Americans who do not currently receive health insurance through their employers or a government program such as Medicaid or Medicare are now required to obtain insurance coverage or pay a penalty tax per the Affordable Care Act’s individual health insurance coverage mandate. These consumers can go to newly created health insurance exchanges (HIX) — offered through the state or federal government, depending on where an individual lives — to enroll in a private insurance plan. It’s definitely a patient-driven process. So, how can healthcare organizations help? They can take advantage of this opportunity to improve the patient experience by connecting patients with much-needed insurance, while simultaneously mitigating patient payment risk. Today’s patients want to be armed with as much information as possible. With this new initiative, healthcare providers can help patients navigate the various options offered through the exchanges by calculating how much patients might spend on insurance and by providing a comparison of plan benefits. However, it’s important for healthcare organizations to take this process a step further by screening patients to determine if they qualify for federal subsidies and beginning the enrollment process. Assisting patients in this way not only improves the patient experience, but also benefits the hospital by getting more patients enrolled with insurance, ultimately leading to higher reimbursement for services provided. That leads to the next likely question: how can healthcare organizations successfully aid in this process? Solutions powered by data and analytics are the key. By using a data-driven approach to HIX screening and enrollment, an organization can identify patients that meet the income criteria for subsidy payments and tax credits, and automate the enrollment process by prepopulating the state’s HIX application form. In much the same way that data is used to screen for various financial assistance programs such as Medicaid or charity care, HIX screening uses key information about a patient’s unique financial situation to accurately determine if the patient qualifies for subsidies to help them pay for their insurance. Interested in learning how you can improve the patient experience when it comes to insurance coverage? Check out our newest product, HIX Screening and Enrollment, and see how it can help support your patients as they begin to navigate the new aspects of healthcare reform.

We live in a choice-based society. Every day we are at liberty to make a myriad of choices. like where we live, where our kids go to school, what to eat, whether to exercise, which car we drive or what movie to see. This era of consumerism also means we have choices for healthcare. And since patients now have greater financial responsibility for their healthcare, they are becoming more selective about where they go to receive medical attention, looking not only for high quality but also positive, cost-effective and informative interactions. As patients become choosier, healthcare organizations must improve their commitment to being good stewards of the care experience. To help make things more manageable, many healthcare organizations are turning or already have turned to payment plans to become more patient centric. To that end, industry estimates point to around payment plans being leveraged for one in five outstanding patient accounts, and use of these tools has grown by more than 50 percent in some organizations. While this information may not be news to you, the crux of this approach is that all too often payment plans take “a one size fits all” approach, following a generic formula for all patients without regard to payment history, demographic information or other key financial data. The result? Default rates between 40-60 percent, defeating the overarching goal of reducing patient bad debt. All is not lost! With a data-driven approach to developing patient payment plans, healthcare organizations avoid the common pitfall with a win-win for both patient and organization. By using technology to analyze key information about a patient’s financial situation, an organization can accurately anticipate a patient’s propensity to pay. The technology can then review this information, along with other financial data and organizational policies — such as minimum payment amounts — and generate personalized payment plans that offer optimal terms and amounts. Taking a data-driven approach is a way to extend your organization’s commitment to compassionate care to the billing and collections process. Embracing this method allows business office staff to be responsive to the patient’s unique financial situation, just as the clinical staff is responsive to a patient’s medical status. Leveraging data to develop the optimal patient payment plan helps set the stage for a positive interaction, boosting patient satisfaction and ensuring patients choose your organization as their long-term healthcare destination. Not only does this improve the patient experience, but healthcare organizations are also better able to collect optimal payment in a timely fashion, knowing what each patient can safely afford. Want to learn more about how to develop personalized payment plans that meet the unique needs of patients? We’d be happy to help. Check out our latest product addition, Payment Plan Advisor℠.

There’s a knock on the door, and it’s “big data.” The promise of Big Data is redefining patient care, becoming the norm in clinical settings as it drives clinical pathways and care decisions. But it’s now time to broaden healthcare’s perception of Big Data to show how healthcare organizations can open the door to other possibilities where it can have a dramatic impact on financial performance. The key opportunity centers on making sedentary data within your organization’s four walls actionable, especially when combined with other valuable data such as credit information, to improve financial performance, patient safety and patient satisfaction. Although there are many benefits to leveraging data in this way, there are three that rise to the top. Who knew the revenue cycle and patient access would be a first line of defense for patient care? A significant, yet often underappreciated benefit of a data-driven revenue cycle is improved patient safety. Identity theft and fraud are decreased by properly identifying the patient at the outset of the healthcare experience. This proactive approach can also ensure healthcare organizations treat the correct patient and avoid the risks associated with misidentification. It’s all about upfront payment whenever possible. The back end of the revenue cycle is shifting to the front — while nothing new, it’s an increasing reality dependent on important data points. Verifying benefits, eligibility and propensity to pay before the patient arrives or in real time at registration not only improves patient-provider interactions, it also allows the registrar, and other patient access professionals, to better understand the patient’s unique financial situation and engage in appropriate and tailored financial counseling discussions. While some processes remain on the back end, it’s really about having a clear understanding of the patient’s financial picture upfront. Collecting with compassion, and for the bottom line. Finally, collections become less about randomly tracking down payments and more about compassionate customer service and targeted process improvement by scoring and segmenting patient accounts. Data and analytics improve collections efficiency and profitability by streamlining processes and proactively assessing and responding to each patient’s unique situation, whether providing a customized payment plan or identifying charity care for a patient in need. And, robust data points on collections agency performance provide insight into which agencies are delivering the most return on which accounts, as well as where agency consolidation or internal support will yield stronger collections results. Big data has transformed clinical care. Now, it’s time to apply the same data-driven approach to mitigate financial risk and enhance the bottom line. Isn’t it time to answer that knock on your revenue cycle door?