Tag: care management

An estimated 82 percent of hospitals receiving Medicare and Medicaid payments in fiscal year 2019 are expected to have their payments reduced because their readmission rates are too high. The Centers for Medicare and Medicaid Services implemented the Hospital Readmissions Reduction Program  to reduce the number of patients being readmitted to hospitals less than 30 days after leaving. This program’s goal is to improve patient care. While  a number of factors influence hospital readmission rates, they often occur when patients are not communicating issues with their doctors or when more communication is needed between patient care teams. For example, when the attending physician in the Emergency Room (ER) doesn’t have the necessary background on a patient’s condition, a patient is more likely to be readmitted. This can lead to longer waits to get proper treatment. To best serve patients by reducing hospital readmissions, healthcare organizations need to improve patient care coordination. Technology enhances communication among inpatient, outpatient, and long-term care teams, and it gives patients more of a stake in their own care. Coordinating patient care USMD WellMed Health System set a goal to significantly decrease its readmission rates, so it needed a way to alert physicians if their patients showed up in the emergency room, particularly within 30 days of leaving the hospital. The organization implemented Experian Health’s Care Coordination Manager and MemberMatch® solutions. Care Coordination Manager provides a messaging platform for patients’ post-discharge care plans, which is a secure place for patients and providers to communicate. It helps hospitals and health systems provide solutions for 30-day and 90-day management of health episodes. In one case, a doctor was able to intervene when a patient with chronic obstructive pulmonary disease showed up in the ER. The doctor was notified, spoke to the ER physician, and developed a course of action that allowed the patient to go home without being admitted to the hospital. In addition to avoiding hospital readmission penalties, USMD WellMed provided better care with the service and made the patient happier as well. While healthcare professionals agree  there is a growing need to help patients become more engaged in their care, many are uncertain about the tools and opportunities to make it happen. Care Coordination Manager introduces an easy way for patients themselves to communicate with their providers and get clarifications on follow-up care. USMD WellMed also implemented MemberMatch, which lets Accountable Care Organizations (ACO), ESRD Seamless Care Organizations (ESCO), and health plans better manage members’ clinical episodes by alerting care managers when a patient is admitted, discharged or shows up in the ER. Doctors appreciate notifications Despite the numerous benefits of reducing hospital readmissions, there was one major reservation when the phone alerts were implemented. While USMD’s physicians wanted to be more attuned to their patients’ needs, they were worried that they would be inundated with text notifications. The program was initially limited to high-risk patients. But once physicians started getting the alerts, they immediately realized the benefits . Some doctors even asked to expand the platform to all of their patients. Ultimately, this tool improved both USMD WellMed’s provider and patient satisfaction. USMD WellMed was able to reach its goal of significantly reducing readmission rates in a short period of time, according to Dr. Bryan Demarie Sr., Market Medical Director of USMD WellMed. The Care Coordination Manager helps physicians and patients take a more proactive approach to treatment by handling problems before they escalate to another stay in the hospital. Opening the lines of communication allowed the healthcare organization to meet its readmission goals, improve patient care and save USMD WellMed from costly penalties. Support the sharing of post-acute patient care information to help providers succeed in the new era of value-based reimbursement. Learn more.

In a recent healthcare information technology survey, more than 40 percent of chief information officers identified patient matching as healthcare’s top IT concern. And though a quarter of the respondents admitted it wasn’t a current priority for their organizations, they did say that it very much should be. There’s no shortage of reasons why, but the most pressing is the need to reduce medical errors, which account for over 250,000 deaths in the United States every single year. Case in point: Seventeen percent of CIOs acknowledged that errors in matching data with the right medical identities have led directly to adverse outcomes for patients. The numbers speak for themselves: Healthcare organizations must find more effective ways to manage the data within their networks. That begins with building a robust medical database that not only hoses data, but also knows how to match it with the proper patients. How robust EMPIs streamline workflows An enterprise master patient index (EMPI) is a database that can help you clean up your data and eliminate duplicate and inaccurate records. It uses algorithms to match exact data elements among disparate records, as well as elements that fall within an acceptable range of possible compatibility. Using technology that can apply an algorithm of probabilistic and referential matching methodologies will allow healthcare organizations to expand beyond the limitations of conventional single methodology matching, as both probabilistic and referential matching techniques provide a higher degree of likeliness. The system assigns these data points to unique identities that follow patients throughout the organization. Any new data generated within the network is also attached to this identity, meaning physicians, specialists, pharmacists, and other members of the patient’s care team can access and update it as needed. EMPI support tools and unique patient identities are building blocks toward creating a healthcare ecosystem that’s truly interoperable. According to an April 2018 survey by Black Book, hospitals with an EMPI report “consistently correct patient identification at an overall average 93 percent of registrations and 85 percent of externally shared records among non-networked providers.” Unfortunately, not all healthcare systems possess the IT infrastructure to support these programs. And as long as some organizations fail to integrate similar platforms, providers won’t reap the benefits of industry-wide interoperability — and patients will continue to suffer. Whether it’s a frustrating billing mix-up, privacy breach, or a detrimental (or even fatal) misdiagnosis, many errors can be successfully prevented with an EMPI. Filling in the holes The goal of such a system should be to standardize data entry and access within each healthcare organization, as well as across the entire industry. Such a network could protect, govern, and match unique patient identities across every discipline and every aspect of their care continuum. But in order for the system to achieve these goals, you need to be sure you’re feeding it relevant, recent patient information. To ensure you have enough patient data to build an EMPI that accurately matches profiles, ask yourself these questions: 1. What kind of medical care have my patients received before this visit? When patients enter a new hospital, they’re given a brand-new identity, or patient number, that’s only relevant to that healthcare system. The identity you assign them within your own organization doesn’t provide any insight about what they’ve experienced before their current visit — and that’s the crux of the matter. When patient information is siloed within a specific system, you have no view of the patient’s medical history. But when it’s shared across systems and fed into a more dynamic and interoperable data management system, patients will ultimately receive better care. 2. Who are my patients when they’re not “patients”? It’s important to understand who patients are when they’re not in the hospital. Yes, they’re husbands and wives, mothers and fathers, brothers and sisters. But some could be physically fit, while others haven’t seen the inside of a gym in years. Some might get regular checkups, but others cannot afford to see a physician regularly. All of these traits factor into your patients’ identities. With a comprehensive EMPI, you can tie them together to understand the environmental and socioeconomic factors that influence your patients’ health. You can then identify what social determinants of health need to be addressed or could potentially influence the efficacy of certain treatments. 3. Can we identify patients without a picture ID? Biometrics such as fingerprints and iris scans are more secure forms of identification than a photo ID. They’ll not only make it easier to identify patients, but will also offer heightened security against fraud. That being said, even biometric identification isn’t 100 percent secure unless it’s part of a database, such as the EMPI, that accurately matches patient identities with relevant medical data. Accepting that the healthcare industry needs better data management and patient-matching strategies is the first step to realizing those goals. EMPIs have shown organizations the value in universal patient identities. Now, they simply need comprehensive databases that are robust enough to keep patient identities consistent across the entire healthcare ecosystem.

This week, Experian Health is a proud partner of National Health IT Week. U.S. National Health IT Week is a nationwide awareness week focused on catalyzing actionable change within the U.S. health system through the application of information and technology. Comprehensive healthcare reform is not possible without system-wide adoption of health information technology, which improves the quality of healthcare delivery, increases patient safety, decreases medical errors, and strengthens the interaction between patients and healthcare providers. Initiated in 2006 by the Healthcare Information and Management Systems Society (HIMSS), National Health IT Week has emerged as a landmark occasion for using health IT as part of the overall solution to improve America’s healthcare as a bipartisan, federally led, market driven initiative. While the healthcare industry has transformed in the last decade as health organizations have moved to electronic health records (EHRs), it brings us one step closer to the vision of comprehensive care coordination, but fully achieving care coordination across the vast health enterprise is still a long way ahead. While a recent American Hospital Association (AHA) survey showed that nearly all reported hospitals (96 percent) possessed certified EHR technology in 2015, the Office of the National Coordinator for Health Information Technology reports that there is very little coordination of patient data across the healthcare ecosystem. Much of this disconnect begins with the inability to transfer data in a secure manner that will match, manage and protect patient identities across enterprises. "As hospitals must now deal with hundreds of thousands of electronic patient records, spanning multiple systems and departments, the traditional technologies to managing patient information are no longer sufficient," says Karly Rowe, Vice President of New Product Development, Identity and Care Management Products for Experian Health. "Leveraging sophisticated matching technology and outside data sources, can improve patient identification and prevent duplicate or overlapping records which result in inappropriate care, redundant tests, and medical errors – as well as make data accuracy higher for clinical, administrative, and quality improvement decision purposes." To solve the industry problem of matching, matching and protecting patient identities across the healthcare ecosystem, we must start by creating a universal patient identifier (UPI) to make patient data truly interoperable. For example, one of the biggest challenges in managing patient data begins when patients move, change names, or switch doctors and their EHR doesn’t follow them. They have to start over, trying to recall events and dates in their medical history with a new doctor, who is tasked with providing care without the detailed insight into the patient’s medical record. But if that same patient had a universal identifier that allowed healthcare providers to communicate with another healthcare provider about a patient, the new provider would know all the ins and outs of that patient’s history, leading to a more holistic approach to care and higher patient satisfaction. Simply put, a UPI can be thought of as a mechanism to link all patient information and associate it with the right individual based on patient data. This is similar to how credit bureaus link an individual’s credit history to the right individual to ensure accurate reporting. Using a similar model, patient data — and supporting patient demographic data — can be used for the common good to improve patient safety, increase quality of care and reduce mistaken identity risks. The benefits of a UPI extend across the entire healthcare system as well, as it improves the quality of patient identities, which can have duplicate, overlapping and incomplete records. Additionally, a UPI can help eliminate incorrect medical treatments; deliver current and accurate patient data; and prevent identity fraud, HIPAA breaches and incidental disclosures of protected health information (PHI). Ultimately, this will build patient trust through increased visibility and record accuracy. Knowing that preventable medical errors, many of which are the result of incorrect patient identification, are the third leading cause of death in the United States. The creation of a UPI will allow the healthcare industry to facilitate accurate information exchange to stop problems before they start. For example, if a patient shows up to fill a prescription and is mistaken for another patient with the same name and given the wrong prescription, there could be fatal interactions with other medications that patient is taking. The National Council for Prescription Drug Programs (NCPDP) has already started using this technology to establish national patient safety identifiers. A national patient safety identifier, or UPI, is a vendor-neutral, cost-effective solution that will link patient data at scale efficiently and accurately to improve patient safety and care coordination. Identity management is a critical, underlying component to every interaction, and healthcare is no exception. To fully achieve the goal of comprehensive care coordination, creating a UPI to help match, manage and protect patient data is the first step in achieving the interoperability of patient data. Participate in National Health IT Week’s Virtual March and help catalyze actionable change within the U.S. health system through the effective use of health IT.

Healthcare has always been driven by data, and today, providers have access to an unprecedented amount from a wide variety of sources. While this influx could be a blessing to the healthcare industry as a whole, it also poses a number of challenges, particularly when it comes to patient identity management. With a soaring volume of patient information coming in from numerous sources, identity errors become increasingly more likely, as well as the potential consequence of fatal mistakes. Keeping this in mind, the importance of effective identity management cannot be overstated. Every year, an estimated 195,000 people die due to medical mistakes. More than half of those deaths – 10 out of every 17 – are the result of identity management errors, such as duplicate records and mistaken patient identities. While current healthcare IT solutions attempt to tackle these discrepancies, they only succeed in identifying about 10 percent of all duplicate records. Consequently, patients often undergo repeated tests or receive incorrect treatment or medication that can result in adverse effects to their health. Also, there is limited coordination of patient data throughout the healthcare ecosystem. The main culprit of this is the lack of secure data transfers that compromise patient records and identity. This raises the question: How can healthcare organizations better manage the massive amounts of data related to each patient’s medical identity? Luckily, such issues can be improved with Experian Health’s Universal Identity Manager (UIM), which creates a single identity for individual patients across multiple disparate healthcare databases. Upgrade your identity management system The ability to share patient information across multiple healthcare organizations with different care management programs is at the core of optimizing overall patient care. Properly utilizing patient and population health data can dramatically improve an organization’s efficiency, raise its quality of care, and lower its readmissions rate. For patient data to be useful, however, providers require a robust infrastructure that allows for secure, precise, and accurate storage of patient data. The same framework should be able to assign patients unique identities across the entire network. In turn, a single, universal patient identity system allows for better analytical insights and more effective care personalization. This kind of management system also allows an organization to add relevant data to a patient’s medical profile faster and more accurately, creating an improved dynamic database that can develop personalized patient engagement and care plans. How Experian Health’s universal identity management software helps Administrative slip-ups in healthcare can have drastic consequences for a patient’s health and wellbeing. Eliminating these inaccuracies is the main goal of Experian Health’s UIM solution. Experian Health has the benefit of leveraging data assets available to us from being part of broader Experian. As a result, the identity management software generates and assigns a unique identifier to each patient that remains consistent across various healthcare systems, such as hospitals, therapeutic facilities, pharmacies, and healthcare payers. Drawing on decades of experience in identity management, Experian Health's multi-matching methodology approach eliminates duplicate and erroneous data through comprehensive search and alert processes. It provides a high degree of likeliness because it expands beyond the limitations of the conventional single-matching methodology that most health systems use today. Even records created on disparate healthcare systems can be automatically analyzed and assigned to the appropriate patient identity. In addition to eliminating discrepancies that could affect the quality of patient care, universal identity management also reduces medical and billing errors, ultimately minimizing an organization's risk of fraud. The solution also works in tandem with Experian Health’s suite of patient engagement and transparency tools, including its Patient Self-Service portal, to further optimize an organization’s ability to deliver personalized, high-quality care. Unique patient identifiers are critical for healthcare organizations to reduce the risks of inaccurate and duplicate records that lead to errors and low-quality care. Combined with Experian Health's suite of patient engagement and price transparency tools, its identity management software is a leap toward making efficient and reliable interoperability more possible across the healthcare ecosystem.

As healthcare in the United States shifts toward a more value-based model, reducing readmission rates has become one of the biggest challenges healthcare organizations now face. Last year, approximately half of all hospitals in the country collectively lost more than $500 million in reimbursements because they had not learned to overcome this roadblock. In most cases, the difficulty doesn’t stem from provider inadequacy, but rather from the inability to effectively coordinate patient care among multiple providers and departments. From treatment specifics and aftercare instructions to prescriptions and follow-up visits, there are plenty of cracks in the communication pavement for important details to fall through. Here's the unavoidable fact: Suboptimal care coordination results in higher readmission costs to hospitals, even for patients with highly treatable conditions. In turn, providers lose much of their profitability, which further hinders their efforts to improve quality of care. Two key (and often missing) factors in care coordination are advanced IT strategies and patient engagement. The only connection among inpatient, outpatient, and long-term care teams is the patients treated in each. Therefore, providers should make it easy for patients to be proactive in their own healthcare. In large part, that requires technology that allows all patients and their care teams to communicate easily and securely, at any time and across any device. Modernizing healthcare communication while reducing hospital readmissions If healthcare providers could simply call or instant message each other with details about patients’ medical conditions, then coordinating care wouldn’t be as strenuous. Without a secure platform, however, healthcare providers might leave sensitive patient health information out in the open for anyone to steal. That liability would be multiplied among numerous physician groups, specialists, skilled nurses, home health aides, and more, possibly affecting several cities and states. All of that is in addition to hazards created by patients who log into public Wi-Fi networks and carelessly leave their mobile devices unattended. There are a lot of elements to consider, but providing a safe and convenient communication platform for patients and their healthcare teams eliminates most security concerns. With a care coordination platform, communication is protected across a broad provider spectrum, no matter what device is used. For example, after a patient is released from the hospital, the Care Coordination Manager generates and delivers real-time messages to members within the patient’s care continuum. These messages, which include discharge details, a checklist for contacting the patient, and schedules for future visits, are automated and delivered within a closed-loop system for optimal safekeeping. Better coordination equals fewer readmissions Closing communication gaps between patients and care teams is a big factor in reducing hospital readmission rates. With this in mind, as a rule-driven platform, the Care Coordination Manager automatically sends email or texts to patients and caregivers about meaningful events. By doing so, patients and their teams stay on the same page at all times with notices for completed test results, newly prescribed medications, and schedule or treatment adjustments. With the platform's two-way, real-time communication capabilities, patients can also ask questions and receive answers about their conditions almost immediately. This helps keep patients informed and engaged, and it encourages them to seek self-care solutions rather than visit the hospital repeatedly for minor concerns. In addition, different providers on the team can easily request information from each other. The Care Coordination Manager is unique and requires virtually no additional training for doctors and staff to utilize. The platform offers all of the benefits of secure, automated communication without the time-consuming catch-up training that often comes with implementing new systems and processes. Of its many advantages, however, the most significant is that the Care Coordination Manager patches up the cracks in care coordination and communication where important patient care information often gets lost. When patients and their healthcare teams can connect and discuss sensitive health information without the worry of security and efficiency, the better care becomes. As a result, organizations can reduce readmission rates across the board, which equally benefits patients and healthcare institutions, all while keeping the main goal of providing quality care top of mind.

Almost every day, new developments come from Washington, D.C. regarding the U.S. healthcare system. From the Affordable Care Act and Medicaid expansion to laws and regulations governing cost transparency and debt collection — there's constant fluctuation. This affects healthcare organizations across the country. They don’t know what rules they’ll be operating under in the future, but they do know they’ll have to meet these changing laws and regulations to avoid fines or lost revenue. Consequently, a crucial question emerges: How do you comply without overburdening employees? Compliance with laws and regulations: 3 ways Experian Health can help The answer is in technology. Healthcare organizations need systematic changes and IT solutions that help establish stability and security. For example, Experian Health’s data-driven technologies help organizations remain compliant with laws and regulations while improving the population's health and ensuring more successful collections. Here are three ways Experian Health can help: 1. Early and accurate cost transparency Nearly 30 states have current laws and regulations that require and govern healthcare price transparency. This list will continue to grow, so organizations need to thoughtfully prepare. Even if it weren’t legally required, patients are now demanding more transparency as they bear more healthcare costs. Historically, the problem stems from patients not receiving accurate, upfront cost estimates. They’re surprised and dismayed when medical bills arrive weeks or months after treatment. If patients are unable to successfully budget for these high costs, then collecting payment becomes more difficult. Experian Health’s Patient Estimates solution solves this by producing fast, highly accurate estimates based on a variety of data. Employees don’t need to manually update price lists, which eliminates the guesswork that leads to outdated, inaccurate estimates. Patients can even self-request treatment estimates through a self-service portal or mobile app. When patients know what to expect before they receive treatment, they’re more willing and able to adhere to payment plans. With our Power Reporting feature, organizations can also accurately judge potential and actual revenue recovery to vastly increase the rate of successful upfront collections. 2. Ensured compliance of third-party vendors Accurate and upfront estimates make capturing revenue easier, but they don't eliminate the need for collections. With patients paying higher percentages of medical costs, healthcare organizations now rely more on agencies to collect debt on their behalf. However, if an agency doesn’t comply with all healthcare laws and regulations that govern debt collections, then it could be liable for its practices. The Fair Debt Collection Practices Act (FDCPA), the Telephone Consumer Protection Act (TCPA), and the Truth in Lending Act (TILA) are examples of these regulations. In addition to maintaining overall compliance in your organization, being responsible for a collection agency working on your behalf can be burdensome. This burden increases when a large percentage of your patients live out of state, making them harder to manage. 3. EMV-optimized payment solutions With more payments coming directly from patients, the risk of credit card fraud is exponentially higher. Healthcare organizations can be held liable for any fraud that occurs on their watch if they haven’t upgraded their systems to be compliant for EMV payments. To help avoid credit card fraud or liability, we offer state-of-the-art card acceptance devices. These are powered by our PaymentSafe technology to provide a patient payment solution that is highly secure and EMV-ready. Because PaymentSafe is processor agnostic, it can be integrated with Experian Health’s eCare NEXT suite of products to leverage the data created at other points in the revenue cycle. It also works in a standalone environment and can be used at a kiosk, through a patient portal, or on a mobile app to accept all forms of tender. PaymentSafe and other Experian Health solutions make up an advanced, integrated revenue cycle that consumes and displays information from a wide variety of sources. The goal is to increase collection opportunities and cash flow, lower the costs of collections, allow staff members to use their time more efficiently, and increase patient satisfaction. It also makes it easier to adapt to compliance regulations that can only be met with the help of advanced technology. The country's healthcare laws and regulations may be in flux, but Experian Health continues to help hospitals and medical groups keep up with safe and secure solutions. By providing increased price transparency, better oversight over debt collectors, and highly secure payment solutions, Experian Health’s suite of products can make navigating complex compliance laws and regulations a breeze. For more information about current laws and regulations in the healthcare industry, please visit: S. Department of Health & Human Services — Laws and Regulations overview Health Insurance Portability and Accountability Act (HIPAA)

Your organization would make a great participant in our Universal Patient Network. We’ve developed a unique solution leveraging Experian’s demographic data to establish a universal patient identifier, which has higher match performance than standard industry tools. We would like to offer YOU an opportunity to leverage our Universal Identity Manager (UIM) Batch product at NO CHARGE.* What you give: Patient demographic data in a secure file/message What you get: File with Universal Patient Identifier (UPI) and identified duplicates (at your specific frequency) How you benefit: Information exchange, care coordination, patient safety, operational efficiency and financial savings Your organization can address duplicate issues and be at the forefront of promoting a universal patient identifier. Contact Experian Health today to learn more! Visit www.experian.com/umpi, email experianhealth@experian.com or call 1 888 661 5657.   *Offer is limited to Experian Health’s UIM Batch Process product and shall remain open for such time as Experian Health may decide.