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In the decade since the Affordable Care Act sparked the transition toward value-based care and pay-for-performance care models, clinical services have been transformed by advances in diagnostics, medical devices and digital technology. However, despite a commitment to improving care quality and patient experiences, the healthcare industry still struggles to influence the factors that have the greatest impact on patient outcomes – the social determinants of health (SDOH). It’s now well-established that clinical factors have a relatively small impact on a person’s health-related quality of life. As little as 20% of the factors that influence health outcomes are attributable to clinical care. The remaining 80% includes social, economic and environmental factors – such as access to safe and clean housing, healthy food, education and transportation. Healthcare providers cannot be expected to solve these challenges alone. That said, providers will benefit from developing plans and investing in systems that foster awareness of the social determinants of health that impact their communities. This will help enable the delivery of the proactive and coordinated services patients need to live healthier lives. The pandemic intensified many of the socio-economic barriers patients face when accessing care, medication, housing and food. It forced sudden changes to the way care was delivered, making it harder for healthcare organizations to sustain high-quality services. When overwhelmed hospitals just needed to get through the day, value-based care took a hit. To support underserved communities, healthcare organizations need reliable insights into their patients’ evolving life circumstances and socio-economic challenges. SDOH data can help providers identify the right strategies to serve their patient population in the most effective way. SDOH should be at the heart of patient-centric services. Healthcare organizations that prioritize the use of SDOH data are strengthening their ability to deliver value-based care. How has the pandemic affected SDOH and value-based care? Value-based care and pay-for-performance models were gaining traction just before the pandemic, and many providers were agile enough to respond quickly to the pandemic with telehealth and other remote services. But against a tsunami of COVID-19 cases, tests and vaccination programs, reimbursement models based on quality measures such as effectiveness, efficiency and timeliness proved fragile in the midst of an emergency. As is often the case, the worst effects of the pandemic were felt most acutely by marginalized and economically vulnerable groups. For example, groups with less stable employment were less likely to have access to sick leave or remote working opportunities, putting them at greater risk of catching the virus. Many community programs were put on hold, with consequences for the individuals who relied on them for food, support, and company. Insights on the social determinants of health can help providers segment vulnerable populations that need extra assistance to take control of their health. Once these populations are identified at the patient level with insights driving one’s unique SDOH risks, providers can develop strategies to ensure the right help is given at the right time. They can offer targeted outreach to ensure patients are able to adhere to care plans and access health checks, even take their medication as prescribed. This can reduce the risk of readmission, minimize hospitalizations, and keep healthcare costs down for both patients and providers. To supplement reliance on expensive and time-consuming patient surveys (that often leave out the “why” of a patient’s circumstances), Experian Health’s SDOH solutions combine analytical expertise, machine learning and proprietary data to generate actionable recommendations on the best way to address barriers to care, medication, housing and food. Combine SDOH and consumer data to personalize patient outreach The key to successful value-based and pay-for-performance care models is treating the patient, not just the disease. Data on SDOH allows providers to offer a more personalized healthcare experience, which is even more powerful when combined with consumer data. ConsumerView pools data on patient interests, psychographics, behavioral insights and broader lifestyle insights to give providers a 360-degree view of their patients. With this data, providers can offer relevant and timely advice to help patients overcome potential obstacles to attending appointments and complying with their care plan, such as information about transportation or childcare. It can be used to personalize healthcare communications too. Rather than blasting patients with one-size-fits-all healthcare information, communications can be tailored to patients’ preferred time and format, so they’re most likely to engage with the message. Making value-based care a reality starts with knowing who your patients are and what’s stopping them from getting the care they need. Find out how Experian Health’s Social Determinants of Health turn-key solutions can give your organization the insights needed to develop resilient and responsive models of care. With these tools, your organization can lay the groundwork to improve patient outcomes, regardless of the challenges that lie ahead.

No healthcare organization is immune to the problem of bad data. One in five patients has found errors when looking at their electronic health record (EHR). This includes incorrect information about their diagnosis, medications, test results and more. If the data held in patient records is incomplete, inconsistent, or inaccurate, this can lead to poor clinical decision-making, substandard patient experiences, and gaps in treatment or follow-up. In Experian Health’s State of Patient Access 2.0 survey, patient identity management emerged as a major challenge for healthcare providers, with almost half of the respondents saying that inaccurate and incomplete patient data hindered follow-up contacts and patient outreach. “Dirty” data also presents a major financial risk, costing healthcare organizations millions of dollars per year. Many providers have stepped up their digital offerings in the last few years, particularly in response to the pandemic. While digitalization offers huge advantages, it does have an unfortunate side effect. As more data is created, shared and accessed, there are more opportunities for mistakes. Some industries may accept a certain amount of rogue data as inevitable, but in healthcare, it mustn’t become the norm. Patient data needs to be consistent, complete and standardized to ensure the highest standards of care. The Centers for Medicare and Medicaid Services (CMS) recognizes the need for an easier and more secure exchange of healthcare data, and are taking steps to facilitate interoperability. As these provisions are finalized, providers can act now to embed data standardization in their digital services. Better data means better decisions, better care and lower costs. As the digital transformation continues, providers must implement strategies to eliminate inaccuracies, enable consistent identity management, and ensure data is standardized across all their systems and networks. In this article, we share three steps to help your organization ensure that patient data remains complete and consistent for better patient identity management. 1. Start with the right patient data As the saying goes: garbage in, garbage out. Reliable patient records require the right information to be added from the start, or errors will follow the patient throughout their healthcare journey. This will only continue compounding over time. A 2021 survey of Experian Health clients revealed that incomplete data arises for a variety of reasons. This ranges from patients not filling out forms correctly prior to their visit or forgetting their insurance cards, to staff having limited time to complete documentation. Typos, misspellings, duplicate data and missing information can also cause identity errors.* Providers should reduce the risk of inaccurate data from being added to a patient’s record in the first place. A standardized approach to data formatting is a good place to start. For example, if a patient is accustomed to writing their date of birth in a European format, with the day before the month, they may enter this incorrectly when filling out online patient access forms. Configuring calendar drop-down menus in such a way that prevents this will avoid these basic but costly errors. With a Universal Identity Manager (UIM), each patient’s record can be maintained in a standardized format. Probabilistic and referential matching techniques are used to check the patient’s identification information against existing databases, for a more complete view of the patient regardless of any data gaps. 2. Solve patient matching challenges with robust identity verification It doesn’t matter if patient records are accurate if staff pull up the wrong record when they speak to a patient. Providers should prioritize consistent identity management to ensure clinical and non-clinical staff see the same and correct information, regardless of where or when a patient interacts with their organization. Identity Verification validates the patient’s identification information during pre-registration and check-in by instantly accessing demographic information. This includes the patient’s name, address, Social Security number, date of birth, phone number and insurance coverage data. If there’s a mistake, it’s easily found and corrected. 3. Standardize data to maintain clean patient databases Victoria Dames, Vice President Identity Management at Experian Health explains why standardization is so important: “The increasing use of digital services means that more healthcare data is being exchanged within and between health systems than ever before. However, in order to leverage the opportunities that come with a more connected healthcare system, we need that data to be as reliable as possible. Preventing inaccuracies before they occur will be much more cost-effective than scrambling to fix them after the damage is done. With a standardized approach to data collection and management, healthcare organizations can maintain reliable records for every individual patient and stay ahead of the game as more data is generated and shared.” Unique Patient Identifier (UPI) helps providers eliminate duplicate records so there’s a “single source of truth” for each patient. After the UIM matches the patient’s information within a single and accurate patient file, a UPI is assigned to that record and maintained in a master index. This is far more secure than a traditional matching algorithm based on Social Security numbers, which can be vulnerable to errors. Together, these tools help healthcare providers create and maintain a “golden record” for each patient. Data quality will always be a challenge. However, with the right data standardization strategies, providers can make better decisions. This will create better patient experiences and better health outcomes while limiting the financial impact of dirty data. Contact Experian Health today to find opportunities to clean up your healthcare data for better patient identity management. *Survey of Experian Health clients, October 2021 Are you an Experian Health client? Then we invite you to join our Innovation Studio research community. Your ongoing input is key to driving improvements to our tools and products! Sign up here!

US hospitals have provided more than $702 billion in uncompensated care over the last two decades. To protect profits, healthcare organizations must be vigilant about finding any available insurance coverage for their patient’s care. But for many, recent regulatory changes and pandemic-related disruption have made navigating an already complex reimbursement landscape even more challenging. Checking for missing insurance coverage and chasing payments consumes staff time that could be better spent elsewhere. However, with the right revenue cycle management tools, healthcare organizations can reduce profit-eating write-offs and denied claims. Experian Health’s new white paper sets out an end-to-end strategy to help healthcare providers find missing and forgotten coverage. With a comprehensive game plan for minimizing lost revenue at every touchpoint in the patient journey, providers can optimize the patient experience, reduce revenue leaks, and ease the burden on staff. Here, we explore some of the trends that are challenging reimbursements, identify opportunities to find missing coverage quickly, and present best practices to eliminate the risk of bad debt at every stage of the patient journey. Trends that make revenue recovery tougher Healthcare providers must keep abreast of regulatory changes that affect the reimbursement process, which often challenges profitability. For example, the American Rescue Plan Act of 2021 made some key changes to the Affordable Care Act. This included expanding Medicaid provision, decreasing Medicare premiums, and accelerating the COVID-19 vaccination program. For providers, this means an influx of patients who are newly entitled to government assistance, requiring new processes to avoid delayed claims and payments and recover Medicare debt. Many of these measures are a response to the pandemic. COVID-19 has squeezed household finances, leaving some patients without jobs and access to health insurance. Although employment rates are showing signs of recovery, tracking coverage as patients start new jobs remains highly resource-intensive for collections teams. Chasing self-pay revenue can often be more expensive than writing off the initial bill. The growing focus on price transparency may mitigate some of these challenges. Proactive patient engagement can help patients understand and plan for their bills while improving the overall patient experience. The No Surprises Act, effective January 1, 2022, aims to protect patients from unexpected bills for out-of-network care in emergency and non-emergency settings. The regulation protects patients but creates significant work for providers to modify existing processes and systems in order to meet compliance standards. Dustin Whittier, Senior Director of Product Management at Experian Health, explains that automating early coverage checks can be an efficient way to help consumers manage their changing healthcare obligations. He says, “With the increase in high deductible plans, the urgency surrounding COVID-19, regulations such as the No Surprise Act and Notice of Care, and a strategic focus on patient satisfaction and transparency, the impetus to automate knowing the full scope of insurance coverage – as  close to the point of care as possible – has never been greater.” In 2021, Coverage Discovery tracked down previously unknown billable insurance coverage in more than 27.5% of self-pay accounts. The Experian Health team can help healthcare organizations keep on top of changing regulatory requirements and implement solutions that ensure compliance, improve the patient experience, and protect against uncompensated care. Optimizing for revenue recovery at every step of the patient journey Successful revenue recovery starts with a patient engagement strategy that simplifies the steps to reimbursement at every patient touchpoint. A three-pronged approach can increase the likelihood of payment by identifying the opportunities to check for coverage before the patient comes in for care, at the time of service, as well as aftercare. 1. Pre-service insurance coverage checks Verifying and tracking the patient’s insurance status before they come in for care means their financial obligations will be clear from the start. Advance knowledge makes it much easier for patients to plan – and pay ­– their medical bills. An automated coverage identification solution such as Coverage Discovery can scan patient information as soon as they schedule an appointment to find any previously unknown coverage, using multiple proprietary databases and historical information. 2. Identifying coverage at the point of care When the patient receives their treatment, Coverage Discovery can check for any billable commercial and government coverage that may have been missed during pre-service. Providers should also give patients opportunities to pay for care at this point too, to avoid the need to chase for payments later. A simple and quick payment experience can reduce the risk of additional A/R days and collections agency fees. 3. Post-service checks for unidentified coverage Finally, for any accounts that haven’t been settled at the point of care, providers should run further coverage checks before determining whether to send statements and payment reminders to the patient, to write the amount off as bad debt, or to engage a collections agency. Coverage Discovery can detect any discrepancies that could lead to denied claims. It also offers weighted confidence scores so that accounts are reclassified and rebilled appropriately. Automated scrubbing can eliminate manual processes so staff can use their time more efficiently. These steps will help plug revenue leaks at every stage of the patient journey. Not only will that improve cash flow and reduce the risk of bad debt, but it also helps create a more satisfying patient experience. Learn more about how Coverage Discovery helps recover revenue throughout the patient journey and gives patients peace of mind.