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Payers are using automation to adjudicate healthcare claims at scale, leaving providers struggling to keep up. One major insurer was found to have denied over 300,000 claims in two months, with each one taking an average of just 1.2 seconds. Providers that continue to rely on manual claims management methods will see their margins squeezed as the denials challenge grows. The future of healthcare claims management is here – and the answer lies in artificial intelligence (AI). Providers can level the playing field by turning to AI and automation , using tools like AI Advantage™ to streamline healthcare claims management. This article summarizes a recent webinar with two early adopters, Eric Eckhart of Community Regional Medical Center (Fresno) and Skylar Earley of Schneck Medical Center, who are using the technology to prevent denials and increase collections. Small increases in claim denials can lead to major revenue loss Makenzie Smith, Product Manager for AI Advantage at Experian Health, set the stage with observations on the current state of claims management. She notes that one of the biggest challenges when it comes to denials is constantly shifting payer behavior: “So many payer decisions are now being driven by artificial intelligence. Insurers are reviewing and denying at scale using intelligent logic, leaving providers fighting harder for every dollar.” Two hypothetical scenarios illustrate the potential impact of just a 2% increase in denials, assuming other variables remained constant: In an organization with a gross patient revenue (GPR) of $500m, an increase in denials from 10% to 12% could squeeze operational margins from 3% to 2.6%, resulting in a drop in net income from $15m to $13m. In an organization with a GPR of $2000m, an increase in denials from 18% to 20% could wipe out a 0.35% margin completely, causing net income to fall from $7m to 0. Some providers are choosing to stick with their existing processes; changing course seems too risky within thin margins. But as Eric Eckhart points out, “the just-work-harder approach doesn't work anymore.” Providers need a more efficient way to sustain operating margins. How AI Advantage helps reduce denial volume and improve net collections AI technology is emerging as a better alternative to the status quo. By using automation and AI, providers can gain insights into their claims and denial data, resulting in improved financial performance, greater efficiency and improve the future of healthcare claims management. AI Advantage™ – Predictive Denials uses AI to identify claims with a high likelihood of denial based on an organization's historical payment data. This allows staff to intervene prior to claim submission. It identifies undocumented payer adjudication rules that result in new denials. It works within Experian Health's ClaimSource® solution to proactively flag at-risk claims, allowing teams to review them within their existing claims workflow. Key takeaways from 2 real-world examples of AI in healthcare claims management Eckhart and Earley share how they are approaching denial prevention in today's fast-changing claims environment. Below are the key takeaways from their conversation about how AI is helping to optimize reimbursement and support their teams: Providers need to move beyond the “just work harder” approach to claims management Eckhart says that staffing challenges were a major driver of his organization's early adoption of AI Advantage, as it became harder to manage the increasing rate of denials with existing resources: “I think we've all tried the “let's work very hard approach” and worked overtime for months on end, but that's just not a long-term solution. We were looking for something technology-based to help us bring down denials and stay ahead of staff expenses. We're very happy with [AI Advantage] and the results we're seeing now.” Skylar Earley agrees, saying that despite their efforts, the rate of denials stayed the same. “It's so important for us to reduce denials because costs are increasing, reimbursements are decreasing, payments are shrinking. In our smaller community, there are only so many ways to grow revenue. We've got to maximize reimbursement, however we can.” Discover how Schneck Medical Center used AI to prevent claim denials.   Seamless integration with ClaimSource® was key to staff adoption While senior leadership teams may have been on board with testing the new technology, staff members were more hesitant about the potential pitfalls of introducing a new tool. Eckhart says, “Experian were already processing our claims through Claim Scrubber, so the workflow was essentially the same. I got some pushback when I said it was AI. I think the biggest fear for my billers was that they were going to get 5000 alerts that they would have to override and ignore. But we phased it in slowly and that was a good approach.” Earley agrees: “This is probably one of the most seamless products I've seen: it's entirely in ClaimSource®. If you didn't know about it, you wouldn't know it was there. The people using the product don't toggle back and forth between screens, they don't run reports to view alerts. The product shows them what claims they need to look at.” The predictive model gives staff their time back – so savings snowball For both organizations, a big win from AI Advantage was being able to reduce denials so staff could focus on other tasks. Making better use of staff time is increasingly urgent as the growth in denied claims outpaces recruitment. Eckhart says that over the last six months, his team have saved 30 hours a month in collector time. “Now I have almost a whole week a month of staff time back, and I can put that on other things. I can pull that back from outsourcing to other follow-up vendors and bring that in house and save money. The savings have snowballed. That's really been the biggest financial impact.” Reducing denials with accurate predictions Eckhart and Earley report that the success of the tool comes down to the accuracy of predictions, and the fact that it uses their own data. This applies to claims submitted to commercial and government payers, including prior authorizations. For example, Schneck Medical Center is seeing an ongoing reduction in AR days, while the number of authorized outpatient visits has increased by around 2.5% since implementing the technology. In addition to improving claims management processes, AI Advantage also helps root out persistent payer errors. Eckhart says that while denials teams tend to focus on high value claims, smaller payers can sometimes make erroneous denials that add up over time. The tool brings this to light so providers can raise it with the payer and fix it going forward. The future of healthcare claims management is here Ultimately, every prevented denial means more dollars coming back to the provider, increasing their capacity to deliver high quality services. Revenue growth makes it possible to recruit more staff, reduce outsourcing, increase capital purchases, introduce new service lines, and even explore merger and acquisition strategies. Payers are already making strides in their use of AI technology and automation, but with AI Advantage, providers can process accurate claims and reduce denials at a scale and pace to match. Find out more about how AI Advantage™ is changing the future of healthcare claims management and watch the webinar to hear the full conversation on 'The Future of Claims Management. 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Could patient access software be the 'most valuable player' in healthcare? Experian Health's annual State of Patient Access surveys show an upward trend in the use of digital tools and software to help minimize the hoops patients must jump through to access care. In the most recent, 46% of providers said they expected to increase their digital investment over the next six months. The business advantages around increased capacity, reduced cancellations, improved data accuracy and higher patient satisfaction make a strong case for investing in patient access software. This article looks at how patient access tools can solve for some of the most stubborn problems in patient scheduling, registration and payments. Finding the formula for frictionless patient access Revenue cycle management comes down to minimizing service utilization while maximizing revenue potential. This starts with patient access. Efficient scheduling, intake and financial processes means more patients get better care, sooner – and providers get paid for their services without delay. Patient access software includes a range of digital and self-service tools that allow patients to complete administrative patient intake tasks with ease. Appointment management, patient registration, patient outreach, and patient estimates and billing are common use cases for patient access software. These solutions use in-depth data and automation to pre-fill patient information, check data for accuracy and completeness, tailor patient communications and accelerate workflows. Advances in AI and machine learning are creating new opportunities to remove obstacles in patient access and boost patient satisfaction. 5 problems that can be solved with patient access software 1. Painfully slow scheduling operations  Problem: Too often, patient access processes are complex and time-consuming. Over time, small frustrations from errors, delays, and repetitive manual tasks can cause a significant decline in the patient experience. It's unsurprising that 56% of patients want digital options to manage care and speed things up. Solution: Patient access software makes it easier for patients to see their doctor without delay. For example, rather than being forced to call the provider's office and wait for an agent to check for an available slot, patients can use online scheduling software to book, reschedule and cancel appointments whenever suits them best. This also alleviates call center volumes, easing pressure on staff. 2. Error-prone registration processes Problem: Manual intake and registration systems are vulnerable to quality issues, resulting in denied claims, increased admin costs and delayed access to care. Illegible writing, incomplete insurance information and missing forms mean patients and staff must spend more time going back and forth to find and fix mistakes. And at the extreme end of the spectrum, data errors can lead to medical errors, with life-or-death consequences. Solution: Automated patient registration can pull patient data from reliable sources and fill out basic details ahead of time, reducing the need for manual data entry. Preventing avoidable errors in this way improves communication, workflows and profitability. For example, Registration Accelerator is a text-to-mobile patient intake solution that allows patients to complete appointment registration from the comfort of home. The patient takes a photo of their insurance card and driver's license, and then optical character recognition (OCR) technology automatically enters the correct information for insurance verification. The patient can review and sign authorization and consent forms, and confirm their appointments all at once, with just a few clicks. 3. Excessive (and growing) admin burdens and staffing shortages Problem: Patient access is admin heavy. This wastes valuable staff time and resources and diverts attention from patient care. With healthcare staffing shortages reaching emergency levels and patient volumes on the rise, providers must find ways to manage workloads while maintaining output. Solution: By automating administrative tasks and expanding self-service options, patient access software takes the pressure off busy teams. In Experian Health's survey, 36% of respondents reported that technological improvements offset staff shortages, by making better use of staff time and lowering operational costs. Automated prior authorizations are a good example of how digital tools can help tame the admin burden. This software generates real-time updates for multiple health plans, so staff no longer need to cross-reference individual payer policies and websites. It uses exception-based workflows and guided work queues to help staff prioritize their activities. Patient access tools can also issue performance reports, so staff can continue to find ways to work more efficiently. Cutting-edge technology also offers a less obvious but equally important competitive advantage – helping providers attract and retain high quality staff. 4. A patient experience that falls short of expectations Problem: Unnecessary administrative obstacles, unclear communication, and slow processes result in subpar patient experiences. More than 6 in 10 patients don't think their experiences have improved much in the last few years, despite the wider availability of digital patient access tools. Providers need a solution urgently, given that 56% of patients would switch providers for a better patient experience. Solution: With automation and self-service digital tools, providers can finally put patients in the driver's seat and deliver the patient-centered experience that has been promised for years. Patients say they want access and payment experiences to be convenient and transparent, with specific examples including: Accurate pre-care estimates Payment plans Digital payment options A multi-purpose portal Mobile access for scheduling, registration, communications and care Alex Harwitz, VP, Digital Front Door at Experian Health, says that while this list may seem daunting, providers have reason to be optimistic about delivering a better patient experience: “Patients want a lot from the digital front door, especially younger and digitally savvy consumers. Speed, convenience and compassion are through-lines in our patient surveys. As expectations increase, so does the pressure on providers to deliver. But the good news is that technology is advancing too. There's a wealth of patient access software ready to help optimize the patient experience. And you don't have to implement them all at once: Experian Health's patient access tools are specifically designed to work independently or in combination, for hassle-free implementation.” 5. Missed revenue opportunities Problem: Missed appointments, billing mistakes and operational inefficiencies lead to avoidable revenue leakage. A significant portion of denied claims occur earlier in the revenue cycle, so improving patient access processes should be top of the list when it comes to optimizing revenue. Solution: Revenue loss in patient access comes down to data errors, poor analytics and workflow inefficiencies. By leveraging the right software, front- and back-office teams can collaborate to resolve issues and enhance decision-making. Digital tools can also improve the patient billing and payment experience, so providers get paid promptly. Upfront price estimates, payment plan recommendations and one-click payment options can make it easier for patients to understand and pay their bills. Implementing transparent and empathetic billing procedures not only enhances patient satisfaction but also accelerates the collection process. With Experian Health's Patient Payment Solutions, providers can collect payments 24/7 via mobile, web and patient portals. Maximizing revenue opportunities while meeting the changing needs and expectations of healthcare consumers calls for smart patient access strategies. Find out more about how Experian Health's patient access software helps healthcare organizations lay the foundations for a solid revenue cycle and a positive patient experience.

Advances in medical treatments and technology are ushering in a new era of personalized healthcare. Each patient has their own distinct medical history, genetics, lifestyle and preferences, and it is increasingly clear that tailored care plans are essential to improve patient outcomes and elevate the overall experience. Personalized patient care has become more critical than ever, and is key to creating better patient experiences. Equally rapid transformations in data analytics, automations and machine learning have opened up new possibilities for non-clinical touchpoints in the patient journey. Providers can leverage digital tools to personalize everything from scheduling to payments, ensuring that patients get the right information at the right time. Targeted patient outreach and tailored payment plans are just two examples of how providers can use digital tools to foster better patient engagement without compromising efficiency – one patient at a time. Why does a personalized patient experience matter? Patient expectations have changed. Wearables, apps and a steady stream of health-related content on social media mean today's patients are better informed and increasingly engaged in their own health. They expect to be treated as equal partners, not as passive participants waiting to be told what to do by their doctor. Rather than one-size-fits-all communications, patients value proactive outreach and relevant reminders and prompts that help them move through their healthcare journey with as little friction as possible. They're also accustomed to “high-choice, high-convenience” digital experiences that tailor information to their specific needs and preferences. Digital consumer brands like Amazon and Google are moving into the healthcare space, leveraging their insights and technology to offer patients tailored medical solutions. To remain competitive in this changing landscape, providers must embrace a personalized approach to care. Aside from attracting higher patient satisfaction scores, a personalized patient experience also contributes to better health outcomes. For example, research shows that unclear post-discharge instructions result in preventable, unplanned, and high-cost follow-up care. Specific and relevant advice and reminders – communicated through the patient's preferred channels – can greatly reduce the risk of no-shows, delays and gaps in care. There are financial benefits too. As patients consistently report concerns about the cost of care, support to understand and manage bills can make a major difference in their propensity to pay. What does personalized patient care look like in practice? Clearly, there are practical limits to the level of personalization that can be offered. But with the right digital tools and data analytics, providers can segment groups of patients and deliver an experience that is sufficiently tailored so it feels like they have their own healthcare concierge. And rather than adding to the operational workload, the data analytics and automations that facilitate personalization can also streamline workflows and improve overall efficiency. In this way, tailoring the patient experience can contribute to a reduced manual workload, fewer errors and faster collections. Providers don't need to compromise efficiency for personalized patient experiences. Two specific areas that offer a high ROI are targeted patient outreach and tailored payment plans. Strategy 1: Targeted patient outreach Experian Health's State of Patient Access survey 2.0 showed that patients appreciate proactive outreach by providers, though many said this didn't always happen. With digital patient outreach solutions, communications can be tailored for different patient segments. Consumer data can allow patients to be grouped according to need, behavior and preferences, so they can be supported to move to the next step in their healthcare journey with ease. For example, patients with specific chronic diseases can be sent reminders for annual health checks. Those that may be due for regular cancer screening can be sent pre-appointment information. Providers can also engage patients with automated, timely messages through their preferred channels. At the individual level, self-service patient access tools and automations allow patients to book appointments when and where it suits them. Automated text message and interactive voice response campaigns can be used to issue links to patients so they can book right away. And automated appointment reminders are an easy way to ensure patients don't forget to attend, while minimizing the business impact. Strategy 2: Tailored payment plans and billing Patients worry about the growing burden of healthcare expenses. Generic payment plans that do not take account of individual patient circumstances can leave patients feeling unsupported and detached, so they're less likely to pay in full and on time. A more patient-centric approach can help patients manage bills and reduce the risk of bad debt. Digital technology can analyze patient financial information to anticipate the patient's propensity to pay and generate a customized payment plan. This should start with proactively issuing accurate estimates of the patient's financial responsibility. Patient Payment Estimates gives patients a simple breakdown of their costs, directly to their mobile. It draws on real-time price lists, payer contracts and relevant insurance details to maximize accuracy. Similarly, Patient Financial Advisor offers patients a text-to-mobile experience with a secure link to billing information, personalized payment plans and convenient payment methods. Those that can pay upfront in full can do so, while those that need a little more time or advice on financial assistance can be directed to the right pathway. Patient Financial Clearance helps determine the optimal payment plan by screening patients automatically before their appointment or at the time of service, to see if they qualify for charity support. Finally, offering a choice of payment methods rounds out a tailored financial offering. Personalized patient care: the key to greater patient satisfaction To sum up, integrating targeted outreach strategies and tailored financial support can help providers increase patient satisfaction, improve health outcomes and enhance financial performance. At the heart of a patient-centric approach should be a commitment to anticipating patient needs, by simplifying their healthcare journey and offering the flexibility and choice that have come to be expected. Explore Experian Health's suite of patient engagement solutions for more ideas on how to deliver a compassionate and personalized patient experience.