Tag: value-based care
Did you know a whopping 90% of missed revenue opportunities can be linked to denied claims? At a time when providers are working to make up this lost revenue, they are also dealing with patients who are expected to cover more of their medical bills through out-of-pocket expenses. High-deductible health plans, free-care programs and crowdfunding are more prominent, leaving hospitals vulnerable to the patient’s ability to pay. Add in the rise of value-based care, and it’s no secret patients expect an experience that matches their interactions with other consumer services. They’re more engaged in their health and know they have options. Patient collections are down, but expectations are up. Loyalty wavers somewhere in the middle. How should providers respond? Legacy revenue systems aren’t set up for financial models based on value over volume, so providers need to adapt. It’s vital to find ways to help patients navigate the financial side of healthcare and make patient collection processes as efficient as possible. What does value-based care mean for your revenue cycle? Shifting to value-based reimbursements, patient-centric incentives and quality of care programs means your clinical and revenue cycle workflows need to be better connected. Patients must receive consistent and accurate communications throughout their healthcare journey, setting them up for the best possible health outcome and payment options. When the care and finance functions work together, your patient records can be kept up to date and the next admin task will be triggered at the right time. Here are some things your revenue cycle management (RCM) process might be missing: clear and convenient processes for patientsaccurate patient identification from registration to billingability to collaborate with payers to customize workflowsstreamlined workflows to reduce time and resources spent on avoidable tasksautomated processes to support effective collections and spot root causes of denialsreal-time reporting to help improve performance over time [Source: Frost and Sullivan] Data, analytics and automation can help you create more agile processes to minimize revenue leakage and create a better financial experience for patients. 3 ways to close the gaps in a value-based RCM model 1. Use consumer data to help patients make informed decisions A major cause of denied claims stems from patients being unsure about what their treatment will cost. Others are unclear about whether they have appropriate coverage. Help your patients weigh their financial options by providing accurate estimates and working with them to check coverage. Consumer data can support this process by giving you insights into your patient’s social identity, medical history, coverage status, insurance eligibility and propensity to pay. With an intuitive billing process, you’ll improve the patient payment experience and reduce revenue leakage. 2. Use analytics to predict gaps in your revenue cycle Many top-performing health systems use advanced data analytics to predict where the bottlenecks, errors and denials might creep in, so they can take swift action to address them and keep their patients and C-suite happy. For example, with analytics, you can get to know your patients better so you can segment them according to their financial responsibility and ability to pay. Not only does this mean you can focus your collections efforts more effectively, but you’ll have the right insights to help patients navigate the payment process with personalized nudges and relevant messaging. In addition, analytics have a huge role to play in eliminating avoidable denials resulting from unreliable or inaccurate patient data. You’ll be able to spot patterns in denials, so you can implement checks and processes to avoid them in future. 3. Put the right tools in place to close the gaps Close the widening gap between claims and collections starts by ensuring your patients are aware of their financial responsibility. A self-service patient portal could give your patients convenient access to their information in a time and place that suits them. They’ll be able to schedule appointments, enroll in payment plans, and apply for charity. They’ll see real-time, transparent and accurate information about price estimates and their eligibility and coverage. When the financial experience is transparent and frictionless, patients are more likely to feel satisfied and less likely to shop around for care – not to mention being better prepared to meet payment deadlines. And internally, data-driven automated software can help you monitor and manage every step of your revenue cycle. You can make life easier for clinicians and management teams with EHR-integrated dashboards, web-based financial reporting and timely alerts for the relevant teams. Schneck Medical Center used Experian Health’s Denials Workflow Manager to automate tedious manual processes, freeing up staff time and optimizing claims follow-up and collection: “No longer are we waiting 30 to 45 days to review denials. We can review them on the day of [submitting] if we choose to.” (McKenzie Smith, Director of Patient Financial Services) It’s simply no longer viable to use RCM processes that aren’t integrated across your entire digital ecosystem. Providers that can offer a convenient and personalized consumer experience, automate collections workflows and join the dots between clinical care and revenue management will have the competitive advantage in the era of value-based care. Learn more about how your organization can use data to predict and close gaps in your revenue cycle.
It’s the chronic condition no one wants to mention. Symptoms can include missed appointments, unnecessary treatment, poor communication and confusing billing processes. The prognosis is a less than satisfactory patient experience, sub-optimal health outcomes and a sizable dent in provider revenue. We’re talking about inadequate care coordination. Around 42% of Americans live with multiple chronic conditions and for many, inefficiencies in the health system are an added ailment. The consumer experience is often plagued by slow and outdated scheduling systems as patients can find it tough to obtain the referrals and personalized support they need. For providers, poorly coordinated care is a drain on resources, bumping up the average cost of chronic disease management by more than $4500 over three years. Finding a cure for the care coordination challenge is even more pressing in the context of value-based care. A seamless experience for patients is more likely to encourage consumer loyalty, enabling better health outcomes and improved population health. Better coordinated care calls for better connected data When you have a complete picture of each patient and a reliable method of tracking them across the care continuum, you can offer a more streamlined healthcare experience. Your clinical teams will base their decisions on current and accurate patient data. And you’ll have more robust insights into your patient populations, so you can connect the dots between different departments and plan services to meet demand in a more efficient way. Today, providers have access to a wealth of reliable and secure consumer data. There’s no need to rely on intuition and routine, when the tools exist to turn that data into valuable insights to help manage care more efficiently. The goal is to make that process as cost effective as possible. Could automation be the missing piece of the puzzle? Four building blocks for automated care coordination 1. Develop an IT-oriented business strategy In 2016, around half of US hospitals lost $500 million in reimbursements due to readmission-related inefficiencies. Many of these lost revenue opportunities could have been avoided with better use of digital technology. With a revenue cycle built on more efficient and reliable IT systems, you can improve care coordination and protect profitability. 2. Embrace an ‘anywhere, any device’ approach to patient access A truly consumer-centric care management strategy gives patients the ability to access care and support from the right member of their care team, at the time they need it, and through the channel that suits them best. A host of tools can help you achieve this, such as patient portals, online scheduling tools, medical devices and telehealth programs. By giving your patients choice about how and when they interact with services, you can simplify many admin processes and in turn avoid errors, missed appointments and billing mishaps. 3. Use data systems that work across multiple services A common concern raised by clinical teams is the lack of a single source of truth for each patient. As one provider said: “With knee and hip replacements, multiple hands are involved in post-acute care, and often we don’t have enough data and interaction to manage these entities effectively.” (Source: Frost and Sullivan) Solving this requires data interoperability – in other words, having data that’s accessible and in compatible formats across multiple services and facilities. But it also calls for two-way communication and data-sharing. A good example of this is MemberMatch, which gives physicians real-time alerts when their patients are admitted or discharged from emergency departments. When used in combination with Care Coordination Manager, MemberMatch automates processes for scheduling follow-up appointments. It also generates regular status updates on test results, medications and care plan details for other providers. Your physicians can track daily usage and no-show rates. As a closed-loop system, all communications are entirely secure. 4. Leverage data and analytics Finally, consider an analytics platform that gives you near real-time reporting on the performance measures that matter most to your organization, so you can track what’s working and what’s not. Tap into analytics tools that draw on the widest sources of reliable consumer and financial data to give you real-time insights on your care management priorities. An EHR-integrated dashboard can allow you to see a snapshot of trends in performance, including gaps in care, duplication of tasks, patient outcomes and patient feedback, so you can direct resources to the areas where they’ll have the biggest impact. With nearly half of all patient revenue expected to be tied to value-based payments, it’s clear why more providers are testing new ways to improve care coordination. According to Frost and Sullivan, the overarching goal should be to track, predict and manage the cost of patient care. Automated tools can help you achieve this, by improving collaboration across your entire ecosystem. Better care coordination is good for patients, population health and provider revenue. Learn more about how our data analytics can help.
When it comes to value-based care, there’s really just one measure that matters: patient satisfaction. As CMS incentivizes providers to help patients find better care, improve population health and lower healthcare costs, more top health systems are seeing patient engagement as the path to value-over-volume success. Patients are finding themselves footing more of the bill for medical expenses, so elevating the patient experience is essential. If they’re not satisfied, they’ll simply take their dollars elsewhere – not what your CFO wants to hear. Helping patients feel more engaged in their health creates a more satisfactory experience, and in turn, boosts patient loyalty. And what’s more, by giving them opportunity to make informed decisions about their care, you can also reduce preventable admissions, avoid no-shows and fix the revenue leaks in patient collections. It’s beneficial for everyone. Here are four strategies to help you boost patient engagement and create a more consumer-friendly experience in your organization. 4 ways to boost patient engagement 1. Use segmentation and customization The first route to consumer-friendly care is about treating each patient as an individual. With advances in data analytics, it’s now possible to group your patients according to risk (whether that’s risk of a particular disease, exposure to a social determinant of health, or likelihood of non-attendance at follow-up). This allows you to be more targeted in your marketing efforts, provide patients with information that’s more relevant to them, and help each patient move to the next stage of their healthcare journey. Stanford Medical School sees this data transformation as central to its vision of “‘Precision Health’ – a more preventive, predictive, personalized and precise” approach to healthcare. Analytics give you a wealth of insights about the clinical, financial, behavioral and social factors affecting your patients, so you can personalize your patient engagement strategy to each member’s specific preferences and needs. As noted in research undertaken by Frost and Sullivan on behalf of Experian Health: “Analytics help us select patients who will respond to engagement strategies and de-select patients who won’t respond are needed. Not everyone responds to engagement in the same way.” By prioritizing precision marketing, you can create a culture of precision care. 2. Help patients take ownership of their health journey Value-based care is an opportunity to empower patients to be active players in their health. Greater transparency into the billing process, access to healthcare data and consumer-friendly tech can all help patients see what’s happening at each stage of the process. When they’re more informed, they’re more likely to adhere to care plans, turn up to appointments and successfully navigate payments. Your patient portal is a good place to start. Research shows that use of portals enhances patient engagement, satisfaction and health outcomes. Patients can access their records, view test results, schedule appointments at a time that suits and sort out bills with less of the stress. It helps patients ask the right questions and builds a trusting patient-provider relationship. 3. Improve the patient financial experience When two-thirds of Americans are worried about being able to cover unexpected medical bills, any way you can make the payment process more transparent is a big plus. Help your patient navigate the financial side of their healthcare experience with clear, real-time information about their coverage status, estimated co-pay calculations and appropriate payment plans based on their specific circumstances. Putting them at ease will help them meet their financial obligations without leaving a bad taste. In this way, you can build consumer trust and optimize your revenue cycle at the same time. 4. Use SDOH data for proactive outreach Research shows that medical tests and treatments alone are not enough to determine the outcome of a patient’s healthcare journey. We should be paying more attention to the social and economic factors that can get in the way of care. Because when patients struggle to access care, it’s harder for them to follow treatment plans or show up to important follow-up appointments. In a value-based world, tackling social needs is a growing priority for providers seeking to improve population health. When you have a more complete grasp of each patient’s motivations, support networks and personal circumstances, you can create a more efficient patient engagement plan. You’ll avoid wasting resources on patients who aren’t in a position to respond and instead can adopt outreach strategies to help those patients access the care they need. This might include offering alternative payment plans, signposting to logistical support such as childcare or transport, or referring to local community services, such as cooking classes or social clubs. To do this, you need reliable, relevant and accurate consumer data and the capability to draw actionable insights. Experian Health’s unrivaled consumer marketing data can help you better understand your patient population so you can communicate with them and support them in the most effective way. Consumer-friendly care is the new currency in value-based accounting – and the key to positive patient engagement. Find out more about how Experian Health can help your organization lift your patient engagement strategies for greater patient satisfaction, better health outcomes, and a healthier
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
Most healthcare consumers spend only a tiny fraction of their lives in the clinical world of medical appointments and procedures. Where and how they spend the rest of their time has a far bigger impact on their health and well-being. So why are some providers still relying primarily on clinical data to devise their care plans? Clinical data is crucial when it comes to a patient’s diagnosis and treatment options, but it tells you nothing about their ability to stick to a care plan when they get home. How do their living situation and lifestyle habits play into the physician’s treatment recommendations? Consumer data is the missing piece of the healthcare jigsaw. When providers have insights into their patients’ social and economic circumstances, they’re better placed to spot the factors that might hinder access to care, and offer a more holistic, tailored and effective support plan. The predictive power of consumer data Let’s imagine a single mom of two small kids, working two jobs. Her daily life is a race to get everything done on time, give her children what they need and still make ends meet within her weekly budget. When a reminder for her annual wellness appointment flashes up on her phone, she adds it to her mental to-do list. But by the time the appointment comes around, the stress of taking time off work and scraping together the cash for gas or bus fare means she puts it off. She doesn’t go. Six months later, she ends up in the emergency room with symptoms of a serious illness. Had her provider known about the barriers in advance, they could have supported her to get to her appointment and discover her illness sooner. As Dr. David Berg, co-founder of Redirect Health says, “the most important part of getting good results is not the knowledge of the doctors, not the treatment, not the drug. It’s the logistics, the social support, the ability to arrange babysitting.” Consumer data, such as car ownership, employment status, income level and family information can give you these insights early enough to take action. You’ll know whether your patients can get to their appointments easily, whether they can afford childcare, and a whole host of other factors that might affect their ability to stick to a care plan. And once you know those things, you can offer tailored support to give them the best chance of success. How to gather non-clinical insights According to PwC, around 78% of providers lack the data to identify patients’ social needs. Many have basic demographic information on their patient populations, but are missing the more sophisticated insights that could help them better support patients. It doesn’t have to be complicated, but there are a few considerations healthcare providers should vet as they gather and use consumer data to help drive care plan compliance: Evaluate the pros and cons of patient surveys The obvious way to find out more about your patients’ needs is to ask them directly. A survey at the point of registration can help you understand what barriers may prevent them from attending appointments, taking prescriptions or following other medical advice. However, surveys can be time-consuming and expensive to administer, and recording answers by hand can lead to errors. How a patient interprets the questions and how your team interprets the answers may affect the usefulness of the survey data. And a patient’s circumstances may change between completing the survey and trying to follow the care plan. This approach also only includes patients who manage to attend an appointment in the first place. Those without access to care such as the mom in the example above, would be omitted from the survey, so you would miss out on discovering how to help them. Tap data vendors to deepen your consumer insights A third-party data vendor can give you access to data on your patient population’s income, occupations, length of residence and other social and economic circumstances. When this data is packaged up for your care managers, it can be used to inform proactive, preventative conversations with your patients, to solve any non-clinical gaps in care. It’s more cost-effective than patient surveys and removes the risk of personal bias and interpretation. Ensuring the reliability and integrity of your data vendor can be a challenge. Data brokers often use consumer data collected in retail and other industries, which may not be completely relevant to your activities or collected in a way that meets the requirements for use in healthcare settings. It’s crucial to be able to verify the source of the data and confirm that individuals were told how their data would be used and given the choice to opt out. Always ask your vendor if they are an “original source compiler.\" Working with a data vendor in the health space, such as Experian Health, can help avoid these pitfalls, as they will have expertise in the appropriate use of consumer data in healthcare. Understand permissible use of consumer data to stay compliant To use consumer data successfully, you must have confidence in both its accuracy and your ability to safeguard patient privacy. For example, are your data collection processes compliant with the General Data Protection Regulation (GDPR) and the California Consumer Privacy Act 2018 (CCPA)? Working with a data management partner who collects data directly from consumers means you can verify that all privacy requirements and opt-outs are in place. They’ll also help you scrutinize hundreds of public and proprietary data sources, so you use only the most relevant, up-to-date data to inform your decision-making. By evaluating and understanding these three areas, you’ll be able to leverage consumer data to tailor your patient engagement and support and make it easier for your patients to comply with their care plan. The more you are able to see and treat each patient as a whole, individual person, the better their health outcomes are likely to be. Consumer data lets you do that.
When nearly 80% of health outcomes can be traced to non-medical social and economic factors, we need to look beyond the medical world to improve them. Perhaps a lack of transportation prevents a patient from attending an appointment, or juggling two jobs makes it difficult to collect a prescription. Maybe a patient’s care plan calls for lifestyle changes that are simply unrealistic in their current circumstances. When life gets in the way, there’s only so much the physician can do. Creating and maintaining a healthy, happy population truly takes a village – from your clinical team to the community resources around your organization. For many healthcare providers, there’s probably a lot more going in their ‘village’ than they realize. Do you know who your patients really are, beyond their lab tests? Do you know what nearby services are at your disposal to help you offer the best possible care? Knowing your patients and your health improvement ‘village’ means you can offer a personalized experience to your patients, to improve their care management and ultimately help them achieve better health outcomes. 3 ways to tailor care management for better patient outcomes Let’s imagine two patients, who have both recently broken their wrists and been treated in your facility. Gene is 71 years old and David is 34. From the clinical perspective, it might be reasonable to assume that David, being younger, should simply receive discharge directions and a time for a follow-up appointment, and be on his way. Gene, being older, might require a series of follow-ups. But thinking of the village analogy, is there more you could learn about Gene and David to engage with them in a way that’s tailored to their specific needs? Here are three ways social determinants of health data can help you do just that. Use non-clinical data to get to know your patients Non-clinical data can help you learn more about your patients and the lifestyle factors that might affect their health. This allows you to address issues like excessive healthcare utilization, preventable readmissions, no-shows and low patient engagement. Surveys at the point of registration are one way to get fresh socio-economic insights. But these can be cumbersome to implement, and findings can be limited by the nature of the questions. You might also review geographical and community-level data to discover your local population’s income, housing situation, employment status, and so on. This can be useful for population-level care planning, but it’s not patient-specific. A better way is to analyze securely collected marketing data for more specific and accurate information. This could tell you that Gene’s living situation actually has a minimal impact on his ability to access care, healthy food and reliable housing. Additional follow up appointments may still be appropriate, but perhaps less urgent. By contrast, you might find that David has limited access to care because he lives alone and far from public transportation. His lifestyle suggests he’d be unlikely to prioritize getting gas to drive to a follow-up appointment over getting to work. In this situation, a remote health appointment might be the better plan. Know your community resources Once you know what David and Gene might need, you can point them towards any appropriate community resources to increase their chances of a quick recovery. Of course, to do this, you need to know what and where these resources are. For example, can you link David to an appropriate home health or telehealth program, or is there a non-emergency medical transportation service in your area to get him to his appointments on time? If Gene needed support to follow a healthier diet, would a local food bank be available? If either had an unstable living situation, would you know which local or national housing coalitions could help put healthcare within reach? Tools such as NowPow, Aunt Bertha and Healthify exist to connect the dots between patients, providers and wider community resources, and close the gap in holistic care. Be proactive and preventative by holding conversations with your care teams prior to seeing patients When you have reliable insights and data analytics to anticipate what patients like David and Gene might need, you can work with your care teams to develop a shortlist of options ahead of time. In this way, they’ll have realistic and ready-to-use solutions to give the patient right there and then. To truly get the most out of social determinant of health data, your care coordinators need easily digestible patient profiles which they can understand and use in a split-second. Bringing the whole patient into the care plan Healthcare is growing more and more sophisticated in identifying ways to better manage care for patients by using data science and machine learning to predict health events. These insights help coordinate care plans that are preventative and proactive. Essentially, it’s about knowing your patients as well as possible, and being able to quickly match them to the services they need. — Discover how we can help you leverage social determinants of health data for your patient population, so you can bring in the whole ‘village’ of resources to support them on their healthcare journey.
It’s a puzzle many healthcare providers are still working to solve: when over 80% of health outcomes are influenced by non-medical factors, how can health systems help their patients achieve better outcomes? From affording time off work so they can attend an appointment, to accessing healthy food, childcare or transport, your patients’ ability to engage with and benefit from health services can be heavily influenced by a host of social and economic dynamics Understanding these social determinants of health (SDOH) gives you a more complete picture of your patients’ health and life circumstances. You can anticipate their needs, coordinate their care more effectively, and ultimately give them a better healthcare experience. What’s more, harnessing the right data on SDOH leads to smarter investment and operational decisions, yielding advantages for your health system as a whole. That’s why many providers are starting to use non-medical consumer data in their care management planning. Here we look at some of the top use cases for SDOH data. 5 top use cases for data on social determinants of health Reduce missed appointments No-shows cost providers an average of $200 each (plus a lot of wasted physician time). Often these are down to lack of access to transportation or childcare. SDOH data can help you anticipate where these challenges might occur, so you can offer additional services like a free shuttle bus or crèche. You’ll make the experience a little easier for the patient, and potentially prevent an unchecked health issue from becoming something more serious. Save costs from preventable health events Unfortunately, life circumstances can lead to many people using health services in a way that could be avoided. Missed appointments or difficulty following a care plan can lead to escalating medical issues, entailing more treatment and readmissions. Patients might also fall back on emergency services because they can’t easily access appropriate alternatives. SDOH data helps you understand the circumstances that might lead to this kind of patient behavior. For example, if you can spot patients who may be likely to dial 911 because they have no other way to get to the health services they need, you can offer alternatives that avoid an unnecessary visit to the ED. This could help you save up to $2000 per Emergency Department visit and around $10,000 for each hospital stay (which often can’t be fully reimbursed if the patient ends up being readmitted). Increase care plan compliance A patient’s living situation can often determine whether or not they’ll be able to stick to their care plan. For example, specific dietary advice can be a real challenge for a diabetic patient if they have a limited food budget, lack of time to shop and prepare food, or a plain lack of options of where to buy it. An SDOH needs assessment can flag this in advance so clinicians can help patients find a plan that will work for them. Similarly, pharmacies might use consumer data to help minimize abandoned prescriptions or situations where a patient fails to follow dosage directions, which is estimated to cost the industry $290 billion per year. Save administrative and clinical time Analyzing consumer data can help your operations run more efficiently, which benefits your patients through well-coordinated care, timely information sharing and prompt referrals. Many providers are taking advantage of automated solutions for leveraging SDOH data, saving massive amounts of administrative time for care managers by pre-populating patient data and automating SDOH needs assessments. Consumer insights solutions like Experian Health’s ConsumerView analytics can optimize operational efficiencies and ensure your care managers use their time well. Investing in relevant community health programs One of the most impactful use cases for SDOH data is to gain a richer understanding of your member base, so you can invest in the most relevant community health programs. For example, a 2018 pilot project by Atrium Health in North Carolina screened for food insecurity in older patients who may have been at risk of readmission. Emergency food services were provided where needed, and as a result, readmissions dropped by 60%. Your purchasing power can also be a force for change. The Cleveland Clinic outsourced its laundry service to Evergreen Cooperative Laundry, a local collaborative working to combat poverty. Ralph Turner, executive director of patient support services at the Cleveland Clinic says: “Establishing the foundation for people to stabilize their incomes and become part owners in a business… in itself generates health and wellbeing in our community.” Leveraging consumer data to improve patient outcomes These examples show some of the varied ways screening for social determinants of health can open the door to understanding your patients and creating truly person-centered care services. Who knows what opportunities are hidden in the SDOH data for your patient population? Are there gaps in your data? Could you combine different data sets for a fuller picture? What exactly is your consumer data telling you, and how do you turn it into meaningful management decisions? At Experian Health, we have comprehensive data assets and analytics platforms to help you answer these questions and more, and leverage consumer data most effectively.
What if you could flag patients who are at risk of readmission? What if you could anticipate missed appointments or know ahead of time that someone is going to face challenges with their care plan? This knowledge could help you improve patient outcomes, streamline staff workflows and improve your bottom line. So how can you get this non-medical information and use it to improve treatment outcomes? A person’s circumstances can help us understand potential challenges in access to care to predict their behaviors More than 80% of health outcomes are unrelated to medical care. Instead, they are attributable to outside social and economic forces, such as housing, education, unemployment, low income, transportation, access to green space, loneliness, inequality and other non-medical factors. These social determinants of health (SDOH) are the living and working conditions that come together in just the right combination to either promote or a limit a person’s health and wellbeing. As a healthcare professional, you’re no doubt aware that people struggling with financial or life circumstances have a more difficult time focusing on their health and subsequently face more urgent hardships. And it isn’t just the patients who suffer. It has a negative impact on the entire healthcare ecosystem. Why providers should care about social determinants of health When patients struggle to access healthcare services, they’re less likely to follow treatment plans or adhere to follow-up visits. They’re more likely to need to come back with more serious conditions that could have been detected earlier, had they felt equipped to follow the care plan. Not only is this worrying for the patient, but it also leads to excessive service utilization that is costly for providers. Missed appointments are estimated to cost the US healthcare system a massive $150 billion, while each unused 60-minute slot costs an average of $200. And that’s not to mention the opportunity cost of equipment and rooms sitting idle, and all those wasted hours of billable physician time. The shift to value-based care puts more pressure on providers to improve outcomes. But how can they do that when those outcomes are partially determined by factors beyond their control? Considering that 68% of patients have at least one social determinant challenge, the only sensible move is to bring solving for SDOH to the forefront of care planning. “No patient wants to skip appointments and dial 911 as their only reliable means to get the care they need,” said Karly Rowe, Experian Health vice president of product management. “We want to level the playing field by helping providers identify and solve for these socio-economic challenges that make it hard for some patients to get the care they need. SDOH has the ability to improve outcomes, lower costs and increase patient satisfaction, removing the socio-economic obstacles hindering healthcare.” An example of providers and payers collaborating to solve for social determinants of health is the Aligning for Health coalition, which in 2016 referred 33,000 patients to community initiatives. Andy Friedell, a senior vice president at Maxim Healthcare Services said of the program: “We are prioritizing community-based care and social determinant solutions for our patients and clients. In fact, we have effectively used these tools to help reduce readmissions by over 65% for high-risk patients.” How can social determinant data improve outcomes? Let’s look at two examples of how healthcare providers might analyze social determinants to help improve care management. 1. Reducing appointment no-shows For many patients, a lack of transportation is the main barrier to compliance. How do they get to an appointment or procedure if they don’t have a car, don’t live in an area well served by public transport, and can’t afford a cab? Looking at vehicle registration data and public transport services in the area would be one way for a provider to gauge access to care. But does that give the full story? Even if they can find transport, are they juggling two jobs? Do they need childcare? By synthesizing data on transportation, family arrangements, average incomes, and more, providers can anticipate the propensity of someone being unable to access care, and offer solutions such as a free hospital bus service or crèche facility. 2. Preventing escalated health conditions Understanding social determinants is not about identifying unhealthy behavior. For example, a provider might see poor health and point to poor diet. But a patient’s poor diet may not simply result from poor choices. A provider who’s aware of the potential impact of social determinants might consider the propensity of food insecurity – maybe the patient doesn’t have access to healthy food? However, putting the patient at the center and truly understanding social determinants means thinking beyond the ‘food desert’ explanation. Even where healthy food is available, the ability to eat it might be limited by lack of time to cook it, or money to buy it. The provider must adjust their lens and understand how a stressful work schedule, chaotic household and readily available cheap food converge to make it virtually impossible for the patient to even think about putting their health first with a healthy meal. As a result, a patient who could have been identified early on with symptoms indicating the onset of diabetes, for example, instead has their diagnosis delayed because they can’t get to an appointment, while their condition worsens due to their unhealthy diet. Instead of offering dietary advice or signposting to a wholesome supermarket, the provider might choose to work with a registered dietician nutritionist, direct patients to community resources, participate in community partnerships, or even engage with local planning departments and commercial developers. When you understand what drives your patients and recognize the real barriers preventing them from prioritizing or accessing healthcare, you can proactively identify opportunities to solve them. 3. Using the right data to understand and solve for social determinants of health Better care management and improved health outcomes start with understanding the whole patient and the social determinants impacting their life, and then turning those insights into actions. For providers to be proactive, preventative and patient-friendly, they need to know the patient’s socioeconomic background before they enter the room. They must have an idea of what that conversation should look like before they even say hello, and know which SDOH-related programs might be relevant to this patient. Analytics platforms can help leverage wider consumer data sets to spot patterns that affect operational efficiencies so providers can offer more patient-centered care. Of course, if you’re using consumer data, you must have confidence both in its accuracy and in your ability to safeguard consumer privacy. Both can be achieved if you work with a data management partner who can collect data from consumers at scale, with solutions that check all the privacy boxes necessary to allow this data to be used in a healthcare setting. Identity management protocols can guarantee robust patient-matching and cross-system interoperability. So if you weren’t already thinking about what social determinants of health mean for your organization, perhaps think about what you could do now to incorporate a solution that tells you what patients need, provides the right amount of context to understand what external factors might be causing or affecting that need, and then solve for it at the point of care. — The solution exists to help you. You could have the power to identify and solve for social determinants at your fingertips.
