Data and Analytics

Capturing the right data and turning it into actionable insights will improve revenue cycle, patient outreach, and marketing strategies.

Loading...

  Consumer-led care hit its stride during the pandemic. COVID-19 unlocked healthcare’s digital front door, giving patients more control over how and when they schedule and manage appointments. Unfortunately, while digital patient access has made navigating the healthcare system more convenient and flexible in many ways, consumers are discovering that one of the more frustrating aspects of the healthcare experience has failed to keep pace with scheduling, payments and other digital advances: registration.   Waiting rooms. Paperwork. Misplaced insurance cards. Confusing copays. More paperwork! A hassle before the pandemic, registration has become even more challenging for staff and patients in the context of “contactless care.” With more patients starting to come back through the door as a result of vaccination programs and rescheduled elective procedures, there’s an opportunity for providers to smooth out the kinks in the registration experience.   Vaccine “hesitancy” has exposed wider issues in patient registration Headlines suggest that large numbers of patients are fearful of being vaccinated against COVID-19. But dig a little deeper, and the issue is more complex. Many patients do want to be vaccinated, but struggle to navigate complicated registration websites, and therefore aren’t showing up for their shot. The Kaiser Family Foundation reported in January that two thirds of patients were unsure of how to access the vaccine. The high volume of patients having trouble getting the information they need is shining a light into the dark corners of the registration process, where improvements have long been needed.   Improving the patient registration process isn’t just a pandemic problem   While it’s true that COVID-19 is driving the push for online patient registration, improving the overall experience offers wider, longer-term benefits to patients and providers:   A convenient and consumer-friendly registration experience Online registration is easier, faster and simpler for patients. With 73% of consumers saying they want to manage their healthcare admin through patient portals, convenient self-service solutions are a trend that’s here to stay. (Find out more about consumer attitudes to patient access in Experian Health’s Patient Access Survey.)   More accurate patient data and fewer duplicate records When consumers are the ones responsible for entering their patient information, and when they can do it in a time and place that suits them best, that data is far more likely to be accurate. Not only does this create a better patient intake experience, it also reduces the risk of patient identity errors and duplicate records.   With a text-to-mobile registration tool, patients can begin the process with one click, and then easily verify and edit information to make sure their records are up to date and correct.   Operational efficiencies and better claims recovery Beyond the customer experience, improved registration can reduce the risk of denied claims, because the data is processed more accurately and quickly, and can be automatically verified against comprehensive datasets.   Patients can also choose to pay copay amounts upfront through online registration tools, which makes bad debt far less likely, and improves the overall revenue flow.   Safer and smoother registration during flu season COVID-19 put unprecedented pressure on registration processes. But more streamlined systems with remote, mobile-friendly registration tools will make a typical flu season more bearable for patient access staff and patients too.   Patients and staff have suffered through cumbersome registration processes for years. Perhaps one unforeseen benefit of the COVID-19 pandemic is that the days of sitting in busy waiting rooms, filling out multiple forms, will be a thing of the past? Discover how Experian Health’s patient intake solutions could help your patient access department create a registration experience that matches today’s consumer expectations.

Published: August 2, 2021 by Experian Health

“Experian Health’s speed and ability to speak our business language definitely impressed us,” said ACS president, Tim Anderson. “Some of the claims were valid for only a few more weeks, and we were able to submit them in plenty of time. This is the best, fastest platform we’ve seen to reconcile duplicate and data-deficient records. It really helped us achieve the best possible resolution for our clients and our company.” Acadiana Computer Systems, Inc. (ACS) was contracted with numerous labs in Louisiana to submit billing claims, primarily to Medicare, for testing that occurred in the first months of the pandemic. Unfortunately, in the chaos and scramble to offer testing services as quickly as possible in nursing homes and testing sites, the labs struggled to collect needed information to submit valid claims – in particular the Medicare beneficiary’s MBI number, or even a Social Security number. As the pandemic response progressed, a similar challenge developed around the administration of vaccines, particularly in mass vaccination sites and other off-site vaccination centers. Providers struggled to get more than a name and maybe a birthdate, address, or phone number. This left a gap in ACS’ efforts to submit private insurance and Medicare reimbursement claims on behalf of their clients. ACS worked with Experian Health and our Universal Identity Manager (UIM) platform, delivering the Experian Single Best Record (ESBR) – the matching of records through aggregation of disparate information and delivering a single record that accurately identifies separate records that belong to one person. The platform uses multiple data sources to verify, match and consolidate disparate records into one “best record.” ACS assembled the records requiring more identifying data and prepared them for secure transfer to Experian Health. Experian Health securely accepted more than 75,000 patient records and ran them through the UIM platform in 24 hours. It was critical to assign an SSN to as many individual records as possible, and to confirm an associated MBI number for Medicare billing, if applicable. Results included: 69% assigned unique records 12% identified as duplicate records With the information delivered back from the matched records, ACS had all the necessary data needed to continue the billing process. Within a week claims were submitted, expected to exceed $20 million in collections when the process is completed. The ACS group was experienced, savvy and data ready. Their expertise enabled an elegant and efficient exchange and complemented Experian Health’s capabilities. ACS expects to continue to use Experian Health’s UIM platform throughout the pandemic and also for mitigating duplicate records and preparing claims for submission. Learn more about how our Universal Identity Manager (UIM) platform can help your organization eliminate duplicate patient records.

Published: July 27, 2021 by Experian Health

Will handshakes become a thing of the past? Will face masks become a regular feature of flu season? Will home-working remain popular, even after workplaces re-open? COVID-19 forced some abrupt behavior changes that challenged existing cultural norms, but as the pandemic subsides, how many of these adaptations will survive?   For healthcare executives, the return to on-site medical visits raises similar questions. Healthcare consumers were already expressing an appetite for more convenience and control, and the pandemic accelerated the use of digital solutions for everything from patient access to telehealth. Being able to book appointments, complete pre-registration forms and make payments online is the new baseline.   As patient volumes start to increase, hospitals and physician groups shouldn’t take their foot off the gas with digitalization, particularly in patient intake, which doesn’t have to involve in-person contact. There’s an opportunity now to learn from what’s worked well over the last year and cement the pandemic’s digital legacy.   What does the new normal look like in patient intake? Getting back to basics with convenience and compassion Once crisis mode has passed, providers can refocus their efforts on the building blocks of an optimal health service: high quality care and a convenient and compassionate patient experience. After the uncertainty and loss of control over the last year, patients want autonomy and choice. Initiating a smooth patient journey through online pre-registration, patient portals, virtual waiting rooms and digital scheduling can contribute to this.   Many will be happy to say goodbye to piles of paper forms and long waits in the waiting room. But any digital strategy must also support those with limited access to devices and broadband or limited digital literacy. Liz Serie, Director of Product Management at Experian Health, says:   “The goal is to give patients the same exceptional experience and care, regardless of when or how they complete patient intake. Using the same tools that we know our patients are already comfortable with will help to ensure an inclusive approach.”   Digital technology can support a multichannel approach, for example, using automated dialers to make phone calls where mobile apps aren’t an option, or using patient data to segment individuals according to contact preferences. Re-engaging hesitant patients The CDC reported in September 2020 that around 40% of adults delayed care due to the pandemic. While more recent data suggests fewer patients are deferring care, some experts worry that patient volumes won’t return to normal until 2022. How can providers ease the return to care?   Online health portals were helpful in keeping people out of facilities during the pandemic – can they now serve a different purpose in reminding patients to come in for check-ups?   Patients will need clear information about what protocols to follow during patient intake and what to expect from virtual waiting rooms, as well as reassurance that the experience will be safe. Streamlining patient access with accurate data Unlocking the digital front door made logistical sense during the pandemic. It’s even more critical as patient volumes drive back up. Providers will want to review their protocols to be sure that speedy implementation has not left that door open to costly data errors. Is the right information being collected at the right time?   Consumers are looking for flexible and accurate appointment slots for self-scheduling, and they want their financial ducks in a row as soon as possible with quick authorizations and coverage checks. Getting data right first time makes for a smoother patient experience, more efficient staff workflows and fewer claim denials down the line. Preparing for an uncertain future Looking ahead, patient intake protocols will need to be flexible enough to adapt to changing patient needs, particularly if there are further waves of the pandemic. Digital solutions can help providers prepare for the unexpected and shift from a reactive response in a crisis to a proactive step towards the future.   For many providers, future-proofing the patient intake experience is also an important remedy to the financial losses suffered during the pandemic. Digital solutions built on accurate data, consumer needs, accessible information can protect against further revenue loss by giving patients reliable ways to access and pay for care, no matter what the future holds.   Medicine is built on in-person care, but we don’t need to be face-to-face to fill out forms. Patient intake is one area where “the old way” doesn’t have to return. Find out more about how your organization can build on the pandemic’s digital legacy and create a leading patient intake experience.

Published: May 26, 2021 by Experian Health

  More than 7 million households moved to a new county during the pandemic. Huge numbers of Americans deciding to escape busy urban centers is one unexpected side-effect of COVID-19 that’s hitting healthcare providers hard. According to a Pew Research Center study, more one in five relocated during the pandemic or know someone who did. More recent research suggests that just over half of Americans plan to move in 2021!   While fears around the risk of infection and the knock-on effect of rising unemployment prompted some to seek out quieter and more affordable areas early on in the pandemic, motivations for moving in 2021 are driven by new perspectives on what’s important in life. After a year of uncertainty, many are relocating in search of a better quality of life, remote working opportunities, or adventures someplace new.   High turnover calls for better local healthcare marketing  Whatever the reason, relocating brings significant upheaval: new jobs, new schools, a new community – and potentially a new healthcare provider. There’s a huge opportunity for providers who can make it easy for new residents to take “find a healthcare provider” off their relocation to-do lists.   As the “for sale” signs go up, the geography of healthcare use is changing. Some providers are seeing a dip in their consumer population, while others are gaining new consumers. Providers must think differently about attracting new patients to minimize the risk and impact of this high turnover. How do they find them and communicate in the most engaging way? Here, we look at how healthcare marketing strategies can help providers maintain a pipeline of new patients and inspire lasting loyalty in their existing consumer base.   Smart marketing when there’s a surge in new residents  Traditionally, providers looking to draw in new patients might rely on “new mover lists” and mailshots. But these lists don’t reveal much about who these new movers are and what they care about, which leads to generic, one-size-fits-all marketing messages. With the right data, providers can access more meaningful insights about these newcomers’ lifestyles, interests, incomes, and preferences, for a more sophisticated marketing strategy.   For example, one in ten people aged 18 to 29 are affected by pandemic-related house moves. As a healthcare provider in an area with a growing young population, it would make little sense to send mailshots that promote retirement health checks. A more relevant option might be an email or text with information about a new easy payment app or telehealth service. The more providers understand about potential new patients, the more they can customize their patient engagement strategy.   Mindy Pankoke, Senior Product Manager at Experian Health, says:   “The heavy movement patterns we expect this year mean providers must double down on acquisition strategies to maintain a healthy pipeline of new patients as consumers move into their service areas. If multiple health systems are trying to attract the same new patients, you need a clear message to differentiate your services. What’s going to resonate most? How do new patients want you to communicate with them? With the right data insights, you can reach them first with a tailored engagement experience and get the competitive edge.”   ConsumerView aids this by combining hundreds of millions of data points to reveal how patients spend their time, how they spend their money, and how they think. This includes demographic attributes, communication preferences, credit and financial information, plus insights on how individuals may be affected by the social determinants of health.  Using consumer insights to keep existing consumers happy   For regions that experience a net loss in patient numbers, retention marketing will be more important than ever. Patients have more choice now, and as providers compete to attract new members, existing patients may spot competitors’ healthcare ads and be tempted to switch too.   Consumer data powers retention in much the same way as acquisition, by allowing providers to segment patients to offer personalized communications and point them towards relevant services. For example, new research shows that patient loyalty in pediatrics tends to hinge on quality, while choice of adult care is driven by convenience. Segmenting people with young children from those without means you can focus your messaging on what matters most to them. With a supportive patient experience already available to them, those consumers will have no reason to look elsewhere.   Providers shouldn’t rule out marketing to existing patients who have moved. Though they may be in a new area, they can still access services via telehealth. Since convenience is a key motivator, reminding them of remote and virtual offerings could be a great way to retain their business. Focusing on a specific niche not widely available elsewhere is another strategy to retain clients even as they relocate.   ConsumerView is one way to leverage consumer insights to improve the customer experience through targeted outreach, regardless of location. This specialty list of consumer data from a trusted original source compiler draws together everything providers need to attract and retain patients and offer a personalized patient experience as communities adjust to life beyond COVID-19.   Contact us to find out how consumer data could help your organization market to new and existing residents more effectively in 2021.

Published: May 13, 2021 by Experian Health

Knowing that clinical care accounts for only a portion of health outcomes, understanding how patients are affected by social determinants of health (SDOH) continues to gain attention as a critical factor in care delivery. COVID-19 has thrust the issue even further into the spotlight, with socially and economically vulnerable groups hardest hit by the pandemic. At the same time, the expansion of telehealth services over the last year has benefited some marginalized groups, who may feel uncomfortable visiting health facilities or may, for example, sometimes face challenges finding transportation to and from their visits. What’s clear is that when it comes to mitigating the impact of COVID-19’s lingering effects, patient identities based on clinical data alone simply won’t cut it. Providers need a holistic view of patients – both clinical and non-clinical.   Many providers do not have updated contact information for the patients they want to engage, in addition to missing patient-level insights such as housing, food, access to technology, transportation and financial stability data that could help better engage patients. Given the many complicated personal and structural barriers that may exist to accessing healthcare, providers lacking SDOH data in patients’ records are risking avoidable readmissions, unnecessary ED visits, poor care quality ratings and denied reimbursements.   Understanding patient needs and preferences via lifestyle factors – like occupation and technological knowledge – helps providers improve engagement, outreach and access. The results can be game-changing.   The benefits of an enriched, more robust patient record with SDOH Improved certainty of patient needs to achieve healthy outcomes Whether it’s missed appointments, lack of engagement, deferred treatment, or failure to comply with care instructions – if SDOH is the cause, providers need to know.  An enriched patient record that includes clearly defined SDOH risks and insights to those risks is invaluable.   For example, if a patient record includes recommended engagement strategies suggesting medication delivery, or ensuring medications are with the patient at discharge, due to the patient’s difficulty accessing a pharmacy, negative outcome risk is reduced. Significant provider blind spots that might otherwise interfere with desired health outcomes can be eliminated or extensively mitigated with access to this kind of data.   Consumer data gives additional insight useful in risk stratification efforts, allowing care teams to get granular and proactive if, for example, a patient’s lifestyle makes office-hour calls impossible, or if a lack of transportation requires the patient be informed that telehealth is available. Additionally, the data can flag if the patient prefers reminders by text, voice message or email. These considerations make a difference; 80-90% of modifiable contributors to healthy outcomes for a population are regularly attributed to the social, economic and environmental factors that comprise SDOH.   Connecting the dots can improve care coordination SDOH data doesn’t just help flag general access issues; it can also help providers dig into specific challenges that may warrant referrals to community programs or additional staffing support. SDOH data may lead to the discovery that a patient is struggling to access healthy, affordable food and prompt a conversation about getting referred to an in-network nutritionist or local food partnership.   Patient-specific information can be merged with consumer databases covering a range of socio-economic data, initiating proactive conversations with patients that can solve non-clinical gaps in care.   Clarity of the “why” behind patient insights, for better communication and engagement Someone experiencing financial instability as a result of pandemic-related unemployment will expect a different financial conversation than someone who has lived in poverty for their whole life. Further, two patients with high readmission risk can have completely different social determinants of health impacting that risk.  Knowing that patients are affected by SDOH is only one piece of the puzzle. Understanding the bigger picture helps create a whole picture and enables personalized, sensitive, and helpful communication.   A turn-key SDOH solution that helps define the “why” behind the score avoids analysis paralysis and enables a quick, effective engagement strategy based on what really matters to patients. Supplementing patient surveys with consumer data is also important, as it provides deeper insights and recommendations for engagement strategies.   Of course, a connected system only works when the patient identity is accurate and tracks them from service to service. With a universal identity manager, you can have confidence that your teams are all working from a complete, current and insights-rich view of each patient.   Find out more about how Experian Health can help your organization make sense of SDOH data for better patient identity management and a more personalized patient experience.  

Published: May 6, 2021 by Experian Health

Collections were tough even before COVID-19 hit. Provider’s bottom lines were already strained, and the high-deductible trend continued, putting patients on the hook for a bigger chunk of their medical bills.   A highly volatile – but improving – employment environment hasn’t helped, and some patients’ ability to pay hasn’t kept pace with their growing financial responsibilities. Many have new health plans, lapsed coverage or are more focused on other debts, making collections even less predictable. Providers may also feel that payer policy changes haven’t made recouping lost pandemic revenue any easier, with some losing two whole business days per week to completing prior authorizations. It’s no wonder that nearly one in five providers have overhauled their patient collections strategy in the last year.   Now, after a year of the pandemic’s impact on revenue, three dominant trends continue in this space: rising patient balances, an accelerated move toward innovative payment experiences that are moving toward digital engagement as a preferred option to paper or “payment at the counter,” and a realization that compassion is a key factor in solving this challenge.   Avoiding new pitfalls in patient collections   Go-to strategies for improving patient collections before the pandemic might have only included offering more patient payment options, doing more to check for missing coverage, or focusing efforts on patients who are most likely to pay. These are sensible options but, if implemented poorly, they’re more of a band-aid than a cure. Some shortcomings include:   Models relying on historical payment data don’t show the full picture Providers know that focusing their collections efforts on patients who are most likely to pay is the most efficient approach. But determining a patient’s ability to pay on historical payment data alone is likely to be unreliable.   Experian Health’s research suggests that when a collections model relies on historical data alone, around 50% of accounts end up being worked on the basis of no data at all. New accounts are assigned to a “highly likely to pay” segment, whether or not that reflects the reality of their situation. This model costs four times more than utilizing Experian Health’s Collections Optimization Manager, which can predict the ability of patients to pay, even without historical payment, by using multiple data sources.   Collections based on limited data will require more resources to work more accounts, but which ultimately will collect the same as collections based on multiple data sources.   Beware of artificial claims about artificial intelligence To streamline workflows and avoid losing staff hours to inefficient processes, many providers are turning to automated patient collection solutions. Artificial intelligence in healthcare is an exciting prospect, but not all solutions are what they seem.   Matt Baltzer, Product Director at Experian Health, says:   “Many collections tools claim to use artificial intelligence when they’re really using basic automations based on incomplete data. Since the quality of the output is only as good as the data that’s put in, the insights generated by these tools will be severely limited.”   To solve the collections workflow challenge, providers need an end-to-end strategy that integrates multiple high quality data sources, intelligent analytics and a responsive platform that learns and adapts in order to prioritize patients and communicate with them in a way that makes collections easier. Cash payments and price transparency can be part of, but not all of, the solution One way to smooth out a bumpy revenue cycle is to offer discounts to patients who pay in cash. It saves on admin costs and guarantees at least some of the bill will be paid. While this makes sense for minor ailments, admin and treatment costs for chronic conditions and major medical events remain persistently high. A resilient collections strategy needs to work across the board, addressing the many treatments, procedures and care plans that providers deliver and manage every day.   Requirements for improved collections, post-COVID-19 The cohesive, integrated model that providers need has the following key elements:   Multi-data sources for comprehensive analysis Optimal collections modeling uses different sources of data to build a more reliable prediction about a patient’s ability to pay. Combining credit data, behavioral modeling and socio-economic insights can help providers better understand their patients’ financial situation and group them accordingly – quickly and accurately.   Convenience and clarity for patients and staff Automated workflows with easy-to-use interfaces will make collections easier for staff, and eliminate time-wasting manual tasks. At the same time, a smoother, more targeted collections process means staff can engage with patients on the basis of accurate information, with fewer (and less stressful) calls and emails.   Advanced data analytics and automation for fewer errors and denials In-depth data analytics allow providers to screen and segment patients quickly to help prioritize accounts by payment probability, to achieve a higher rate of collections. A tool such as Collections Optimization Manager will evaluate collection performance in real-time, to help providers forecast patient payments and avoid bad debt. Expert consultancy support to stay on top of industry trends With the payments landscape in constant flux, having an expert on hand to help navigate the changes and advise on industry trends is a major asset. Experian Health’s team stands ready to help providers monitor and improve collections with industry insights and best practice strategies.   Find out how Collections Optimization Manger can help your organization avoid patient collections pitfalls and reduce lost revenue in the wake of the pandemic.

Published: April 27, 2021 by Experian Health

As Spotify and Amazon can attest, digital technology plus personalization is a winning formula. Consumers want anytime-anywhere access to the services and products they enjoy, without having to sift through irrelevant information. They want tailored recommendations that will make their life easier. More than eight in ten consumers say they’re more likely to choose businesses that treat them like a person instead of just a number. The pay-off for business—and health plans—is huge: by paving the way for better services, better relationships and a better consumer experience, personalization boosts profits, too. There’s one challenge: delivering personalization requires data. Health plans that want to offer a member-centric experience need the right insights to build a complete picture of what individual members need and want. Yet many health plans are forced to work from stale or incomplete data, notably when CMS hands over a new list of members or a new employer signs on to the plan. A system like that makes it nearly impossible to provide meaningful personalization, and consequently, the member experience suffers. With originally sourced data and consumer insights, health plans can fill in the missing links in member profiles and maximize opportunities to improve the consumer experience. Here, we look at how three specific data-driven strategies could help your health plan attract and retain satisfied members and demonstrate digital excellence by using personalization to drive improvements in communications and care. Personalize member communications for maximum engagement By looking beyond simple demographic data and clinical information, health plans can discover what really matters to members. Consumer data provides detailed insights about the kind of content that will resonate most with the member’s lifestyle, interests and health circumstances. Health plans can tailor their marketing messages accordingly, by highlighting articles about the treatment of relevant medical conditions or sending reminders ahead of annual check-ups.Health plans can also discover when and how to communicate with members so they’re most likely to respond. When member profiles reveal who prefers an email or a text and when, health plans can elicit higher levels of engagement, improve the consumer experience and see better results from targeted outreach campaigns. Make improvement decisions based on the most relevant data Consumer insights can also be used to develop improvement plans that zero in on exactly what members need for the best possible health outcomes. Combining insights on patient behavior patterns with an understanding of the challenges facing individual members means health plans can segment members, so the right support goes to the right place.For example, efforts to drive up medication adherence are going to be far more successful if based off accurate and current member profiles. Specific members can be sent automated, personalized reminders to fill out prescriptions in good time before they run out. Compare that to a “spray and pray” awareness campaign using generic messages that are likely to be ignored. Data-led improvement strategies are operationally efficient and create a better experience for members. Help members overcome social barriers to health Finally, when member profiles include a snapshot of how social and economic factors influence their ability to access healthcare, health plans can take action to offer support. Closing the gaps in care that arise when a patient fails to turn up to their appointment or ends up being readmitted to hospital, can often involve quite simple solutions. If data suggests the member has small children, but there’s no other adult in the household, it makes sense to cross-promote childcare services. Similarly, if the member isn’t known to own a car, a health plan could offer information on free transportation.Understanding these social determinants of health can help health plans offer proactive support so members enjoy better health outcomes in the long run. Experian Health’s rich datasets give health plans access to member-level insights on more than 330 million consumers, with data analysis and automation tools to help make business decisions based on the most relevant, current data. Contact us to find out how we can help provide the personalized experience members are looking for.

Published: April 6, 2021 by Experian Health

    Many thought the end of COVID-19 was in sight with the availability of a vaccine, and while that is somewhat true, an entirely new set of issues has arrived: how to properly administer and manage the vaccine. Now that a COVID-19 vaccine is approved and underway, providers need to execute a medical billing and coding strategy to sustain vaccination efforts. We interviewed J. Scott Milne, senior director of product management at Experian Health, about what’s changed and what providers can do to prepare. How can providers ensure that vaccine administration codes are billed correctly? The ICD-10 and CPT codes for the COVID-19 vaccine haven’t existed until now, which means providers have a new set of codes to learn and unfortunately, those codes seem to change or update almost daily. As more vaccines are introduced, more codes are also introduced, and not just for the vaccine as a whole, but for each specific dose of the vaccine. For example, dose one of the Pfizer vaccine will have a code that differs entirely from dose two of the Moderna vaccine. Keeping up with these changes isn’t only difficult for provider staff, who are likely already stretched thin, but they certainly don’t want to run the risk of submitting a claim with incorrect information. The errors are what result in denials or undercharges. A solution like Claim Scrubber ensures code sets are current on a daily basis – a necessity for times like these – but applies an extensive set of general and payer-specific edits before preparing the claim for processing. That means claims for vaccine administration are error-free before submission to the payer or clearinghouse. Providers can eliminate undercharges, boost first-time pass through rates and do away with costly, time-consuming rework. But proper coding is only the first piece of the billing puzzle. The second piece is to verify the accuracy of payment received from third-party payers. How can providers ensure that third party payers will reimburse at the contracted rates? Providers can certainly get reimbursed for administering the vaccine, but there are a lot of moving parts to keep up with. For example, both Medicaid and Medicare will reimburse providers for administering COVID-19 vaccines, but the percentage of what is covered will differ by carrier and the reimbursement rates can vary both by state and type of arrangement. Reimbursement rates will also vary amongst private payers. Then there is the variation in reimbursement based on vaccine type and dosage -- vaccines that require a single dose may be reimbursed at a rate different than those that require two doses. Even without the vaccine rollout underway it can be a headache for hospitals and health systems to manage multiple payer contracts and reimbursement methodologies. A solution like Contract Manager will pinpoint variance in reimbursement quickly and easily, accurately pricing claims and comparing actual allowed amounts to expected amounts. It is a tool built to adapt to changes within the industry, so providers can capitalize on emerging reimbursement schemes and changes in payer payment policies. It can also help identify sources and patterns of errors so recurring issues can be promptly resolved. The end result: the provider organization can the payer revenue that is due for vaccine administration. Interested in learning more about how providers can optimize vaccine-related reimbursements?   Other blog posts in this series: Segmenting your patient population for the COVID-19 vaccine Engaging patient segments with convenient, secure scheduling solutions Authenticating portal access with automation Optimizing reimbursements by capturing missing coverage

Published: March 30, 2021 by Experian Health

The urgency to move quickly and vaccinate the population has introduced an entirely new set of challenges for providers regarding patient identity. Many continue to leverage existing processes and solutions already in place, manually handling the pain points that come with them, but now at scale and at an unprecedented rate. As the rollout moves forward, the strain on provider resources will only deepen, as will the risks associated with patient misidentification. The data mess behind the scenes Many patients are registering for the vaccine through a patient portal. While the self-service nature of signing up for the vaccine via a portal is beneficial, patients are unfortunately able to register for a portal account more than once. In fact, some of our clients have reported seeing as many as 1,800 duplicate records created per day. Those duplicate records are generated from some individuals who forgot their log-in account information and opted to create a new account, and others who simply forgot they had an account. With the sense of urgency to secure a vaccination appointment, consumers are moving at a rapid speed and simply want to grab a spot with the quickest credentials available. Regardless, multiple registrations for a single patient will create duplicate patient information. Duplicate records are not only costly (the estimated cost of remediation is $96 per duplicate pair), but they are an incredible drain on staff productivity, and ultimately, they are detrimental to patient safety. Multiple records of a single individual pose a risk for potential allergies, reactions, medical history and more. Even more, it is detrimental specifically to the efficacy of the vaccine as it will be harder to gauge in real time how many patients have been vaccinated, and at what stage, and make it more difficult to truly understand what percentage of the patient population has actually been vaccinated. UIM: not another stop-gap solution Experian’s Universal Identity Manager (UIM) platform is tailor-made for a situation like this as it was developed to create a single view of the same patient with their most current information. The matching technology accurately identifies patients and matches records within and across disparate healthcare organizations, providing a more complete understanding of who a patient is, despite the data gaps or errors that may exist in patient rosters. With it, providers are not only preventing duplicate and overlaid patient records but UIM can also minimize errors and fraud in patient records. It additionally improves staff productivity by decreasing the need for record reconciliation—a benefit likely welcomed by many if they are continuing to see anywhere near 1,800 duplicate records per day. When integrated with a solution like Precise ID, providers can both reconcile duplicate records, and effectively stop them from being created in the first place. By automating the patient portal enrollment process, healthcare organizations can remove the manual processes associated with portal enrollment, optimize critical IT staff resources while securing patient information and support a positive patient experience. State-of-the-art identity proofing, risk-based authentication and knowledge-based questions help providers securely verify each patient’s identity as they enroll for the patient portal. Explore how Experian Health can help resolve and enhance identities as part of the vaccine management process and beyond, not only by resolving duplicate records, but also by enhancing records with the best demographic and social determinants of health data available.

Published: March 10, 2021 by Experian Health

Subscribe to our blog

Enter your name and email for the latest updates.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Subscribe to the Experian Health blog

Get the latest industry news and updates!
Subscribe