lead to denials. The survey showed all these factors at play, and their negative impact on reimbursement, collections, and the patient experience. While the traditional way to alleviate staffing shortages is to increase recruiting and retention efforts, these approaches no longer work when there simply isn't enough available staff to hire and train. Healthcare organizations must consider new partnerships with technology providers who offer automation tools to streamline human workflows. Revenue cycle management software eliminates repetitive tasks and lessens errors that lead to rejected claims. Digital technology can help solve labor shortages by reducing staff workloads and improving operational performance. Automation can streamline collections by prioritizing the accounts most likely to pay. These tools help existing revenue cycle teams work more efficiently while enhancing patient encounters. Finding 2: Healthcare staffing shortages roadblock a positive patient experience. 8 of 10 survey respondents say patient experience suffers due to gaps in staffing coverage. 55% report the patient experience is most heavily affected at intake, and 50% say at appointment scheduling. Staffing shortages and turnover cause an undue burden on the healthcare workers left behind. The survey asked respondents to indicate the top pain points experienced by revenue cycle professionals, and one of the major challenges was staff burnout. Stress has a detrimental effect on patient interactions throughout the revenue cycle. The survey shows staffing shortages impede patient satisfaction in critical areas within revenue cycle functions, including: Scheduling appointments Patient registration Prior authorization Insurance coverage confirmation Patient estimates Revenue cycle interactions can be delicate, requiring extreme patience and clear communication. Healthcare organizations must provide the support their revenue cycle teams need to handle these crucial conversations appropriately. To improve the patient experience, organizations must first improve the workflows and workloads of these critical back-office teams. When healthcare organizations have the right tools to eliminate manual tasks that bog down revenue cycle staff, these professionals can spend more time on the compassionate handling of patients and their accounts. Providers have the opportunity to solve these challenges with digital patient engagement solutions that improve workflow efficiencies at every level of the revenue cycle. Patient scheduling software creates a self-service environment that 73% of healthcare customers prefer. Patient intake improves with online software that automates the tedious paperwork that tie up staff. Better technology can create price transparency without manual effort, ensuring patients understand their responsibilities up front instead of facing surprises during or after care delivery. Finally, a frictionless online payment platform allows patients to handle their obligations seamlessly without staff intervention. Finding 3: Errors arise when healthcare providers are short staffed, leading to claims denials. 70% of survey respondents say staff shortages exacerbate denial rates. 92% of survey respondents said new staff members make errors that negatively impact claims processing. Some of the most common reasons for healthcare claim denials include: Incomplete collection of claims data Coding errors Billing errors Eligibility verification errors Missed insurance verification Healthcare operations and revenue cycles are full of manual processes. RevCycleIntelligence reports one-third of prior authorizations are completed manually, and two-thirds of hospitals haven't automated any part of their denials management processes. Yet technology has made significant strides toward reducing these error-prone manual tasks. Leveraging artificial intelligence (AI), with solutions like AI Advantage™, within the complexities of claims processing could cut provider spending by up to 10% annually. Eliminating repetitive tasks with automated claims management solutions improves the lives of staff, cuts manual errors that tie up cash flow in reimbursement wrangling, and creates a better, less stressful environment for customers. Reducing the impact of healthcare staffing shortages with revenue cycle automation and technology Sometimes, 100% agreement isn't the desired outcome. In this case, the healthcare staffing shortage statistics found in the survey shows healthcare providers agree unanimously that chronic staffing shortages create a problematic environment for employees that costs revenue and patient engagement. While technology exists that can maximize revenue staff workflows to extend the reach of overburdened employees; survey participants suggest that healthcare organizations continue to approach solving these issues by adding staff.  But healthcare's staffing challenges are not new. While organizations have historically invested revenue in higher salaries and sign-on bonuses to attract staff, technology offers a new opportunity for history to avoid repeating itself. It's time for healthcare organizations to support their teams with automation. These tools alleviate mundane, error-prone tasks that tie up staff. Experian Health offers these organizations a way to improve the lives of everyone within the revenue cycle by allowing back and front-office teams to focus on patient care, rather than filling in forms. It's a more humane way to handle a very human staffing crisis. Download the survey or connect with an Experian Health expert today to learn how we can help your healthcare organization combat staffing shortages.