Tag: patient access
Recently I had the opportunity to present at a regional chapter of the National Association of Healthcare Access Management about the growing need for business intelligence to improve patient access functions, as well as revenue. In speaking with attendees, it became clear that automating the patient access workflow with real-time data can create a more efficient and accurate process. Here’s how. As the responsibility for paying healthcare bills increasingly falls to patients themselves, patient access can make or break the revenue cycle. From registration and verifying insurance details, to scheduling appointments and collecting cash payments—this is the front line for the financial side of the patient experience. When you consider that half of denied claims occur earlier in the revenue cycle at the point of registration, improving those early-stage patient access processes is the obvious place for providers to look when seeking to minimize lost revenue. Revenue loss in patient access is mostly due to errors in patient identification, inadequate data analytics and inefficient workflows. If front and back office teams were better connected and able to work together quickly to communicate and resolve issues, many of these errors could be prevented. Without reliable tools and workflows to support this, those teams often must resort to manual fixes for any errors that arise. Unfortunately, this takes time and effort, blocking opportunities to find new ways to improve decision making and business performance. Healthcare is becoming more competitive. Providers must work to leverage the right data in the right way to safeguard profits and offer a better patient experience. That said, where should you start? Doing more with less requires the right data insights There are two sides to the solution: first, you need to be sure your data is accurate from the start. Around a third of denied claims are caused by inaccurate patient identification, while 12% of patient records are duplicates. Cleaning up your data with high-quality demographic data can help eliminate preventable denials. Secondly, you need to be able to draw insights from your data to help make smarter decisions in the future. Let’s say you notice a spike in late payments from a certain population. Why is that? Looking at historical data on patient and payer behavior can point to emerging trends and help you figure out where to focus your efforts in response. Or perhaps you’ve recently added a new function to your patient portal. Analytics can help you see if and how patients are using it and evaluate its overall performance. Once you have your data and analytics in place, you can start to use it to make improvements. Automating the patient access workflow with real-time data can create a more efficient and accurate process. It will also help link front and back office staff with shared systems that minimize errors and wasted staff time. 3 ways to use data analytics to streamline patient access For providers looking to streamline their early revenue cycle processes using the power of data, three areas to focus on are: Creating a better patient experience Increasing numbers of self-pay patients means patient loyalty is a growing priority for providers. Creating a positive, straightforward patient financial experience is essential for hospitals and health systems looking to reduce the stress and anxiety many patients feel when dealing with healthcare bills. Using data insights to identify the sticky parts in your patient access processes can help you spot opportunities to improve the consumer experience. For example, are patients receiving duplicate communications because the system is failing to update demographic information? Are there bottlenecks or backlogs that are creating stressful delays for patients? A business intelligence tool such as Revenue Cycle Analytics can help you pinpoint the root cause of delays and errors so you can work to fix them—and level-up your patient experience. When Martin Luther King Jr. Community Hospital (MLKCH) realized patient registration in their busy Emergency Room was a bottleneck and source for claim denials, they implemented an automated platform to streamline their registration process and improve the data being captured at the point of registration. Lori Westman, patient access manager at MLKCH says: “We get fewer denials because we’re getting true verification data, and our patient volumes continue to increase. So the fact that we can take off two to three minutes, at least, on half of our registrations is speeding up the work for the team, and the turnaround time is much better for the patients.” Uncovering potential revenue loss Analytics can show you exactly where your revenue cycle is losing money. Using appropriate benchmarks and custom KPIs, you can analyze accounts across the entire cycle to make sure your existing revenue cycle solutions are performing optimally and identify new opportunities for improvement. By gathering together multiple data streams into a single dashboard, you’ll get an at-a-glance view of your revenue cycle performance, so you can drill down to the root cause of denials. This also helps link up your front and back office staff. Rather than working retrospectively to address issues as they happen, your back office team can use insights from whole system data reporting and analytics to give front office staff immediate feedback on where denials are occurring. Monitoring payer rules and performance With American hospitals footing the bill for more than $620 billion in uncompensated care over the last two decades, it’s vital to verify a patient’s insurance options as soon as they set foot in the hospital. With up to date information on payer rules and a robust process for finding missing coverage, you can avoid protracted negotiations with payers and focus on denials, rejections and exceptions. A payer dashboard can also help you assess how payers are performing against one another, so your discussions around timely payments will be based in fact. By analyzing performance around pre-service, point of service and post-service, you’ll be better placed to work more closely with payers to minimize the risk of both late payments and denied claims. Learn more about how data analytics and an automated patient access workflow can help eliminate costly denied claims, boost revenue cycle performance and improve the patient financial experience. Steven Thiltgen is Director of Analytics Consulting for Experian Health
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.
Flu season came early to Australia this year, with more influenza hospitalizations compared to last. And 93% of reported cases were the more dangerous Influenza A strain. If you’re wondering what this has to do with your healthcare organization, the answer is that generally speaking, flu season in the U.S. often mirrors what’s just happened in the southern hemisphere. In short, get ready. The number of cases in Australia has U.S. health officials gearing up for a challenging flu season over the next few months. Although flu activity is currently low in the US, the Centers for Disease Control and Prevention (CDC) expect this to increase in the coming weeks, particularly as Australia experienced an unusually severe early flu season this year. For healthcare organizations, this will likely translate into extra demands on staff and services, crowded emergency rooms and higher rates of admission. Your organization most likely already has a robust winter health contingency plan in place. Still, there may be new ways to use data analytics and technology to increase efficiency, so you’re as prepared as possible. Are you ready? Three ways technology can help providers prepare for flu season Create a flu-preparedness patient engagement strategy At this time of year, patients can be exposed to many misconceptions about flu and how to prevent it. A helpful way to make sure your patients are informed about how to protect themselves against illness is to communicate the risks, encourage vaccinations and promote preventative behavior. Consumer data can help you to deliver personalized messages to patients in a time and format that suits them best, segmenting your patient groups according to risk status. Whether you’re contacting them through their patient portal, email or in-person touchpoints, a tailored approach will create a more reassuring patient experience, while allowing you to target your information campaign to the right people at the right time. Promote telehealth services More hospitals and pharmacies are turning to telehealth systems to help manage flu season. Patients can log on to watch information videos and have virtual consultations with physicians without being exposed to germs in the doctor’s office. Reducing the number of patients showing up to access services in-person can help relieve pressure on services, while minimizing the risk of infection spreading. Check in with your telehealth provider to make sure everything is in place to provide your patients with the virtual care and advice they need. Streamline patient registration With more patients likely to be coming through the doors, the last thing you need is a time-consuming registration process hindered by lengthy and often unnecessary eligibility checks. Automating registration, financial clearance and other patient access processes can eliminate many manual tasks, save time and reduce errors so there are fewer denied claims. At such a busy time of year, your patients, staff and bottom line will thank you! How one Los Angeles hospital streamlined patient registration to manage flu season Martin Luther King, Jr. Community Hospital in Los Angeles worked with Experian Health to streamline patient registration and insurance verification. With a high-traffic emergency department and limited front-line staff, manual quality assurance and multiple payer website checks were creating bottlenecks and inaccuracies that took up more time to fix. Using Coverage Discovery, the hospital was able to improve efficiency in insurance verification, while Registration QA saved time in validating patient and payment information. In addition, eCare NEXT® helped automate workflows and generate data insights for further improvements—integrating seamlessly into the hospital’s existing Cerner® system. Speaking about the improvement made ahead of last year’s flu season, Lori Westman, patient access manager at MLKCH, said: “We have a lot of returning patients to our emergency room, so once we check that patient in, their eligibility automatically runs in the background and our staff doesn’t have to go into another website to check their eligibility. This has saved us two to three minutes of our registration time.” “We average about 300 patients every 24 hours. Heading into flu season, they’re expecting to hit a 400-per-day volume, so the fact that we can take off two to three minutes at least on half of our registrations is going to speed up the work for the team that much faster, to have a turnaround time that much better for more patients to come through.” Find out more about how we can help you streamline your Patient Access processes, so your organization is fighting fit for this year’s flu season.
Healthcare consumerism is on the rise. Your patients no longer see themselves as passive participants in their healthcare journey—they’re active consumers, who have come to expect the same frictionless experience they might find in other industries. They have options. If they’re dissatisfied with their experience, they can go back to the menu of providers and choose something different. But when patients feel supported and respected through their healthcare journey, they’ll remain loyal to your organization, even becoming brand ambassadors. Following the Medical Group Management Association’s (MGMA’s) Annual Meeting in New Orleans a few weeks ago, it became clear that nurturing patient loyalty remains at the top of the list for medical groups looking to stay competitive in an increasingly consumer-driven market. For providers wanting to create an outstanding patient experience (and encourage greater patient loyalty), a good place to start is improving access to care. Win patients’ hearts and minds before they’ve even set foot in your facility. The goal should be to leverage advances in digital technology to make it as easy as possible for patients to find physicians, access schedules, book appointments and take control of their health. Improving patient access through digital care coordination Medical groups should look at how they are using data and digital technology to improve the patient experience in three key areas: Scheduling Laying the groundwork for a positive patient experience starts with making sure the appointment process is as painless as possible. Imagine a mother is woken during the night by her sick infant. Using a traditional scheduling model, she’d have to wait until the next day to call and schedule an appointment with the pediatrician. But if she could schedule an appointment there and then through the pediatrician’s website, this would not only be more convenient and reassuring for her, it would reduce operational strain on the medical practice, who would have fewer calls to handle. Online self-scheduling is the most convenient way for patients to both find a physician or specialist and access care, all on their own terms. By implementing online scheduling, medical groups will see higher rates of patient satisfaction and engagement and an increase in patient acquisition and retention. Care referrals The referral process is another common pain point for patients. For such a crucial process, it’s surprisingly consumer-unfriendly. Patients struggle to connect with recommended specialists and when they do, they often can’t get an appointment for weeks. Many organizations don’t realize how much revenue they could be losing when frustrated patients look elsewhere for care. With a more sophisticated referral process, providers can transform the discharge experience and ensure patients get the follow-up appointments they need—within the same network. One health system in the south east has generated tens of millions of dollars simply by booking follow-up appointments before patients even leave the facility, so they’re less likely to be lost to out-of-network referrals. Decision support Most providers have scheduling rules that determine which patients their clinicians should see and when. What they don’t always have is a way to automate the process so that patients can book online or seek a referral, while still following these scheduling criteria. The provider needs to be confident that if a patient with knee pain wants to book an appointment with an orthopedic specialist, they need to be sure they don’t inadvertently choose someone who specializes in shoulder injuries or pediatrics. The problem isn’t solved by booking by phone. Securing referrals through a call center can be a cumbersome process, eroding patient trust and contributing to scheduling bottlenecks and staff dissatisfaction. But when scheduling is digitized, providers no longer have to worry about these challenges. Automating decision-making creates a simpler process for everyone and most importantly, ensures the patient connects with the right specialist in the least amount of time. How analytics can help you create a consumer-centric organization For leaders considering how to create a more consumer-centric health system, re-imagining patient access should be a top priority. A tool such as Patient Schedule gives your patients a convenient and simple way to manage their appointments and follow-up, so they see the right clinician at the right time, without any of the usual hassle that comes with the scheduling process. On the flipside, automating your patient access protocols also gives your team the intel required to increase capacity to see patients and boost revenue through better acquisition and retention. You’ll be able to track how many patient visits turn into booked appointments, identify the points at which patients drop out of the process and spot bottlenecks in your scheduling. These insights could reveal endless opportunities to make simple tweaks that will give both patients and staff a smoother ride through patient access. Data analytics mean you no longer need to be operating blind when it comes to unblocking the bottlenecks in patient access. You’ll know exactly where to focus your efforts to improve the experience for your patients and grow your competitive advantage at the same time.
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.
For many patients, the unknown cost of unexpected care is a source of anxiety: two-thirds of Americans are “very worried” or “somewhat worried” about being able to cover unexpected medical bills. No wonder, when around 56% say they wouldn’t be able to afford an unexpected bill over $1,000. In cases where insurance doesn’t cover the entirety of the bill, responsibility for paying the balance falls to the patient. The lack of price transparency leads to confusion and stress for patients, and unnecessary administrative costs for providers, who are left to chase payments from growing numbers of self-pay patients. Moving towards more transparent pricing Traditionally, patient billing has been calculated at the end of the revenue cycle, after insurance adjustments have been made. In recent months, a push for meaningful price transparency is emerging as a result of consumer demands about the cost of care, pressure from governing bodies, and bipartisan support for a legislative solution to surprise billing. In response, healthcare organizations are increasingly looking to move patient billing to the front of the revenue cycle, to give consumers greater clarity about what to expect when their bill arrives. Estimating patient liability is far from simple. It calls on front office staff to make complicated calculations based on insurance benefits, charges, contractual adjustments and provider discounts. If staff are doing this manually, they may find themselves using outdated pricing lists that don’t include current insurance information, rates and discounts. So how should providers ensure their front office staff have the right tools in place to give accurate, personalized estimates for each patient? Data-driven technology can help reduce surprise billing Data-driven technology that automates, simplifies, and unifies the revenue cycle can ensure timely communication on billing between healthcare providers and insurers. This means your front-office team can base estimates on accurate, up-to-date information. To reduce the risk of errors creeping in, price transparency and collection practices should be standardized across the enterprise. A pricing transparency tool eliminates the need for manually updated price lists and removes the guesswork that often leads to mistakes. It can also include reporting features that let you track potential and actual collections, so you have greater insight into the opportunities for revenue cycle optimization. Helping patients navigate the cost of care As patients bear more out of pocket payment responsibility, they expect a better consumer experience. Creating an optimal patient collections strategy and frictionless experience is ever more important. Full transparency calls for accurate and up to date pricing to be available to patients before they receive care, along with a detailed breakdown of what their insurer will cover. When they know what the difference is, they’ll know upfront how much they’re likely to need to pay. Additionally, clear and proactive communication around the billing process can help eliminate the shock factor, improve the patient collections process, and create a better patient financial experience all round. You could provide a text-to-mobile experience that delivers a text message with a secure link to the patient’s estimated bill. Or you might integrate a price transparency tool into your patient portal or mobile app, that lets patients see a personalized cost breakdown based on real-time pricing and benefit information, alongside methods for secure payment. A price transparency tool can also help you gather insights into a patient’s financial situation and propensity to pay, so you can optimize your collection strategies from the start and get them onto the right program. El Camino Hospital in California set an organizational objective to improve price transparency. Terri Manifesto, Senior Director (Revenue Cycle) says: “We decided to do a soft launch of a patient estimator tool, and the very next day, even without advertising it yet, our patients found the tool on the website and started using it. The feedback was excellent. We’re providing a lot more estimates than we could before because it’s 24/7 and patients can use it on their mobile device, their laptop or their desktop. Some advice I’d give other hospitals is to think of the patient when you’re deciding what to do to best communicate your prices. What would the patient want?” Working with a partner such as Experian Health lets you combine industry-leading technical expertise and payment tools with your own knowledge of your patients, so you can create the best payment experience for your consumers. Using data-driven technology, you can work to eliminate the pain of surprise bills and promote price transparency, resulting in greater revenue opportunities and customer loyalty.
Experian Health announced it has acquired MyHealthDirect, a SaaS-based company specializing in digital coordination solutions in scheduling. We interviewed Jason Considine, Experian Health general manager of patient engagement and collections, to learn more about the acquisition, as well as opportunities arising in healthcare due to the rise in consumerism. What led to Experian’s interest in MyHealthDirect and the ultimate acquisition? We’ve had a relationship with MyHealthDirect for several years. Experian Health has been reselling the MyHealthDirect solution since 2017, and we’ve long recognized that their platform’s digital care coordination capabilities would be a great match with our existing solutions. MyHealthDirect\'s platform links patients with the right providers, offering online scheduling tools and referral coordination to ensure more timely access to care for patients. These solutions have proven to increase appointment and referral rates, improve call center efficiency, reduce no-shows and enhance the overall patient experience. By coupling this technology with our Experian data, we can ensure patients are getting the care they need in the management of chronic diseases and wellness programs. This acquisition evolves our core revenue cycle management capabilities and helps us make gains in the patient engagement space with all-new innovative offerings. You referenced “digital care coordination.” What does this mean and how does it apply to healthcare? Digital care coordination, as it applies to the MyHealthDirect suite, is comprised of self-scheduling, call center, referral coordination and automated outreach solutions, making it easier for people to access healthcare. By combining these scheduling solutions with Experian’s existing digital patient engagement solutions, we can deliver a seamless consumer-centered experience – from serving up an estimate, to streamlining the registration process, to providing consumers with the ability to pay their healthcare bills via multiple channels. Today’s healthcare consumer expects a turnkey, personalized, on-demand experience. When you think about the best engagements we all enjoy in retail, financial services, travel and entertainment, the expectation is that the healthcare experience should be no different. We need to arm consumers with the ability to streamline their healthcare and make it easier for them to access care. Why is the scheduling component so key in the overall patient journey today? Scheduling is the one of the very first steps of the care journey and booking an appointment has traditionally been a poor experience. Common frustrations include not being able to reach the provider, finding out that no appointments are available, or being forced into a time-consuming three-way call between the health plan and provider. Without fast and easy access, patients may not be able to get the care they need. When healthcare plans use technology to better connect patients to needed care, quality scores for patient experience rise and efficiencies are gained. Can you give us an example on how more automated approach to scheduling could lead to better health outcomes for the consumer? Sure. Take for instance an individual who is living with diabetes. It is important for this person to have regular check-ins with their provider to monitor their condition and adjust care plans accordingly. If this person is challenged to see their provider, or doesn’t have regular appointments booked, they could run the risk of becoming an unhealthy diabetic, being faced with additional health challenges. By tapping into digital appointment scheduling, a provider or payer could create an automated outreach plan to make the scheduling hassle-free. Appointments could be streamlined and scheduled directly on the phone via IVR or text, and appointment reminders can be delivered. How do you see providers responding to the rise in healthcare consumerism? It’s no secret that healthcare costs are rising, and consumers are increasingly bearing more of those costs. Providers, therefore, are telling us they need to deliver a better experience. They are asking for digital technologies to gain rich insights into consumer behavior and then adjusting their care delivery plans accordingly. They recognize that consumers have a choice on where to take their healthcare business, so they need to compete. In the case of scheduling, MyHealthDirect conducted some research and revealed 66% of patients would switch providers for more convenient access. In that same study, 77% of patients think the ability to book, change or cancel appointments online is important. My point? Those providers and payers investing in on-demand tools to interface with their consumers will win, simplifying many of the administrative tasks associated with healthcare. — Learn more about scheduling solutions.
Over the last twenty years, American hospitals have provided more than $620 billion of uncompensated care for cases where no payment was made by a patient or insurer. This includes financial assistance, where hospitals provide care at a reduced cost for those unable to cover their full bill, and bad debt, where patients have not applied for financial assistance and cannot or will not pay their bill. Despite extensions to Medicaid coverage under the Affordable Care Act, the number of uninsured people in the United States is still approaching 30 million. For these often-vulnerable populations, safety-net hospitals provide essential care regardless of the patient’s ability to pay. But safety-net hospitals are themselves under increasing financial pressure, experiencing more than double the uncompensated care costs of other acute hospitals. And when safety-net hospitals are closed down or struggle to meet demand, nearby hospitals must cover the shortfall in care. It’s a problem for everyone. A Kellogg Insight report found that when more people are uninsured, hospitals bear the cost by providing uncompensated care to the tune of $900 for each additional uninsured patient. Craig Garthwaite, Assistant Professor of Strategy, describes hospitals as “insurers of last resort”: “People are still going to the emergency room and they are still receiving treatment – so the cost is still there. When governments do not provide health insurance, hospitals must effectively provide it instead.” Hospitals might respond to the burden of uncompensated care in three ways: shifting the cost of care to other payers, cutting the cost of services to all patients and removing unprofitable services, or accepting lower total profit margins. All have the potential to damage quality of care as well as revenue and workflow. But beyond these major systemic responses, there are steps providers can take to reduce their risk of unpaid care and optimize their existing revenue framework. Protect your revenue by finding missing coverage quickly The new reimbursement landscape forces providers to manage more self-pay patients, with high-deductible health plans and health savings accounts. This puts a lot more responsibility and stress on patients themselves, who may not be able to afford their co-payments. Uncovering missed or undisclosed insurance coverage is also costly and time-consuming for providers. Regardless of ability to pay, if your patients are wrongly classified as uninsured or as having only one insurance option, you’re likely to lose revenue. As the financial risk of uncompensated care continues to grow, there are important questions for healthcare executives to consider: How do you decrease your accounts receivable balances and self-pay write-offs? How do you increase cash flow from re-billed claims? Are you missing any opportunities to bill additional payers for services? Are you identifying coverage for emergency department inpatients in time to meet your notice of admission requirements? The answers boil down to having the right processes in place to discover which patients can and cannot afford to pay, ideally before they go through the billing system. When you know this, you can move quickly to direct them to alternative sources of funding. How to find insurance coverage to avoid bad debt and charity write-offs An automated coverage discovery solution could help you identify patient accounts that don’t have sufficient insurance coverage, without the expense and hassle of engaging a collections agency. This proactive software integrates with your revenue cycle to search government and commercial payers automatically, so you can find insurance coverage that may have been missed or forgotten. It relies on multiple data sources and reliable demographic information to detect any inaccurate financial classifications and alternative coverage options. It can also shed light on product usage, productivity and financial results, which may help you fine tune your revenue cycle in other ways. Murry Ford, Director of Revenue at Grady Health System explains how Coverage Discovery allows his team to identify an accurate coverage match for patients without the patient having to share this information: “We use Coverage Discovery when the patient is admitted… the system automatically attaches the coverage to the patient’s account. No one has to get involved – it’s touchless, it’s seamless, and it’s worked really well for us. It’s brought in revenue that we would not have identified otherwise.” Every dollar found in this way is a dollar you’re not writing off to bad debt, or spending on unnecessary patient collections and admin. Mike Simms, Vice President of Revenue Cycle at Cone Health says: “Coverage Discovery is wonderful... After every admission, the next day we get a file which gives us insurance on those that we’ve missed. We can add that insurance to the patient account and bill the insurance company. In the end it helps us resolve accounts in a timely manner. Since we’ve been using Coverage Discovery, we’ve received over $3 million in payments, and that’s more than a 300% ROI.” An automated solution like this can be plugged in immediately to handle unresolved accounts for you, resulting in faster and more accurate collections, greater patient satisfaction, and improved staff workflow – ultimately reducing your organization’s risk of uncompensated care. Learn more about how Coverage Discovery Manager works.
The United States’ health system has become the most expensive in the developed world, and high administrative costs are a big factor. They account for more than 25 percent of spending on hospital care, making American healthcare administrative costs higher than any other country. Much of the problem comes from the complexities of payment. With public health programs, private insurers, and patients themselves all splitting the bill, it’s difficult for hospital administrators to determine who pays what in each situation. Especially during patient registration, they are bogged down by the time-consuming process of verifying patients’ eligibility for insurance and other programs. For these reasons, Martin Luther King, Jr. Community Hospital decided to focus on improving its patient registration process. The private nonprofit safety net hospital in South Los Angeles serves a high-need community and sees about 300 patients per day. Manually checking in all those people meant that MLKCH’s administrative team had an overwhelming workload. The hospital needed an integrated solution. Automation simplifies hospital patient registration The hospital’s staff was spending a significant amount of time checking different payer websites and making phone calls to determine each patient’s eligibility for insurance and various programs. Then, the benefits information had to be copied and pasted into the hospital’s non-integrated platform, which was another slow process that often resulted in inaccuracies. Quality assurance to find and correct those errors was a manual process, too, taking up more of the administrative team’s bandwidth. To free up resources and reduce errors, the hospital wanted to automate its verification processes, streamlining its registration, quality review, and more. MLKCH also needed its hospital patient registration software to work well with the Cerner system it already used. It decided to implement Experian Health’s eCare NEXT® platform. “We decided to use Experian Health’s software within Cerner versus a couple of the products we were looking at, at the same time, because it truly integrated within Cerner,” said Lori Westman, patient access manager at MLKCH. “When we presented this to our CFO, he liked the fact that it was integrated within Cerner; he didn\'t want us to have to go out to another third-party payer to pull information back. It\'s all about time and the time we can save on our registrations. That was the biggest selling point — the integration within Cerner and its seamless registrar on the back end. To the team, it\'s just another program they\'re working with in Cerner.” The software from Experian Health automates registration and financial clearance, among other patient access processes, which account for up to 80 percent of manual preregistration tasks. The system assesses patients quickly, replacing the information-gathering that staff has traditionally done. For MLKCH, which sees many returning patients, if a patient is already in the system at check-in, eCare NEXT pulls up his or her eligibility automatically when an administrator accesses the account. This saves several minutes, making it a notable patient registration process improvement. The system also eliminates a large portion of redundant tasks. When using the platform to check eligibility with one plan, eCare NEXT also searches for other applicable plans. For example, MLKCH treats a large Medicaid and managed care population, so checking a patient’s eligibility required visits to both the state’s and the health plan’s websites. But eCare NEXT will verify both automatically. Additionally, the fact that eCare NEXT integrated seamlessly with Cerner has improved the hospital’s patient registration process. Because the two platforms work together, patient data has become more accurate and the quality assurance process is less cumbersome. MLKCH was able to implement new QA standards after staff became familiar with the automation tool. The team also found that the enhanced data from eCare NEXT can shape user education and pinpoint areas for further improvements. And while there were some concerns that a new platform would take a long time to adopt, the rollout of the patient registration system was smoother than expected. The administrative team got a robust solution with exceptional support to ensure users have every resource they need. Ultimately, implementing an automation tool eliminated MLKCH’s most time-consuming registration tasks, allowing staff members to focus only on the tasks that needed their attention. This made their jobs easier and more efficient while also reducing training needs and improving compliance. The registration process became much faster. Automating preregistration tasks and eligibility verifications has also ensured MLKCH’s administrators have more accurate eligibility information. This integrates with Cerner to increase the quality of patient records. But the most important benefit of improving the patient registration process has been how it affects patients. These time savings get passed on to them in the form of quicker registration and less hassle proving eligibility. Using eCare NEXT has not only helped the hospital\'s administrators, but it has also allowed MLKCH to enhance patient service. Westman adds: “We get fewer denials because we\'re getting true verification data, and our patient volumes continue to increase. So the fact that we can take off two to three minutes, at least, on half of our registrations is speeding up the work for the team, and the turnaround time is much better for the patients.” Need to streamline your patient access department? Learn more or schedule a demo with us today.
