Tag: consumer data
While the various waves of vaccine priority may be largely defined, the ability for many providers to segment their patient populations based on those designations isn\'t always simple. Without accurate data, there’s a risk that some vulnerable patients will be missed out. We interviewed Mindy Pankoke, senior product manager at Experian Health, about the challenges in segmenting patient populations for the COVID vaccine and how providers can best overcome those challenges. How does addressing patients’ barriers to care increase vaccination rates? The early versions of this vaccination have two doses which comes with its own set of challenges. Getting a vaccination is one thing but getting people to follow up for a second dose in a certain time frame is another. It’s the non-clinical factors that will prevent patients from getting the vaccine. So, things like inflexible work schedules, lack of transportation or even the access or comfort levels with technology required to schedule an appointment online can prevent patients from receiving or prioritizing the first and/or second dose. It can be an uneven playing field with those patients that do not have more flexible schedules, a vehicle or even access to the proper technology to schedule and register for both doses. It’s much easier for patients to prioritize getting the vaccine when those non-clinical factors are a non-issue. What challenges may providers face when trying to segment patient populations for vaccine administration? There are a lot of gaps in patient demographics which can make it difficult for providers to accurately identify and segment patients. Think information like date of birth or occupation. If providers want to segment by age, which many will likely do for the first wave of vaccinations, that would require a complete record of every patient with an accurate birth date. Providers may also want to segment by occupation, knowing essential workers are also eligible for the vaccine. But how can you understand who is an essential worker? Especially when that definition may vary by state or local government? Including non-clinical insights and enhancing demographic data as part of the patient record can help providers fill in the gaps and better segment patient populations for vaccine administration. By combining the power of Experian’s consumer demographic information with more than 40 years of experience compiling consumer data from self-reported and state license boards, Experian Health is able to drill down into occupation data to view different types of employment (construction, utility, etc.) for you to use to outreach, verify and streamline the scheduling (and automated scheduling) or the COVID vaccination. What are some best practices to move from identifying at risk or priority populations and operationalizing that information into actually administering the vaccine to those groups? This is really where it all comes together, and really where providers need to act fast. Once a group is identified, providers can automate the process as much as possible. First, it is imperative that providers clean up their data. Recent processing of Experian’s Universal Identity Manager solution has identified 1,800 duplicate records in COVID vaccination registrations, for individual facilities. Providers can remove the duplicates, enhance the demographics where they may be out of date or missing, and put in place a proactive system to call out and prevent duplicates moving forward. And the vaccine has a shelf life, correct? So even after segmenting the right patients, how can providers act fast to ensure it is administered? So another best practice is to automate the scheduling for as many vaccination appointments possible. With a tool like Patient Schedule, providers can leverage the demographic data to programmatically push out a notification to a patient’s cell phone via IVR or text message, have them verify their eligibility based on the age or occupation data from Experian, and then allow the patient to book their appointment on the spot for a time that works best with their schedule. On the back end, the Patient Schedule solution syncs with the clinic or mobile vaccination site’s calendar to confirm the appointment, allowing staff the opportunity to tackle other pieces of the COVID vaccination strategy. Anything else you\'d like to add? Providers will also want to risk stratify using social determinants of health insight on the individual level. Patients in every wave of vaccine priority present an opportunity for better patient engagement (68% of the US is impacted by at least one social determinant of health hindering them from accessing or prioritizing their care). Many patients will need help adhering to that second dose and knowing that information and those circumstances on the individual level can help providers engage in the best way possible to ensure the vaccine is administered correctly. Interested in learning more about how Experian Health can help supercharge the COVID-19 vaccine management process?
If President Biden’s two trillion-dollar stimulus package is approved by Congress, support will include funding for a national vaccination program. While the arrival of the vaccine is an immense relief, the logistics for rolling it out across the country present a major challenge. Even at a rate of one million shots administered per day, it could still take 18 months to vaccinate 80% of the population. There are numerous supply, distribution and communication challenges to overcome, both at national and state levels. And for individual healthcare providers, mass vaccine administration calls for a holistic approach, to make sure the right patients get the right dose at the right time and place. Could data analytics and digital automation tools be the key to identifying, engaging and supporting patients as the vaccine program is rolled out? Here are 6 ways digital technology could help your organization improve vaccine management. 6 digital tools to include in your vaccine management plan Segment patient groups with consumer data Deciding who gets the vaccine first is only hurdle number one. Providers must then segment patient populations according to risk categories (such as age or occupation), so they know who should be at the top of the list. Without accurate consumer data, there’s a risk that some vulnerable patients will be missed out. The answer lies in data analytics. By synthesizing thousands of data points for more than 300 million Americans, ConsumerView gives providers the detailed insights needed to segment and target patient populations. At the tap of a button, providers can find out which patients are essential workers or in high-risk groups, so they can be channeled into the vaccine program without delay. Improve patient access and engagement with data insights According to the Kaiser Family Foundation, six in ten older adults say they don’t know when and where to get the vaccine. Many patients also face access barriers such as lack of transportation or childcare, or poor digital literacy. If providers don’t account for these in their outreach and engagement efforts, their vaccine program will fall flat. Consumer data can again help providers understand who their patients are, to identify those who might have trouble getting the vaccine. Insights on the social determinants of health can point to the best communication channels and support services to offer. Keep track of patient identities with secure patient portals If providers are reaching out to patients and encouraging them to schedule vaccine appointments through their patient portal, they must have confidence that the person signing up and logging in is who they say they are. The right security protocols can help validate and protect patient information. One example of identity proofing technology is Precise ID®, which uses knowledge-based authentication (questions only the real person would be able to answer) and device recognition to verify patient identities. Prompt patients to book a vaccine appointment with automated outreach Imagine if patients could receive a text or voice message notifying them that it’s time to schedule their vaccine, with a link and simple instructions on how to book. With automated outreach, providers can proactively text or call a segment of patients with self-scheduling options and specific messages about the vaccine and its safety. Not only will this help to increase vaccination rates, it’ll reduce call center volumes at a time when staff are already under pressure. Make it easy for patients to schedule appointments with online self-scheduling In order to meet daily goals for vaccine administration, it has to be easy for patients to book appointments. The last thing any provider wants is no-shows. By deploying scheduling software that ties vaccination qualification rules into the booking process, providers can match patients to a convenient slot, ensure they meet the correct segmentation criteria prior to booking, and confirm whether the appointment is for the first or second dose. And of course, an online self-service scheduling tool such as Patient Schedule allows this part of the patient journey to be completed with minimal face-to-face contact, minimizing risk of infection. Speed up reimbursement with automated coverage discovery Finally, providers must make sure that vaccine-related reimbursements run smoothly. CMS has ruled that every American should have access to the vaccine without incurring any out-of-pocket costs. But although the government may be footing the final bill, providers still need to seek reimbursement by payers, which means they still need a reliable way to check a patient’s coverage status. With Coverage Discovery, providers can run quick, comprehensive checks of commercial and government coverage, and identify the right payer for administrative services. Digital software and analytics can provide efficient, secure and convenient ways for providers to guide patients through the vaccine management process, without delay. Contact us for more information on how Experian Health can support your organization to deliver a vaccine management plan.
With Google’s acquisition of Fitbit in November 2019 and Apple’s recent foray into smartphone-based clinical research, the ‘big four’ tech giants are ramping up their efforts to take a slice of the $3.6 trillion healthcare industry pie. These investments aren’t new. Between 2013 and 2017, Apple, Microsoft and Google’s parent company, Alphabet, filed a combined 300 health-related patents, while Amazon has been looking to expand into the pharmacy space since the early 2000s. Historically, it hasn’t been easy for new players to get into the healthcare game. Up to now, tech companies have mostly stayed in their lanes, using their expertise in cloud-based computing, artificial intelligence and supply chain management to break into health markets around the edges. What gives them a big advantage now is the rise of healthcare consumerism, especially in the digital realm. Patients expect to be treated as individuals, with communications and services that are convenient and tailored to their needs. The personalization that so delights them is powered by their own health data and a focus on the consumer experience – two of the tech companies’ biggest strengths. Providing a consumer-centric experience has been challenging for the healthcare industry. In fact, it’s been challenging for many legacy industries (banking, insurance, etc.). Amazon and others have a head start in being able to leverage vast quantities of consumer data and turn insights about their customers’ lifestyles, behaviors and preferences into a better consumer experience. How can healthcare providers compete? Understanding consumer data is key to a better patient experience and better population health The buzz around consumer data opportunities isn’t limited to the tech world. Recognizing the role of consumer data in improving both the patient experience and population health, more health systems are investing heavily in data analytics, looking at how they use data to market to their consumers and address the social determinants of health. Mindy Pankoke, Senior Product Manager for Experian Health, says: “Consumer data is becoming more important in healthcare because patients are people. They\'re more than a clinical chart or claims form. They have lifestyles, they have interests, they have behaviors. This is called consumer data. ‘Social determinants of health’ has become a huge buzzword in the healthcare industry and it\'s more than buzz. It\'s data about people\'s lifestyles that we can use to improve their health.” Over 80% of health outcomes are attributed to the social determinants of health, so knowing who your patients are and what they need is increasingly important if you want to improve their wellbeing. When you understand what’s going on in your patients’ lives, you’ll know whether they need assistance with transportation, understanding their healthcare information, managing a care plan or accessing healthy food. You can communicate with them in the most effective way and point them towards services that could help them access care and avoid more serious conditions. And even better, much of this can be done through time-saving automation tools. Where to start with consumer data Today’s leading healthcare providers are using consumer data in three main areas: 1. Streamlining patient communications Whether a patient is getting treatment for a broken leg or multiple chronic conditions, their healthcare journey probably involves hundreds of touchpoints with your organization. Consumer data helps you cut to the chase and give them the exact information they need to make their next decision or complete their next task, in the most convenient way. Data analytics allow you to create a slicker patient experience, by giving the right message in the right format – whether that’s in marketing to new patients, sending bill reminders, or encouraging wellness checks. 2. Segmenting patients according to social determinants of health In a study of 78 social needs programs published this month, Health Affairs reported that health systems invested more than $2.5 billion in interventions focused on housing, employment, education, food security, community and transportation, between 2017-2019. Clearly, some patients will benefit from these services, while others won’t. There’s no point giving the same information to every patient. Consumer data lets you segment your patient population and target information about social programs to the ones who need them most. 3. Creating bespoke services for your specific patient population Consumer insights tell you exactly what’s blocking your particular patient population from accessing care, now and in the future. You’ll know how many have difficulty attending appointments, how many might struggle to read complicated instructions and how many will be too busy to download and use your new healthy recipe app. Analyzing your population’s needs and tendencies allows you to predict future demand for different services and develop interventions to solve those specific challenges. Future-proof your consumer data strategy by working with a trusted partner As the big tech companies are coming to discover, healthcare data regulations are complex. You need to know where your data comes from, for the sake of both accuracy and permissibility. Working with a trusted data vendor in the health space can help ensure the reliability and integrity of your data, as they will have expertise in the appropriate use of consumer data in healthcare. They’ll help you pull insights from only the most relevant, current data, so you can build a competitive consumer experience on the strongest foundations. Find out more about how Experian Health’s consumer data analytics can give you a holistic view of your patients and the social determinants that affect their health.
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
The stats are alarming: Up to 80% of health outcomes are not due to medical factors, but to a patient’s social and economic circumstances—such as their income, housing situation and even whether they own a car.68% of Americans are affected by at least one social determinant of health (SDOH).Approximately 24% of hospitals and 16% of physician practices screen for food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence—which means the majority don’t screen for all relevant social needs. The healthcare industry has been talking about the importance of addressing social determinants of health for years, but many struggle with how to collect the insights. For example, if 68% of Americans are affected by at least one SDOH, how do they even discover the one? What is the ideal way for providers to screen for SDOH? Should they simply ask the patient? Do they start a visit with a survey, probing for details that could ultimately impact care management decisions? Providers know these sensitive topics – housing instability, financial instability, food insecurity and onward – can be tough and uncomfortable conversations. So, where to begin? Should you rely on patient surveys to capture SDOH? Patient surveys can be a useful way to find out about many potential barriers to care. However, they bring limitations: Your insights will be limited to the patients who show up—so anyone who has struggled to attend an appointment (and therefore potentially with higher needs) will be left out It can be time-consuming and expensive to give staff the time and space to conduct personal interviewsThey rely on patients to be willing to share openly, but some may not feel comfortable doing soThere is room for error in how questions and answers are interpreted by both the survey team and respondentsSocial circumstances can change over time, so it’s possible that the information gleaned in the survey may not be relevant a few months down the line. Knowing SDOH can have such a huge impact on a patient’s health certainly means clinicians should discuss these topics in the exam room, but relying solely on patient surveys and conversations could lead to gaps in intel. When should you screen for SDOH? Screening for social needs when a patient first registers or engages with your services is a good starting point. But what happens when their situation changes between diagnosis and treatment? What if they disclose a social need to a specialist that wasn’t flagged on their initial intake form? Does your staff know how to discuss sensitive social issues? Can they create a safe space for patients to share? Have you got clear referral pathways when an issue is flagged? Look for possible touchpoints in the patient’s journey where referrals to support services would be appropriate. Looping in the relevant primary care services is a good way to make sure your patients are connected to community-based programs and supported throughout their journey, whenever a new or changed social need is identified. What types of data could offer the SDOH insights a provider needs? Geographical and community-level data can help a healthcare organization understand their patient population’s income, housing situation and employment status. These are useful for population-level care planning but aren’t patient-specific. A better way is to analyze securely collected consumer marketing data for more specific and accurate information. Working with a trusted data vendor that is a compiler of original-source consumer data can help you navigate your options. The real predictive power of SDOH data comes when you combine patient-specific information obtained through screening, with consumer databases. A third-party vendor can help you access data on your patient population’s income, occupations, length of residence and other social and economic circumstances. Your care managers can use this to inform proactive, preventative conversations with patients to solve any non-clinical gaps in care. Bottom line … When healthcare organizations have a holistic view of patients—and the SDOH that play a role in their lives—they can take steps to help prevent avoidable hospital visits, emergency department (ED) utilization, appointment no-shows and worsened conditions by encouraging and facilitating earlier interventions. The key is to start with the right data.
In today’s fast-evolving healthcare industry, consumer expectations are changing. Individuals are footing an increasing portion of medical bills, so they’re paying closer attention to their healthcare options. And with digital technology enabling choices for everything from where to bank to what to eat (and even who to date!), patients are now expecting a similar consumer-centric experience when it comes to their health. But what exactly are they looking for? Providers should respond to this rising consumerism with two things: convenience and engagement. Many patient tasks are time-consuming, tedious and repetitive. The use of outdated technology draws unfavorable comparisons with the intuitive apps used in other industries. And all too often there’s a one-size-fits-all approach to marketing. The opportunities to improve the patient experience are huge. As the competition for consumer business heats up, providers should look for ways to step up their patient engagement strategies to attract new consumers and inspire loyalty among existing members. Consider how to make it as easy as possible for patients to access the care they need, whether that’s through frictionless scheduling, simplified registration processes or proactive communication about free transportation options. Data-driven technology and automation can help drive improvements in both convenience and engagement. Here, we look specifically at how automation could help you meet changing consumer expectations in the world of patient access. How can automation make patient access more convenient for consumers? Patients hate administrative and financial tasks that take them away from family, friends and other priorities. When looking for an easy, streamlined patient access experience, they might ask: Can I make appointments online? Can I get an out of pocket estimate for my cost of care? And can I price-shop my services? Can I do my pre-registration work before I show up for my appointment? Can I manage my bills and all my health information online? Can I do all of this from my mobile or tablet device at a time when it’s convenient for me? Automation can help you deliver against these expectations and remove stress and hassle from many patient access tasks. By using consumer data and technology to trigger the next stage in the process, you can help patients navigate the complex healthcare system, making registration, billing and payment more convenient. For example, online self-scheduling lets patients plan appointments when it suits them. You’ll increase appointment and referral rates, improve call center efficiency, reduce no-shows and enhance the overall patient experience. Or how about offering patients a one-stop-shop for managing all their healthcare admin, through a digital patient portal? This makes it much quicker and easier for them to get price estimates, set up payment plans, update insurance information and stay on track with appointments and treatment plans. By automating the registration and billing processes, you’ll improve self-pay collections and decrease bad debt. If you can say “yes” to the above questions, you’ll be making life easier for your patient access staff too. Reliance on manual data entry processes means staff are constantly battling bottlenecks and dealing with avoidable errors and duplicate records. Not only does this waste employee time, it opens the door to major safety issues and lost revenue: patient identification errors can cost up to $2,000 per patient and are associated with a third of denied claims, costing the average hospital $1.5 million each year. How can automation support better patient engagement? This isn’t just about removing obstacles or introducing speedy tools. You can use automation to improve patient engagement at various touchpoints during the patient access process. Consumer data paired with automation can help you nudge patients by text or email to make appointments, so they don’t miss out on important checks. You can deliver personalized updates, reminders and offers, so your patients feel taken care of and know exactly what’s happening throughout their healthcare journey. Using lifestyle, demographic, psychographic, and behavioral data from the highest quality sources, you can also use automation to segment your audience into groups based on all sorts of variables, in order to communicate with them about the right services, at the right time. Now is the time to leverage technology for a better patient access experience. It’s clear that awareness of the potential ROI in automation is growing. Still, many providers have only scratched the surface when it comes to integrating automation within their revenue cycle operations. Given that 66% of patients would switch providers for more convenient access, it makes sense to consider how you can leverage technology to simplify all sorts of patient tasks, from pre-registration to payments. Learn more about how automation could help your organization create a better patient access experience for consumers.
When a doctor pulls up a patient’s record, it should be a safe assumption that the information on the screen relates to the patient sitting in front of them. It should contain every detail of the patient’s medical history, along with their current address and accurate personal information. It certainly shouldn’t contain anyone else’s data! Yet all too often, patient records are plagued with inaccuracies. Around 30% of patient data in electronic health records is incomplete or inaccurate, and up to half of records are not linked to the correct patient. The ONC estimates that around a fifth of patients may not be matched to their entire medical record within an organization, while more than a half of records shared between organizations contain errors. Despite all of modern medicine’s ground-breaking achievements and our increasingly digitized world, the ability to share information between different payers and providers in a reliable and secure way remains frustratingly out of reach. Could a universal patient identifier unlock interoperability? Imagine a healthcare ecosystem where administrators and clinicians can safely exchange information without worrying about whether it’s inaccurate, incomplete, or incompatible with each other’s systems. Interoperability could make life easier for healthcare staff and patients alike. While regulations such as the Affordable Care Act introduced many carrots and sticks to drive up adoption of electronic medical records to support interoperability, they also revealed a critical gap in healthcare: the need for a universal patient identifier (UPI). This is an identifier that would help manage patient identification across the whole healthcare ecosystem. A UPI would allow providers and payers to follow patients throughout all their major medical and life events and be sure that the information they hold for their member or patient is 100% accurate, current and complete. Instead, the absence of a UPI, compounded by the sheer volume and fluidity of patient data, has created significant issues downstream. Billing errors, unnecessary treatment and testing, HIPAA breaches, prescriptions filled for the wrong patients and many other issues all play a role in the growing number of preventable medical errors (estimated to be the third leading cause of death in the US). Striving for truly interoperable patient information should be a priority across the entire healthcare industry. Still, while federal funding for a UPI is currently being considered by Congress, we’re seeing more and more industry-led responses to help improve patient identity management. 5 benefits of using a universal patient identifier for interoperability Improve patient safety How can physicians be sure they’re recommending the right treatment for a patient, when there could be a vital piece of information missing from their medical history or allergy list? How can a pharmacist feel confident handing over a prescription, when there’s a chance the patient in front of them isn’t the same patient named on the script? A UPI can help avoid ‘wrong patient’ events and allow providers to share information to spot trends in recurring errors so that action can be taken to prevent them in future. Lower healthcare costs The West Health Institute found that that medical device interoperability could save the U.S. healthcare system more than $30 billion per year. For individual providers, UPIs could improve productivity by reducing the amount of time clinicians and hospital staff spend trying to sort out inaccurate records. And with nearly a third of claims denied as a result of patient misidentification, this could mean savings in the region of $17.4 million for the average hospital. A better patient experience Patients are right to be frustrated when their physician doesn’t have up-to-date records about them, or their provider sends appointment reminders to an old address. Expecting patients to fill out multiple forms (often multiple times) is inefficient and hardly contributes to a positive patient experience. A tool such as Universal Identity Manager can help providers exchange timely data, eliminate duplicate records and coordinate care, so the patient is supported throughout their healthcare journey. Stronger privacy Electronic records linked with a UPI allow healthcare organizations to phase out manual processes—which is not only more efficient, but also helps minimize the risk of patient data falling into the wrong hands. It’s much easier to keep the data secure when it’s contained in a single record, compared to multiple versions of a record filled with scribbled notes and random updates that could easily end up attached to the wrong record. Experian Health’s Precise ID gives healthcare organizations a HIPAA-compliant way to authenticate patients and reduce the risk of a data breach during enrollment. Better data to tackle the social determinants of health As consumer data opens up new opportunities to improve population health, a network of shared data will be essential for identifying trends in the social and economic factors that affect medical outcomes. Interoperable data sets and technologies can enhance the way public health data is collected and used, for better patient outcomes and population health. Interoperability currently remains a challenge, but the tools exist to improve the way information is shared and used across the healthcare ecosystem. By integrating clinical data into the patient access workflow, you can increase productivity, reduce costs, and ultimately improve the patient experience. Contact our team to find out how this could help your organization achieve more efficient, accurate and actionable data sharing.
I attended the Fall 2019 Conference of the National Association of Accountable Care Organizations (NAACOS) in Washington D.C. and wanted to share some insights on how top-performing Accountable Care Organizations (ACOs) are using data to drive improved quality and cost of care. Over the last decade, we’ve seen the number of ACOs surge. Propelled by the shift from volume- to value-based care, over a thousand ACOs operate across the U.S., bringing together groups of physicians, hospitals and other providers with a collective ambition to enhance quality of care, reduce healthcare costs and improve patient outcomes. While some ACOs participating in the Medicare Shared Savings Program have succeeded in improving quality and realizing some savings for the program, the value-based model is still evolving, and results can be mixed. More dramatic and holistic moves will have to be made to convert today’s annual incremental savings of 1 to 2% to make a dent in the estimated annual waste of nearly $389 billion in administrative complexity and another $45 billion due to lack of coordinated care. So what separates the top performers from the rest? At NAACOS last week, speakers confirmed that the most successful ACOs are those that effectively shift care towards primary care physicians (PCPs) and away from acute settings and skilled nursing facilities, implement a process for continuous improvement and adopt a performance-first culture. This is easier said than done. Here’s my top recommendations to help ACOs leverage data-driven insights to lower costs while improving patient outcomes. Offering insights into member utilization of healthcare resources in real-time I recently worked with a client that needed real-time alerts of member activity including admissions, discharges, and Emergency Room (ER) visits. These insights enabled this client to proactively manage active member episodes of care, optimizing the setting and deliver of care for the member’s specific needs. For example, a member was frequently visiting the ER with complications from his Chronic Obstructive Pulmonary Disease (COPD) condition that the client’s care team was managing. This was a needlessly costly way to treat the symptoms. To help get their members the right care at the right time, this client started leveraging automated alerts for their members as they presented within the healthcare continuum. The next time this patient sought treatment in an out-of-network ER for their COPD, their primary care physician (PCP) received an alert about her patient as soon as they registered, before a doctor had even seen him, and certainly before an ER workup converted to an admission. The PCP called the attending ER doctor to share the patient’s history and ensured the ER physician that this patient would receive next-day follow-up care in the PCP’s office. Knowing that follow-up was in place and the patient wasn’t in immediate need of care, the ER physician discharged the patient home. Given that the average cost of an admission can run $22,000, and an outpatient visit less than $500, the savings delivered by this kind of care coordination becomes significant. More importantly, the member experience is much improved in that they get to go home instead of an unnecessary overnight stay in the hospital. And this is just one example—multiply this kind of episode management across all member encounters and consider the improved member quality of life across all attributed lives and the savings for the health plan or ACO in the aggregate. Real-time alerts provide a win-win for both patient and ACO by affording care teams the opportunity to optimize the setting of care for quality and cost. Care coordination for episode management To improve episode outcomes and reduce readmissions, visibility into the compliance of a patient’s post-discharge care plan through the duration of the entire episode is critical, so well-coordinated care requires that clinical context be shared between providers. A frequent barrier to this flow of useful data is that clinicians’ electronic health records (EHRs) aren’t always interoperable. To solve for this, some ACOs are attempting to move all their providers to a single EHR and care management module. However, for some this may not be an option. In these cases, ACOs can opt for Care Coordination Manager: a rules-driven, closed-loop messaging and distributed workflow orchestration platform that enables health plans, ACOs, allied health, and community partners to share and assign care plan requests across a diverse provider community. Care Coordination Manager is vendor-agnostic and able to populate EHRs and care management modules at the point of care with key clinical context. This flow of tasks and content supports high-quality coordination of care and management through transitions of care. Proactively address non-clinical barriers to health for improved patient engagement and health Another characteristic of top-performing ACOs is that they utilize a 360-degree view of their members to address potential barriers that prevent members from engaging in their own healthcare. These SDOH factors can include things like housing or financial instability, food insecurity, limited access to transportation or healthy food options, and other non-clinical factors. Only about 20% of costly health episodes are due to medical factors, so it’s vital for ACOs to incorporate a more comprehensive and actionable understanding of the social needs of the populations they serve. For example, medication adherence is a bigger challenge for a patient who may have difficulty getting to a pharmacy or understanding medication instructions. Identifying and mitigating these risks up front gives the patient a better chance of adhering to their prescribed regimen, which in turn gives them a better chance to stay healthy, ultimately lessening the disease burden and thus the cost of the ACO’s membership while improving the patient’s quality of life. ACOs can take a proactive, preventative approach to addressing these challenges by collecting and analyzing member data and using these insights to tailor interventions. Patient-supplied information through surveys, like PRAPARE, is a good starting point, but surveys can be limited by access to the patient as well as the patient’s ability or willingness to answer honestly. Additionally, unless mapped to structured data such as ICD-10 Z codes, survey data is challenging to scale for broader insights into the ACO’s membership. Instead, consider healthcare consumer data that’s sourced directly from a reliable vendor. Analysis of this demographic, psychographic and behavioral data allows you to flag patients based on need, so you can identify the best way to communicate with members to help them own their healthcare journey. For example, in a recent report by the Department of Health and Human Services’ (DHS) Office of Inspector General (OIG), one ACO described how asking patients with chronic conditions to make a daily call to a care coordinator led to 43% fewer emergency room visits and 47% fewer readmissions. As ACOs grow amidst pressures to take on downside risk and manage costs while improving quality—timely data collection, sharing, analysis and action will continue to provide the foundation of high-quality episode and population health management; along with engaging members and community partners in the healthcare journey. What’s clear from discussions at the NAACOS conference last week is that the opportunity exists to work smarter across many emerging payment models. Could data be the key to unlocking that opportunity? McLain Causey is Director of Product Management at Experian Health.
Last week, I spoke at the technology briefing of a national health plan group to give a presentation on the role of consumer data and patient identity in healthcare and how social determinants of health (SDOH) can help payers improve population health and lower costs. To illustrate the importance of leveraging consumer data for SDOH outcomes, I like to use the example of Vern. Vern is 78 years old, lives alone in a lower income apartment complex and hasn’t attended a wellness check in several years. Last month, he had an unexpected trip to the emergency room (ER) due to heart disease and continues to be readmitted for his condition. But why does he keep getting readmitted? Is it because he can’t afford his prescribed medication? Is he having a difficult time finding transportation? Or could it be that when it comes to healthy eating—buying fresh product on a weekly basis is challenging for him? These are some of the SDOH that could be contributing to Vern’s readmission—not solely his now heart disease. Had his care team known more about Vern, aside from his condition, they could have proactively addressed some of his barriers to care and prevented the ER admissions—saving them from costly care episodes and preventing negative outcomes for Vern. By utilizing SDOH insights, Vern’s care team can help ‘even the playing field’ for him by understanding his non-clinical barriers to health, what key things are driving those barriers, and what makes sense to address them. All of this, of course, underpinned by an accurate identity (but, let’s talk universal patient identification another day!). With SDOH insights, Vern’s care team could have gotten him to his wellness checks, his condition would have been detected earlier and he would have received the services he needs proactively. This would save countless dollars in repeated readmissions, ER visits and other costs associated with a chronic condition that can’t get better when your members don’t have the luxury of prioritizing health over basic needs. To avoid these missed opportunities, many healthcare organizations are turning to consumer data to understand their patients or members better. Insights on SDOH are transforming the care experience for people like Vern, as well as saving money for patients and the healthcare industry. Here are three ways consumer data is driving improvements in population health and lowering healthcare care costs at the same time: Helping patients lead healthier lives Research shows that clinical care alone is not enough to safeguard a person’s health. Up to 80% of health outcomes are attributable to non-medical factors such as your financial situation, stability of living arrangements, access to transportation and healthful food options, amongst other things. Around 68% of Americans are affected by at least one of these SDOH, which can make prioritizing good health a challenge. When healthcare organizations are more informed of the SDOH impacting their patients or members, they can take steps to help prevent avoidable hospital visits, ED utilization, appointment no-shows and worsened conditions by encouraging and facilitating earlier intervention. For example, 1 in 8 Americans are food insecure. If care teams are able to recognize when this is an issue for the people they’re caring for—they can look at partnering with community organizations, like a local food bank or meal delivery service, to address gaps in nutrition for better health outcomes. Reducing the financial burden of healthcare expenses In the U.S., healthcare has the world’s largest gross domestic product (GDP) spending (18%). By helping your members overcome barriers to attending appointments and potentially discovering health issues sooner, the healthcare industry can reduce the costs of healthcare. For example, 3.6 million Americans miss out on medical care due to transportation problems. If care teams knew who they were and what specifically is impacting them ahead of time, they could step in to arrange transportation or offer alternative options, like telemedicine, so problems can be detected earlier. Not only is this better for the patient’s health, it’s better financially too—emergency room visits cost an average of nearly $2,000 while inpatient hospital stays come in at an average of $10,000. When 33% of ER visits are from those experiencing homelessness—the extreme condition of housing instability—it’s imperative that we consider more than a patient’s profile from a claims or clinical data perspective. Offering a better patient experience When healthcare organizations can see each patient as a whole person, they can offer better engagement plans that make prioritizing their health a smaller mountain to climb. Does your patient prefer information by phone, text or email? Do they use their patient portal? Are there other services they might benefit from, that can help improve their health in other ways? Armed with the right data, you can answer these questions and tailor your communications with each patient, ultimately helping them achieve better outcomes. What’s more, when you leverage consumer insights to improve your population health strategies, you’ll also create a better patient experience through improved care coordination, prompt referrals and timely information sharing—making the whole process better for everyone. Translating consumer data into intelligent business decisions With reliable consumer data sourced from Experian—an original-source provider and data steward when it comes to consumer privacy—you can learn more about your patients and make the right care management decisions to address the non-clinical barriers to health impacting the health of your members and your organization. Learn more about how to leverage consumer data to help improve outcomes for your patient population. Mindy Pankoke is a Senior Product Manager for Experian Health
