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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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Healthcare administration revolutionized

The world of healthcare, as everyone knows, can be complex. And in such a complicated system, solutions that simplify, automate, and reduce busywork can make a real difference in both patient satisfaction and workplace efficiency. Although healthcare is, by its nature, a high-touch field, there are several opportunities to allow automated software solutions to handle the basic processing tasks associated with patient management. When routine interactions with patients are automated, medical and administrative staff members can devote more of their time to the cases that need the most attention. Automated workflow solutions also simplify and reduce busywork to make a noticeable difference in patient satisfaction and workplace efficiency. Obviously, that outcome is desirable for all parties involved. It reduces costs, improves morale, and results in satisfied patients. In an ideal workflow environment, employees can personally attend to problem cases and resolve certain issues manually while an automated system handles the run-of-the-mill cases that cause administrative backlogs. Experian Health has worked hard to develop just such a system. We call it eCare NEXT®. Introducing eCare NEXT The eCare NEXT platform, using an approach called Touchless Processing™, is able to offload a number of key patient processes, including scheduling, preregistration, registration, and admissions. Touchless Processing is an exception-based system, meaning that it automatically flags patients who require manual follow-up with staffers. The system updates data in real time, and users can interact with it through either a work queue system or by responding to triggered alerts. Healthcare organizations using the system can automate up to 80 percent of human intervention in the patient management process — allowing healthcare staff to focus on larger, more important initiatives to improve the patient experience. And Touchless Processing doesn't just free up staff time; patients see immediate benefits as well. One of the biggest frustrations in a patient's experience is the inability to get a reliable estimate for how much a service will cost. The eCare NEXT system sorts through all the complex factors that affect healthcare pricing — which are often too complex for hospital billing departments to accurately estimate on their own — and quickly determines accurate cost estimates for both the patient and insurance. Efficiency results in lowered costs — and happier patients The eCare NEXT system cuts costs in other ways, too: by reducing staff training needs, by ensuring compliance, by enforcing transparency, and so on. The benefits of an automated patient management system can manifest themselves in all sorts of ways. Blessing Health System, based in Quincy, Illinois, implemented eCare NEXT and found that it reliably increased efficiency and accuracy in patient management: "Experian Health provided our staff with a reliable, real-time registration error-alerting process. Our overall registration accuracy rate has improved significantly since implementing eCare NEXT. We now have the tools we need to be successful in one user-friendly application." Blessing's employees found that eCare NEXT improved dashboard capabilities and made it easier to view critical data, including missed estimates and copays. It was a clear upgrade over Blessing's previous system, in which employees manually calculated patient estimates. After adopting eCare NEXT, Blessing's point of sale collections increased by over 80 percent, its clean claim rate increased from 63 percent to 90 percent, and denials went down by 27 percent. And because the process had become so much more accurate and efficient, the average number of days an account spent in accounts receivable decreased by 28 percent. There’s no need to labor under an outdated administrative system that's certain to cause backlogs, errors, and intense frustration for patients and staffers. By offloading patient management work to the eCare NEXT system, healthcare providers can do what they do best: help people. For more information, contact Experian Health or check out our Touchless Processing whitepaper.

Sep 04,2018 by

Stay in sync with Patient Estimates

In the healthcare industry, transparency is everything — you want your patients to be as informed as possible every step of the way. Unfortunately, that doesn’t always happen with pricing, leaving both patients and providers unsure what the final bill is going to be. That’s where Experian Health’s Patient Estimates tool comes in. With this solution, you can provide your patients with timely, accurate projections of the costs of their care either before or at the point of service. By better preparing patients for their bill, Patient Estimates helps you avoid the underpayment problems you’re likely all too familiar with, leaving you more time to focus on providing the care that really matters. The power of accuracy The pricing process in healthcare is complicated. Constantly translating the shifting policies of insurers, suppliers, and partner organizations requires a level of attention that healthcare providers are rarely able to spare. But unless you thoroughly understand all the details that go into a pricing estimate, the only thing you can really offer is speculation. And patients are stressed enough as it is; the last thing they want to worry about is whether their costs are going to unexpectedly skyrocket once the bill comes. Each projection that comes from the Patient Estimates tool undergoes several data-gathering stages before delivering any results. Patient Estimates collects information from the patient’s insurance provider, including claims history and payer contract terms, as well as the hospital's chargemaster price. This data is automatically posted to a centralized work list, which can be customized by a healthcare provider depending on its needs. Imagine you need a price estimate for a patient who needs a common procedure or you’re trying to pinpoint the costs of a very specific procedure. You can narrow your search in the Patient Estimates platform to match your patient’s unique situation, and then you can easily pull that pricing information back up at any time. Most importantly, this data is equally accessible for your patients — you can print estimates in a variety of languages or customize scripts for your staff to read. As altruistic as this all sounds, Patient Estimates isn’t just a way to fulfill an ever-increasing obligation of state mandates for price transparency. Getting accurate pricing estimates slashes the time you’d spend manually updating pricing lists and scrambling to create an audit trail for a patient. By automating this grunt work and providing accurate upfront information, Patient Estimates can make your collections process easy and efficient — not two words you typically associate with collections. “The tool is really behind a lot of our success with billing and quick client payments,” says the Baylor University College of Medicine’s director of patient access. “Partnering with Experian Health has allowed us to be an advocate for our patients while also protecting our bottom line.” Patient Estimates isn't just a useful resource for patients; it's also an efficient tool providers can use to avoid age-old payment problems. After all, your organization runs on payments, and you’d hate to miss out on essential revenue because you didn’t give your patients accurate information in the first place. Bundle up Combining Patient Estimates with other Experian Health services can extend the benefits across a wider range of services. Patient Estimates connects with Eligibility, for example, to generate up-to-date benefits information that can inform a patient's treatment plan. It also works in lockstep with our Contract Manager solution to price estimates based on a provider’s payer contract, no matter how complicated it is. The College of Medicine at Baylor University is among the providers that use Contract Manager to analyze contracts throughout clinical practice departments. After adopting Experian Health's product suite, the school overhauled its internal collections strategy and generated more than 18,000 patient estimates while collecting $4.2 million in contractual underpayments it would have previously missed. Baylor has used its package of Experian Health products not only to streamline its workflow, but also to improve its patient collections rate and negotiate stronger contracts. You don’t have to draw a hard line between helping your patients and making a profit. In fact, the two go hand in hand when you take the right steps. With Patient Estimates, everybody can get on the same page. Contact our team today to find out how to boost transparency in your organization. To learn more about Baylor University College of Medicine’s experience with price transparency, please download this case study.

Aug 28,2018 by Experian Health

Q&A with Kristen Simmons on top pain points on consumer’s healthcare journey

Patient responsibility for their cost of care is rising dramatically. By 2025, it’s estimated that 20 percent of all consumer earnings will go to healthcare costs. As such, consumers are increasingly wrestling with how to navigate the healthcare journey, and providers are seeking ways to provide more transparency around costs. To dig deeper into these shifts, Experian Health conducted a study to assess the patient healthcare journey. A summary of findings were released in an all-new paper, Embracing consumerism: Driving customer engagement in the healthcare financial journey. We interviewed Kristen Simmons, Experian Health senior vice president of strategy and innovation, to learn more about the study. What prompted you to conduct this study on the “jobs” associated with the consumer health journey? In speaking with our clients and top thought leaders in the healthcare space, we are naturally aware that our industry is ripe for change. Consumers expect a more seamless, transparent healthcare journey – from start to finish – but we wanted to dig in and understand more specifically how they view each dimension of the process. What “jobs” must they tackle on their quest to getting the healthcare they need? What’s working, and where are they experiencing pain in the process? We wanted to hear directly from consumers to understand their current situation and motivations, and simultaneously assess how providers are feeling about the state of healthcare. Tell me more about the “jobs-to-be-done” methodology. Why did you take this approach to conduct your research? Consumers purchase and use products and services because they satisfy one or more important jobs they are trying to accomplish. In healthcare, this largely centers around the goal of getting better: Cure the ailment, fix the broken bone, complete the annual well-check visit. Qualitative insight into the “jobs” consumers need to get done ensures that we start with a “needs” mentality when we innovate products and solutions, rather than an “ideas-first” mentality. In our work, consumer interviews revealed 137 jobs associated with a typical healthcare experience. We then conducted a quantitative survey to measure the level of importance associated with each of these jobs, as well as the consumer’s current level of satisfaction with their ability to get each job done. These responses helped us develop a heat map illustrating the greatest pain points and opportunities for improvement. And let me tell you, there is a lot of work to be done to improve the customer experience in health! Are you surprised to see that the financial “jobs” associated with the consumer’s healthcare journey to be the most painful for consumers? I think we all knew the financial aspects of the journey would be a pain point, but it was surprising to see just how dominant this pain was ranked across absolutely every financial element of the journey from start to finish. Ninety-four percent of consumers ranked financial experiences as a major pain point in their overall healthcare journey. Additionally, 98 percent of consumers ranked worrying about paying their medical bills as a “very” to “extremely important” pain point. We need to build solutions and processes that offer consumers more transparency around the financial aspects of the healthcare journey—and importantly, help them know what to expect at each step along the way. This will alleviate some of the stresses of the unknown and allow healthcare consumers to focus on what matter most – getting the care they need. Beyond the consumer survey, you also interviewed 22 providers about their priorities for creating a better patient experience. What did you learn in these discovery calls and face-to-face interviews? Healthcare providers want to see change as well. They are obviously focused on healing people, but they recognize the need to give focus to the marketing and business aspects of providing care. They told us they want to find ways to provide more clarity around charges, and education around how charges can change along the way depending on health discoveries. They additionally cited desires to measure the customer experience, improve their IT infrastructures, build customer loyalty and even link customers with charitable organizations who can help with healthcare costs and payment. They fundamentally understand that all aspects of the consumer or patient experience is important, and some are beginning  to recognize that the financial and clinical aspects of healthcare may be more interrelated than once thought. The theme of “consumerism” bubbled up in both the consumer and provider responses. Can you expand on what “consumerism” means in the healthcare space? With the rise of digital technology, consumers have unprecedented power. They expect to be provided with a turnkey, individual experience that is fast and seamless. Think Amazon. Think Apple. Think about review sites like Yelp. While other businesses have been shifting their focus toward delivering meaningful and valuable consumer experiences, healthcare has largely stayed the same. But, costs are rising for governments and employers, and this is placing pressure on healthcare organizations to think differently about how they deliver value. Those rising costs are also directly impacting consumers, driving more shopping behavior and greater adoption of new online tools and resources (think WebMD) that give them more control. These shifts mean that driving consumer engagement and redefining how healthcare organizations interact with people is no longer a luxury, but a necessity. Providers need to make the customer experience a priority. Our survey results validate that, and I’m certain the expectations will only increase in the years to come as the next generations enter the healthcare arena. To learn more about the survey findings, visit Experian.com/consumerhealthstudy.  

Aug 21,2018 by Experian Health

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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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