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Published: November 21, 2025 by Adam.Lewis@experian.com, joseph.rodriguez

3-effects-of-rising-healthcare-costs-blog-2024

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Three ways to make patient collections more compassionate

When it comes to paying for healthcare, “compassionate” is probably not the first word that comes to mind for patients. As they foot a greater portion of medical expenses, it’s often an experience rife with stress and uncertainty. Providers try to give accurate price estimates, but when patients switch coverage plans or payers change their policies, it’s difficult to be sure the original estimate matches the final bill. And what if a patient simply can’t afford to pay? When 56% of consumers say they would not be able to pay an unexpected bill over $1000, this not only indicates a tough ride for patients, but points to why so many providers are struggling to collect in full – around two-thirds of patient balances over $200 go uncollected. It’s unsurprising, then, that more healthcare organizations are looking at ways to create a better financial experience for patients. Understanding the collections process from the patient’s perspective and moving away from a “one size fits all” approach may be the key to a healthier revenue cycle. Could a more compassionate approach to billing help patients meet their financial obligations? How providers are turning to compassionate billing to help patients and improve revenue Thanks to advances in data analytics and technology, providers have a host of tools at their disposal to improve the patient financial experience. The following three strategies are generating some great results for providers: 1. Use data to give patients the right payment options A common pitfall across healthcare billing is to treat every patient the same. But sending a bill and hoping it gets paid is clearly not a reliable collections strategy. A compassionate billing approach means you look at each patient’s current financial situation and consider their ability and likelihood to pay. With the rich data analytics now available, you’ll know whether a simple statement will be enough to prompt payment from the patient, or whether a little extra handholding will be needed. Are there other payment plans that might be more appropriate? Would they benefit from a call or text to remind them of the next task they need to complete? Data analytics let you tailor the process so you can help your patients pay their bills in the way that suits them best, including finding missing coverage. Novant Health used Collections Optimization Manager to automate and increase patient collections. With this solution, Novant Health saw a 5.8% increase in unit yield year-over-year, and an overall recovery rate of 6.5%. Overall increased revenue and cost savings amount to an impressive rolling average return on investment – 8.5:1. 2. Personalize the way you communicate with patients Data analytics don’t just help you offer payment plans based on the individual, they allow you to determine a patient’s preferred method of communication. Do they prefer to get a statement in the mail or via email? Are there particular communication messages that will resonate with different patient groups? Paying bills can be a sensitive topic, especially if someone is struggling financially. Being able to create personalized messages at each touch point in the process is a helpful way to build compassion and consumer trust into the financial experience, so patients are more likely to engage with the process. The University of California San Diego transformed their patient financial experience by using Collections Optimization Manager to segment patients, as part of a broader exercise to improve collections. Knowing more about individual patients’ circumstances meant they could offer more relevant communications and build a more sensitive patient engagement strategy. 3. Make it convenient and easy to pay Every patient will thank you for a quick and painless payment process. Offering flexible payment options including online, in person and phone is critical. According to Kyle Wilcox of Grinnell Regional Medical Center, this is all about the ‘golden rule’ of patient payments: treating patients as you would want to be treated. He says: “At GRMC, we provide consumers with a range of choices to make payments, such as in person, by mail, electronically online or via mobile technology, and by cash, credit or debit card. Doing so allows them to pay in a way that is most convenient for them, improving their satisfaction and the hospital’s likelihood of receiving payment.” What’s more, efficient payment tools can improve your staff workflows too, giving them more time to help patients who need extra assistance and reducing the cost to collect. Heather Grover, Vice President of Product Management for Patient Collections, Experian Health, said: “We had a small community-based hospital use Collections Optimization Manager product with PatientDial. On average, the cost to collect for many of our clients is anywhere between 7% and 15%. They saw theirs decline to 5% and over a two-year period, their cash collections increased to 42% prior.” Ultimately, there are some patients who can pay and some who can’t. It’s a sensitive topic to navigate, but when patients feel supported, they’re more likely to be able to meet their financial obligations. Collections Optimization Manager lets you figure out who’s who and offer them the most appropriate support to get their healthcare bills paid, so they can get on with life.

Feb 10,2020 by Kerry Rivera

How consumer data can help attract and retain healthcare consumers

Before brands like Apple and Amazon became synonymous with consumer culture, the healthcare experience didn’t have much motivation to change. If you felt ill, you’d go see a doctor. The doctor would check you over, make a diagnosis and set you on the appropriate path to treatment. It was on you to initiate contact: your physician’s only job was to provide whatever care was needed, once you were in the system. Today, the healthcare journey can look quite different. Patients have options. In an increasingly crowded market, it’s now up to providers to reach out and woo healthcare consumers. To stay ahead of the competition, providers must seek innovative ways to attract new consumers and inspire loyalty among existing members. Chris Wild, Experian Health’s Senior Director of Consumer Engagement Solutions, says: “Health systems have started taking a good, hard look at how they engage with patients, whether that’s marketing to new populations or encouraging patients to come in when they are sick. It all comes down to data. With a complete picture of the patient, you can loop together clinical information with insights about their lifestyle and attitudes, so you really know who they are and what they’ll need from your health system.” Three ways consumer data can help you attract and retain patients Data-driven marketing and engagement is a growing opportunity for providers. With the right data platform, it’s easier than ever to leverage reliable, high-quality data and analytics to better understand and serve your patients. In fact, Wild suggests there are three main ways marketing data can benefit healthcare providers (you can watch Wild talk about these on video): 1. Marketing to new and existing members Why should prospective patients choose your hospital or physician’s practice? What would prevent existing patients from being tempted to switch providers? Understanding what makes your patients tick lets you pinpoint the exact benefits, priorities and language that will resonate with them most. As Wild says: “If you’ve got five health systems competing in a town of 1.5 million people, how are you going to differentiate yourself? Once a patient picks up a provider and they’re relatively satisfied, they don’t change a lot. They’re starting to look at things like quality. They’re starting to look at cost and what’ll give them the biggest bang for their buck, but getting to them first is a big first-mover advantage for sure.” ConsumerView bundles up reliable information on around 500 demographic, psychographic and behavioral attributes to help you get to know your target market, so you can get the right message in front of them at the right time. 2. Engaging with patients to improve health outcomes Even if you’re the only health system in town, there’s still a need to engage. You want your patients to achieve the best possible health outcomes and often that requires them to take ownership of their health. You can help them do that by encouraging them to come in when they are sick, or by pointing them toward services that could make it easier for them to access care. To do this effectively, you need to know what your patients need. ConsumerView has around 1500 verifiable data points on 300 million US consumers, covering about 98% of the US population. These can be used to discover how your patients think about their health and how they make their buying decisions. When that’s merged with your own information about their clinical journeys, you can give them a truly personalized healthcare experience. 3. Future-proofing your services Finally, you can use these analytics to better understand your current patient population to make smarter decisions about the investments you need to make in future. Where are the bottlenecks in the patient’s healthcare journey? Where should you put new services? Robust data analytics help you say, “we need to invest here and this is why.” Wild says, “I’m working with one analytics team that’s looking to better understand where they’re going to allocate physical and human resources so they can follow up with their patients more completely. They’re digging in deep to understand what their current patient population looks like, and then using that data to understand what their future population may look like.” Data analytics helps you predict demand for services, so you can direct resources accordingly. You’ll be able to identify trends in patient pathways, so you can engage with patients earlier and make sure they get prompt care and support, giving them a better chance of a good outcome and saving your organization time and resources. Learn more about how your organization can drive marketing results through customer segmentation, targeted messaging and analytics

Feb 03,2020 by

Best practices to future-proof your patient identity platform

It’s amazing to look back at how far medical science and digital technology have come – and how those two worlds are increasingly intertwined. Ten years ago, the idea of managing your healthcare bills or making appointments through an app on your phone would have been unthinkable. Now we take it for granted! But having all these tools at our fingertips means there’s more data being shared between different services and platforms. As a healthcare provider, you might be accessing and sharing patient data multiple hospitals, primary care services, pharmacies, patient portal providers, payers and more. It’s vital to make sure that data is accurate. Research by RAND Corporation revealed that between 8-16% of patient records are duplicates. Trying to provide care on the basis of unreliable data is inefficient and expensive for providers, who lose staff time and revenue trying to match up records and reconcile the data on file with the patient in front of them. According to RAND, a mid-size health system absorbs as much as $96 for each duplicate. What this means for patients is even more worrying. According to the US National Institutes of Health, “195,000 deaths occur each year because of medical errors, with 10 of 17 being the results of identity errors or wrong patient errors.” In a value-based system where patients are covering more of the costs themselves, the financial impact of having unnecessary repeat tests or longer-in-patient stays due to delayed treatment is an added pain. Currently, standard health IT products have some catching up to do, as only 10% of duplicates are spotted. But looking ahead, the future of patient identities is promising. Unique patient identifiers are key to unlocking value-based care The twin trends of value-based care and healthcare consumerism are bumping up patient expectations. They expect a seamless experience. They expect their records to be updated immediately. They’re confused when one department doesn’t have access to information that was just shared with another. And they definitely don’t want to see different services working off different versions of the same record. The answer for many high-performing health systems is to introduce unique patient identifiers (UPIs). This allows a patient’s record to follow them throughout their healthcare journey, ensuring that at every touchpoint, clinical and admin staff are confident in the accuracy of the information they hold. But transitioning to any new system can involve a bit of culture shock for those involved, and so careful planning is essential. What steps can providers take to make sure they implement a patient identity management strategy that’s built to last? How to future-proof your patient identity platform 1. Make sure everyone’s on board with the plan First, whatever solution you’re using to manage patient records, it’s essential that your patients, staff, payers and any other parties involved all buy in to the new approach. Changing the way you handle data and introducing new digital tools such as UPIs can often call for a mindset shift in the way your team and consumers think about data. Be sure to communicate the benefits of UPIs to patients, payers and staff. For example, UPIs can: improve patient safety, by preventing duplicate and inaccurate recordslower healthcare costs, by eliminating inefficiencies and errorssafeguard patient privacy, by keeping records securecreate a better patient experience, by supporting patient-centered carehelp staff access up to date information about their patient’s healthcare situation 2. Choose a UPI system that works within and outside your network Some providers use hospital- or practice-based patient identifiers, where a master patient index is used to link all versions of a patient’s record held within a single organization. An enterprise master patient index (EMPI) does the same, but across several facilities or services. A cross-enterprise solution makes it much easier to manage patient identities across your entire network, without having to wrangle disparate records that don’t interface well with each other. When this system is based on ‘referential matching’, which uses wider data sources and UPIs to build a more connected and accurate data ecosystem, you’ll get a much more complete view of your patients and far fewer inaccuracies. 3. Use data analytics to improve decision-making UPIs bring another advantage: they enable you to analyze health, credit and consumer data for a single patient, giving you useful insights about your patient population as a whole. A network of interoperable data can help you spot trends in the social and economic factors that affect health and wellbeing, so you can target your resources more effectively. As the world of public health data matures, it’s highly likely that UPIs will become the norm. Data-sharing remains a challenge, but by using digital tech to your advantage, you can improve the way patient records are managed in your health ecosystem. Learn more about how UPIs could help close the patient data gap in your organization.

Jan 27,2020 by

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How healthcare providers can prepare for flu season

Flu season is rapidly approaching, which means healthcare providers must ramp up their preparedness efforts. What can they do to ensure they're ready to meet the seasonal surge in demand? Recent data from the southern hemisphere, often a forecast of what's to come in the US, suggests that this year's flu season will likely be similar to last year. The CDC warns that while “we cannot predict what will happen in the United States this upcoming season, we know that flu has the potential to cause significant illness, hospitalizations and deaths.” With hundreds of thousands of people hospitalized each year, providers must find ways to prepare for rising patient volumes and manage the risk of infection among patients and staff to keep services running smoothly. Making it as easy as possible for patients to book and attend vaccination appointments will be critical. Digital patient access will be the key to streamlining patient care. Using digital tools to prepare for flu season 2024-25 As services face increasing pressure, digital and automated tools can help healthcare providers prepare for flu season by easing staff burdens. More patients mean more appointments to schedule, more registration forms to fill out and more people in waiting rooms. Opening the digital front door helps manage high volumes by allowing patients to complete more access tasks online and prevent bottlenecks. Here are three strategies to implement to support staff and patients through a challenging season: 1. Manage infection risk with online self-scheduling An online patient scheduling platform has two clear benefits – it relieves pressure on staff during busy times and gives providers control over patient flow. Fewer calls need to be made by call center agents. No-shows are less likely because patients can book, reschedule and cancel appointments, and receive automated reminders, which makes the best use of physicians' time. Online scheduling also plays a part in infection control as providers can incorporate screening protocols to identify patients with symptoms of COVID-19 or flu, and manage their onward care pathway appropriately. Empowering consumers to take control of their healthcare with a patient scheduling system might encourage vaccine registrations, which could help reduce the burden on health services when staffing shortages remain stubbornly high. What's more, patients now expect the flexibility and convenience of scheduling appointments at a time and place that suits them. Experian Health's 2024 State of Patient Access survey found that six in ten patients want more digital tools to manage their healthcare. This indicates a growing demand for easy, simple and transparent processes. Watch the webinar: See how IU Health used self-scheduling to manage increasing patient volumes with less staff – and gain insights on using digital scheduling to scale operations beyond flu season. 2. Offer mobile registration to manage demand Should patient volumes increase, patient access staff will be under even more pressure than usual. Anything that can reduce the administrative burden will be a win. Experian Health's Registration Accelerator allows patients to complete intake forms and insurance checks through their mobile devices before stepping through the door. Their details can be pre-filled automatically, reducing the risk of error. This creates a quicker, more efficient patient registration experience that minimizes issues for staff to resolve. Mobile-enabled registration is also far more appealing for patients, who'd rather complete registration from the comfort of home than sit in a waiting room filling out lengthy forms. Plus, it reduces in-person interactions, thus minimizing exposure to infection among staff and patients. Given that 89% of patients say digital or paperless pre-registration is important to them, providers that offer online patient intake solutions will have a clear advantage in attracting potential new customers during times of high demand. In practice: See how West Tennessee Healthcare replaced clipboards with clicks with Registration Accelerator. 3. Reduce no-shows and increase engagement with automated patient outreach Providers must communicate proactively with patients to keep them in the loop as the situation evolves. With an open rate of 98%, text messages are a direct and convenient way to communicate quickly with patients. Automated patient outreach can increase vaccination rates by notifying patients about flu shot availability and offering a direct link to schedule an appointment. Automated reminders reduce no-show rates and help ensure no slot goes unused as patient volumes increase. Messages can also include tailored instructions for specific at-risk groups to emphasize the importance of timely vaccination and provide directions. This approach helps manage patient flow, increase patient satisfaction and ensure providers are prepared for the seasonal surge. Contact Experian Health today to learn how digital patient access solutions can help healthcare providers prepare for flu season in 2024. Learn more Contact us

Oct 22,2024 by Experian Health

Finding insurance coverage without SSN

Finding previously unidentified insurance coverage is a high-stakes treasure hunt for healthcare providers. If patients are unaware of active coverage or eligibility for Medicare and Medicaid, they will be left footing a bill that could have been covered by a payer. If they can't afford it, their account may end up being written off to bad debt, and providers will miss out on reimbursement opportunities, leaving millions of revenue dollars on the table. Hunting down missing or forgotten coverage on the spot is a challenge for providers, particularly if the patient does not have a Social Security Numbers (SSN) or the payers in question do not use SSNs to verify eligibility. It's a problem worth solving though and can improve the patient financial experience while preventing avoidable revenue loss. The shift away from Social Security Numbers Historically, providers have used demographic information like Social Security Numbers (SSN) to verify patient identities and locate coverage information. Without a unique patient identifier, SSNs were a stable way to link a person's health information across multiple health systems and payers. However, the use of SSNs for identification and verification purposes has dropped in recent years due to concerns about patient privacy and the risk of identity theft: SSNs give identity thieves a mechanism to assume a person's identity and access financial information and health records illegally. Moreover, SSNs are unreliable identifiers, as it is possible for more than one person to use the same number. Recognizing the need for more secure and trustworthy identifiers, many payers have moved away from SSNs. In 2018, the Centers for Medicare & Medicaid Services began the process to remove SSN-based Health Insurance Claim Numbers (HICNs) from Medicare cards, replacing them with Medicare Beneficiary Identifiers (MBIs). These are now the primary means of checking a person's identity for Medicare transactions like billing, eligibility status and claim status. Similarly, many health plans also shifted away from using SSNs as primary identifiers, instead opting for member IDs or other secure identifiers to verify and track coverage for their members. Find billable coverage with historical data With demographic searches on the decline, providers need a more efficient and reliable way to search for coverage. As a data-driven company with a historical repository of claims data, Experian Health is uniquely positioned to help providers search for coverage. Combining search best practices, multiple proprietary databases and historical information, Experian Health's Coverage Discovery® locates patients' billable commercial insurances that were unknown or forgotten, and combs through Medicare and Medicaid coverage. This flags accounts that may have been destined as a write-off or charity and maximizes reimbursement revenue by identifying primary, secondary and tertiary coverage. Not only do fewer accounts go to bad-debt collections, but providers can automate the self-pay scrubbing process. In 2022, Coverage Discovery tracked down billable coverage in almost 30% of self-pay accounts and found more than $64.6 billion in corresponding charges. Closing the coverage gap caused by Medicaid disenrollment Coverage Discovery offers another important benefit: helping providers offer additional support to patients on lower incomes who find themselves without Medicaid, at least for a short time, following the end of continuous enrollment. As of July 2023, more than 1.6 million Medicaid enrollees were disenrolled. Providers can use the tool to confirm whether Medicaid coverage remains in place, or to uncover any additional billable government or commercial insurance that could give patients peace of mind. Patient Financial Clearance can also help screen patients for Medicaid eligibility before or at the point of service, then route them to the Medicaid Enrollment team or auto-enroll them in charity care if appropriate. Case study: Read the case study to find out how Luminis Health used Coverage Discovery to locate $240k in billable coverage each month. Leverage technology to locate unidentified coverage Thanks to advanced tools like Coverage Discovery and Patient Financial Clearance, it's much easier for providers to locate alternative coverage options for patients, using multiple sources of data. These tools leverage secure identifiers and comprehensive searches across databases, allowing providers to reclaim revenue that may otherwise go unclaimed, and reassuring patients that they won't be left holding an unexpected bill. Find out more about how Coverage Discovery can help find previously unidentified coverage and reduce bad debt.

Sep 13,2023 by Experian Health

6 effective revenue cycle strategies for healthcare providers

Compared to other industries, healthcare tends to be more resilient to economic turbulence. But the weight of the pandemic, labor shortages, rising costs and increasingly complex reimbursement structures are squeezing hospital margins. A Kaufman Hall National Hospital Flash Report in July 2023 found that many hospitals underperformed, and the gap between high-performing hospitals and those struggling continues to widen. Providers must find new and effective ways to improve revenue cycle management, should any new uncertainties emerge. With pressure mounting to increase efficiency and reduce expenses, more providers are turning to automation and artificial intelligence (AI) to eliminate unnecessary manual work and optimize revenue cycle management processes. For example, Stanford Health Care leveraged automation to reduce their cost to collect. Banner Health improved patient collections with transparent price estimates. Schneck Medical Center zeroed in on claims management and incorporated AI to reduce denials. In the face of a cashflow crunch, healthcare providers increasingly turn to data-driven revenue cycle management (RCM) strategies that span the entire patient journey. This article lists six of the most effective income-generating digital RCM strategies that providers are using to maximize profits. Building blocks of a healthy revenue cycle At its core, revenue cycle management is about ensuring providers are fully reimbursed for the care they provide. The true ROI is much broader – efficient financial and administrative processes for patient billing, claims management and collections contribute to better care, satisfied patients, high-performing staff and good financial health. Realizing these benefits calls for revenue cycle processes built on three principles: Efficiency – streamlining processes to reduce resource utilization across the entire billing cycle Accuracy – ensuring all patient and claims data is correct and complete to avoid denials and delays Transparency – giving patients, providers and payers relevant and timely information, so they can act with confidence in each financial transaction. To achieve this, providers are moving away from slow, costly manual systems. Digital RCM tools are becoming non-negotiable. 6 data-driven strategies for effective revenue cycle management 1. Increase efficiency in patient access Revenue cycle management starts when the patient books their appointment and ends when the final bills are settled. Claim denials and delayed payments often arise from data errors and miscommunications in the early stages of the patient journey, which means patient scheduling and registration processes are critical to streamline RCM. With automated, data-driven patient access tools, providers can simplify tasks across the patient journey, so patients can move from one stage to the next with as little friction as possible. Fewer errors mean delays and disappointment are more easily avoided. Automated registration and online self-scheduling can also lead to savings through more efficient use of staff time and reducing the number of appointment no-shows. Experian Health clients find that online tools allow them to make relatively minor adjustments to their workflows, with a major impact on productivity. 2. Deliver accurate and timely patient billing Patients want the payment process to be as painless as possible. In multiple surveys, Experian Health has found that patients are worried about the cost of care, while 63% of providers believe patients frequently postpone care because of cost concerns. Clear, comprehensive estimates, billing and collections practices can make it easier for patients to navigate their financial journey. And with the end of continuous Medicaid enrollment, it's likely that more patients will find themselves unsure of their coverage situation, and in need of greater support to manage the financial process. For Stanford Health, the key to improving revenue cycle management centered around patient billing and collections. To achieve the dual goals of improving the patient experience and increasing collections, they used data-driven insights and automation to remove uncollectible accounts, prioritize accounts with a high propensity to pay, find missing coverage and reduce the manual workload. Collections Optimization Manager helped Stanford Health identify the best possible collections strategy, by scoring and segmenting patient accounts with the highest propensity to pay. Coverage Discovery® supplemented this strategy by checking for any unidentified primary, secondary or tertiary coverages that can potentially reduce self-pay amounts and avoidable charity designations. As a result, Stanford Health achieved a $4.1m increase in average monthly payments and efficiency gains of $109k per month. 3. Provide transparent price estimates Experian Health's State of Patient Access 2023 report suggests that fewer than three in ten patients know how much their care will cost in advance, while nine in ten consider it important. Delivering accurate pre-care estimates to help patients plan for bills could therefore be an easy win to improve the patient experience and recoup more revenue. Banner Health used Patient Estimates as part of a wider strategy to improve patient collections. This solution generates detailed estimates of the patient's financial responsibility along with recommendations for payment plans and financial assistance, if appropriate. Listen in as Becky Peters, Executive Director of Patient Access at Banner Health, talks about streamlining the patient registration process and improving patient access with pre-care estimates. 4. Effective claims management Perhaps the biggest opportunity to improve revenue cycle performance lies in claims and denial management, which accounts for a major proportion of wasted healthcare dollars. Summit Medical Group Oregon–BMC paired Enhanced Claim Status with Claim Scrubber to submit cleaner claims the first time and avoid lost revenue. These tools help providers submit accurate claims and monitor claim status to prevent denials and resolve issues quickly. For Summit Medical Group, this led to a 92% primary clean claims rate, and a reduction in accounts receivable days and volume by 15%. Experian Health also offers a new solution that leverages machine learning and artificial intelligence for predictive reimbursement. AI Advantage™ uses AI to predict and prevent claim denials based on historical claims data. In the first six months, this solution helped Schneck achieve a 4.6% average monthly decrease in denials and decreased time spent on denials by 4x. 5. Easy ways to pay (plus clear pricing and payment policies) How easy is it for patients to pay? This simple but important question points to another vital element of effective revenue cycle management. A compassionate and convenient patient payment experience that matches consumer experience in other industries can encourage earlier payments. Easy digital options are especially important for millennial and younger patients: research by Experian Health and PYMNTS found that 60% of younger patients are looking for digital services. Experian Health's patient-friendly payment tools are designed to help patients navigate their financial responsibilities with confidence and ease. For example, PaymentSafe® allows providers to securely collect payments anytime, anywhere, including mobile payments and patient portals. 6. Operational efficiency with automation, data and analytics RCM processes generate vast amounts of data, providing valuable insights into the organization's operational performance, revenue trends and areas for improvement. Being able to parse and translate this data into actionable insights is essential to determine the right strategies to pursue to optimize financial performance. But this in itself can be a major lift. Revenue Cycle Analytics is a web-based tool that breaks down data into actionable insights across billing, reimbursement and payer performance, presenting KPI data via comprehensive dashboards. Effective revenue cycle management strategies from start to end From labor shortages to rising costs, healthcare providers are finding creative ways to manage cash flow. While each healthcare organization’s needs and goals are different, understanding these six key strategies of successful revenue cycle management can help hospitals manage their revenue cycles more effectively and efficiently, while responding to new uncertainties. Find out more about how Experian Health helps healthcare organizations leverage automation and AI to streamline processes and boost revenue cycle performance.

Aug 16,2023 by Experian Health

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