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In today's digital world, it's easy to access information with just a click. But despite being constantly connected, many patients find themselves lacking the vital information they need to navigate their medical journey successfully. Waiting weeks or months for appointments and dealing with confusing medical jargon on forms can create additional stress. Additionally, limited office hours make it difficult for busy patients to receive important information. Closing the patient engagement gap is just as crucial for providers: delays and misunderstandings lead to scheduling gaps, poor productivity, missed reimbursement opportunities and costly no-shows. Automated patient outreach has the potential to eliminate these challenges. By implementing the right strategy, providers can establish better communication with patients, anticipate their needs, optimize care plans, and provide improved patient experiences. This approach allows staff resources to be utilized more efficiently and effectively, resulting in better health outcomes and financial performance. It's a win-win situation for both patients and providers. What is patient outreach? Patient outreach refers to proactive efforts by a healthcare organization to educate, inform and engage patients in their healthcare journey. Effective patient outreach strategies may include sending patients prompts for health checks, appointment reminders, test results, and information about billing and payment. Ideally, communication will be initiated through whichever channel the patient finds most convenient, whether it's a phone call, text message, email or patient portal. If patients are supported to stay engaged in their care, they will be more likely to adhere to care plans and take the necessary next steps. Leveraging the benefits of automated patient outreach While online self-scheduling, digital patient registration and contactless payment methods deliver the convenience and choice patients desire, automated patient outreach goes a step further to improve patient access and close more gaps in care. Interactive voice response (IVR) and text messaging (SMS) campaigns are helping providers reach out proactively and efficiently to scale scheduling efforts without pulling in additional staff resources. Here are just a few benefits that providers see as a result: 1. Extended outreach capabilities Automated patient outreach surpasses traditional call centers in its ability to effectively reach multiple patients with timely and accurate information. This advanced technology allows for thousands of automated calls per day, eliminating the need for manual facilitation by agents. For instance, SMS and IVR campaigns empower patients to self-schedule appointments without requiring a phone call. Call center agents can easily identify patients who have not booked appointments and follow up accordingly. For those who prefer booking by phone, automated outreach provides a queue callback feature, ensuring that patients are promptly connected to an available agent instead of waiting on hold. This allows agents to efficiently work through the queue. 2. Increased appointment bookings Reaching more patients means more booked appointments, and in turn, fewer gaps in care. Experian Health's patient outreach technology automates the entire scheduling process, from guiding patients to best-fit appointments to issuing reminders to reduce no-shows. Real-time scheduling information ensures that canceled slots are offered to other patients, so those patients can see their doctor sooner, and the doctor's time doesn't go to waste. Convenient self-scheduling options can also increase patient satisfaction and loyalty, which can benefit both patients and providers - by ensuring timely access to care and better use of healthcare resources. 3. Better adherence to treatment plans and fewer unplanned admissions Strategic communication can also help patients stick to medication schedules, book follow-up appointments and make lifestyle changes that will reduce the risk of complications and improve their health overall. This is particularly helpful for chronic disease management and post-operative care, where post-discharge engagement allows providers to monitor and catch any issues before symptoms get worse. A 2022 evaluation of automated text message outreach found that this technology can reduce the risk of 30-day hospital readmission by 41%. 4. Improved patient engagement and satisfaction In today's world, phone calls dominate healthcare communications. But is that always convenient for patients? What if they are at work when their provider calls? In such cases, would they prefer a text message or an email? With reliable consumer data, providers can select the channel that patients will be most likely to engage with. Experian Health's State of Patient Access survey 2.0 found that patients appreciate proactive outreach, though many say this doesn't always happen. Providers that can leverage consumer data, combined with automated outreach, will be better placed to keep pace with evolving consumer expectations. 5. Improved collection rates A final important benefit of patient outreach software is evident on provider balance sheets. Inbound and outbound calling with secure, cloud-based dialing software can generate and issue bill reminders and self-pay options to patients. Experian Health's PatientDial solution provides IVR, bill reminders and self-pay options, which reduce the need for agent interaction. If it's quick and easy to pay, then patients will be more likely to clear their bills in a timely manner. For providers, that means higher in-house collection rates and fewer accounts receivable days eating into the bottom line. In 2021, Experian Health's PatientDial solution helped clients collect over $50 million in patient collections, through more than 250,000 IVR transactions. The automated dialer featured helped our clients save 900,000 labor hours, which would have been otherwise spent in manual dialing. Key considerations when implementing automated patient outreach Building a successful patient outreach strategy can be challenging. It's crucial for providers to deliver timely and pertinent information without overwhelming patients already susceptible to information overload. It is crucial that communications are secure and compliant with privacy regulations such as HIPAA, and consistent with the provider's brand to avoid being mistaken for spam. Additionally, any new systems or technology implemented should be easy for both staff and patients to navigate. By choosing a patient outreach solution that offers a user-friendly interface and ongoing support, providers can ensure that staff hit the ground running. Find out more about how Experian Health's automated patient outreach solutions can help providers improve patient engagement and close more gaps in care.

In today's healthcare landscape, providers face the challenge of making costs transparent and understandable for consumers. The Hospital Price Transparency Rule has driven progress in this area, but there is still work to be done. In 2022, 70% of hospitals complied with the Hospital Price Transparency Rule, up from 21% in 2021, according to the Centers for Medicare & Medicaid Services. The Rule mandates hospitals to provide consumer-friendly pricing displays for more than 300 shoppable services, plus a machine-readable file with rate information. To address this challenge, healthcare organizations need to leverage price transparency solutions that empower patients throughout their financial journey. By equipping patients with advanced knowledge of treatment costs and coverage details, providers can facilitate informed healthcare decisions, expedite payments, foster patient loyalty, and gain a competitive advantage. Prevent confusion about costs with transparent healthcare pricing A recent KFF survey found that almost six in ten insured healthcare consumers have encountered problems paying for care in the last year. More than half said they found it difficult to understand their health insurance, while three in ten said their insurance paid less than expected. Confusion about coverage can lead to delays, denials and difficulties in accessing care. Two scenarios are common when patients are faced with unexpected and increasing healthcare costs: 1) they delay care until their year-end deductibles are met, or 2) they forego care completely. Neither is good for their health, and both can disrupt providers' revenue cycles. By arming patients with advanced knowledge of treatment costs and how these will be split between patients and payers, providers can help patients make informed healthcare decisions without worrying about sticker shock. And price transparency is not just a question of compliance - making healthcare billing more transparent can be a driver for growth, through expedited payments, patient loyalty and market advantage. Compassionate financial counseling, flexible financing programs, clear billing statements and simple payment options all play a role. What can providers do to improve price transparency? Step 1 in delivering price transparency is to ensure compliance with the Hospital Price Transparency Rule. Experian Health and Cleverley + Associates have partnered to help providers satisfy the requirements. Experian Health's Patient Estimates supports providers in compiling the required list of shoppable service items, while Cleverley + Associates delivers the machine-readable files quickly and at scale. Jamie Cleverley, President of Cleverley + Associates, says: “Trying to pull together all of the required information in one place led to a lot of complexity for hospitals, at a time when a lot were short-staffed. We became a natural resource for hospitals. Since we have the information and the technical capacity, we could relieve the anxiety around compliance.” Riley Matthews, Lead Product Manager at Experian Health, says the joint approach has succeeded in helping hospitals comply with both aspects of the rule: “We had a portal that we can integrate with our clients' websites, where patients are able to walk through a user experience that guides them to their price estimates. Cleverley came in with the complex machine-readable files and has been a fantastic partner from the start… We're able to solve both sides of the price transparency rule and provide a holistic solution that delivers value for our clients.” Hear Riley Matthews and Jamie Cleverley discuss how this strategic partnership will help healthcare organizations address the challenges with compliance: Utilizing healthcare price transparency solutions throughout the patient journey To round out the patient financial experience, healthcare organizations should consider proactive solutions that promote clarity and convenience at every financial touchpoint. For example: Patient Financial Advisor is the first solution in the market to provide consumers with a pre-service, mobile-estimated patient responsibility and payment experience. This allows patients to make easy, secure payments as soon as they're ready. Patients get a clear breakdown of everything they need to know about their financial obligations, delivered straight to their mobile devices. To solve for confusion around coverage, Experian Health's Coverage Discovery® solution helps patients find missing or forgotten coverage. Patients welcome their providers' help in identifying additional coverage options, so they aren't billed for costs unnecessarily. Providers can seek reimbursement through those plans, rather than sending accounts to collections. Providers can also promote clarity when it comes to payments. PatientSimple offers patients a secure, 24/7 portal to view and manage their healthcare costs in a straightforward and convenient way. Not only can they see accurate price estimates at the touch of a button, but they can also apply for charity care, set up payment plans, update payer information and make payments to multiple providers. Implementing healthcare price transparency solutions to meet regulatory requirements Creating a more transparent approach to healthcare pricing and billing can be a daunting task in the context of ongoing regulatory change and operational challenges. It's time to incorporate Experian Health's innovative solutions to navigate ongoing regulatory changes, overcome operational challenges, and enhance the financial experience for both providers and patients. Find out more about how Experian Health is helping providers comply with price transparency rules and exceed patient expectations for clear and comprehensive billing experiences.

Is the digitalization of patient access services losing momentum? Experian Health’s State of Patient Access 2023 survey suggests that both patients and providers feel there’s still work to do to open healthcare’s digital front door. Where are the gaps? And how can providers fulfill patients’ digital expectations? This article looks at the advantages of offering a digital patient access experience and three technologies that can help providers stay competitive and give patients what they need and want. What is healthcare’s digital front door? The term “digital front door” refers to the virtual gateway through which patients access healthcare services and information. It has become a synonym for patient access, encompassing the digital touchpoints patients interact with when they’re booking appointments, registering for care, verifying insurance eligibility, paying for services and checking their medical records. This can include a hospital’s website, mobile apps for registration and payment, patient portals, telemedicine platforms and online appointment scheduling systems. Digital services have become an integral part of daily life, and healthcare should be no different. Patients and providers alike are seeking streamlined ways to connect and engage. What are the benefits of opening healthcare’s digital front door?  According to the State of Patient Access survey, patients want one thing above all else: to see their doctor as soon as possible. More than three-quarters said online scheduling was a top priority. Being able to book appointments online sidesteps geographical and practical barriers to care, reduces wait times, and prevents more serious and costly health situations from arising. For providers, this is an effective route to patient loyalty as well as better health outcomes. Opening healthcare’s digital front door unlocks financial advantages, too. Registration forms can be pre-filled with verified patient data, eliminating the errors that can occur through manual processes. This saves time, effort and expense for patients and providers later. CAQH estimates that the efficiencies gained through automated processes across the entire revenue cycle, including patient access, could allow the medical industry to release savings of as much as $22.3 billion each year. As healthcare labor challenges continue, a third of providers also noted that digital technology can help offset staff shortages, easing pressure on staff by automating repetitive tasks. Clarissa Riggins, Chief Product Officer at Experian Health, says, "For those in the healthcare industry who have been hesitant about implementing technology due to fears about replacing workers, the current staffing shortage may be the catalyst they need to change." And with a wealth of insights about service utilization and staff workflows now at their fingertips, data-driven digital services can facilitate continuous operational improvements. Why has the digital momentum slowed? Despite these benefits, patients report a slowdown in the digitalization of patient access. While the acceleration of the adoption of digital services seen during the pandemic could be expected to level off, survey responses from patients and providers hint at a more significant dip. Only 17% of patients think patient access has improved over the last two years, and 47% of providers say it’s gotten worse. Riggins says, "Patients have increasingly high expectations for easy and efficient tech-enabled solutions when it comes to accessing healthcare services...The bottom line is providers must prioritize updating their technology to avoid being left behind. Patients, especially younger generations, are demanding a better 'digital front door' experience or they could look elsewhere for care. In fact, Experian Health's survey found that 56% of patients who believed the access experience was worse said they would switch providers because of it." How can healthcare providers improve their digital front door? Fulfilling patients’ digital expectations comes down to three things: 1. Quick and convenient self-scheduling Survey results show that 76% of patients want to schedule appointments online or via a mobile device. With Experian Health’s patient scheduling software, providers can offer patients the option to book, cancel and reschedule appointments from any device, at any time. This omnichannel platform acts as the central scheduling hub across an entire health system. Self-service scheduling and integrated text and IVR outreach campaigns reduce the number of calls to agents. And for those calls that are needed, guided search makes scheduling quicker and easier. 2. Mobile-enabled patient registration Data from Experian Health and PYMNTS found that a third of patients chose to fill out registration forms for their most recent healthcare visit using digital methods, while 61% said they’d consider switching providers to one that could let them manage care through a patient portal. Aside from boosting patient engagement, automated registration also reduces the risk of denied claims, by preventing data entry errors that occur during patient registration. With Experian Health’s patient intake software, providers can simplify registration for a better patient experience, reduced administrative costs and fewer denied claims. 3. Anytime, anywhere payments More than seven in ten patients say they want to be able to pay for healthcare using online or mobile methods. But before that, they also want to know in advance how much their bill is likely to be. The survey suggests that providers still struggle to deliver accurate, upfront cost estimates to patients. With tools like Patient Financial Advisor, Patient Estimates and self-service payment options, providers can help patients navigate the financial side of their healthcare journey, resulting in prompter payments and more positive reviews. Implementing new systems and tools can be daunting, but with the support of an expert vendor, providers can deliver the convenience and choice that patients demand in the most efficient and cost-effective way. As labor costs continue to rise, now is the time to invest in digital technology to ease pressure on staff, increase patient engagement and safeguard revenue going forward. Discover how Experian Health is helping to open healthcare’s digital front door with comprehensive patient access solutions.

How do patients rate their “patient access” experience? For most, the rating comes down to how quickly they can see their doctor – and many don't feel like their expectations are met. In December 2022, Experian Health surveyed more than 1000 adults who'd accessed care in the previous 12 months to gauge perceptions of patient access. Most think the experience remains unchanged or has gotten worse in the last two years, despite advancements and providers' heavy investments in technology.  Almost 8 in 10 of those patients say “seeing a doctor/practitioner quickly” is their biggest pain point. Other major factors include the level of friction involved in scheduling and registering for care and obtaining accurate pricing estimates before services are rendered. Patient access tools can help ensure that patients receive the care they need in a timely, efficient manner. Breaking down barriers for friction-free patient access What hinders patients' ability to see their doctor quickly? For some, the obstacles are logistical: patients may live far from facilities or lack reliable transportation to get to appointments. Others may have financial concerns, where a lack of insurance coverage or fear of mounting bills prevents them from seeking care. Language and cultural barriers can make it difficult to engage with healthcare services. But for many, it comes down to friction in the “patient access” process itself. This includes long wait times for appointments, disjointed scheduling systems, manual registration processes, and limited payment options. These processes are not only critical to patient satisfaction but also have real consequences for the patient's health and the provider's bottom line. One effective approach to improve access to care is to continue leveraging patient access tools, which has been proven successful in several use cases. Use case 1: Reduce wait times with online self-scheduling Among patients who think access has worsened over the last two years, 49% say their main challenge is finding appointments that fit their schedule, while 40% blame the scheduling process itself. Online self-scheduling solves both, making it easier to book and reducing wait times. With online self-scheduling, patients can log on to book appointments any time they like. There's no need to wait until the phone lines open and speak to customer support representatives. A self-scheduling tool like Patient Schedule can incorporate each provider's business rules and scheduling protocols, so patients get real-time access to the earliest available appointments. By allowing patients to easily cancel or reschedule appointments, same-day slots can be opened up to other patients, so they can see their doctor sooner. Use case 2: Increase operational efficiency with digital patient registration Staffing shortages are an ongoing stressor for providers, so making the best use of available staff time is crucial. Patient intake software can automate many of the manual activities associated with patient registration, such as helping patients fill out forms or manually entering information into electronic health records. In addition, more than 8 in 10 providers say their patients prefer an online registration experience. This corroborates earlier findings from a study by Experian Health and PYMNTS, which found that a third of patients prefer to fill out registration forms at home. Experian Health's Patient Intake Solutions allow patients to complete registration from their mobile. Data can be automatically pre-filled and checked against existing records to save time and avoid errors. Not only is this more appealing to patients than filling out forms in a stuffy waiting room, but it also helps drive down the risk of costly and time-consuming denials. Use case 3: Boost patient engagement with targeted patient outreach Another way to leverage patient access technology is through targeted, automated outreach. With automated text message (SMS) and interactive voice response (IVR) campaigns, patients can receive a personalized link to schedule their appointment directly. Alerts can be sent when earlier appointments become available, which both reduces wait lists and makes it more likely that patients will book. Patients can be sent bill reminders and payment options in the same way. Automated outreach solutions that incorporate reliable consumer data make sure patients get the details they need in a format and timeframe that helps them take action. Use case 4: Speed up collections with accurate estimates and payment plans As rising staffing and supply costs put a squeeze on healthcare profit margins, expediting collections is crucial. This begins with patient access: if patients can pay for care right at the start of their healthcare journey, this eases pressure on both parties to make sure bills are paid in a timely manner. Upgrading payment technology to include upfront pricing estimates, payment plan recommendations and convenient payment methods can all help patients better manage their financial responsibility. Unfortunately, it's still common for patients to go into procedures without knowing how much they'll owe. In Experian Health's survey, 65% of patients said they did not receive an estimate prior to care, and 40% said they were likely to cancel care without advance notice of costs. Leveraging tools such as Patient Financial Advisor and Patient Payment Estimates can automatically arm patients with the information they need to plan and manage their bills. Utilizing patient access tools to meet patients' expectations It is evident from the results of the State of Patient Access 2023 survey that patient access remains an issue. To ensure patients receive the care they need in a timely and efficient manner, providers must make a concerted effort to leverage digital technology. Although healthcare providers have made great strides in providing more efficient patient access solutions, clearly there is still much progress to be made.  The success of any patient-focused initiative relies heavily on being able to meet patients' expectations with timely, effective tools and resources. As healthcare evolves and continues to put a priority on improving outcomes, it's important to take proactive steps toward ensuring the best possible experience for patients when accessing their care. Find out more about how Experian Health's patient access tools can improve patient access and increase profitability for healthcare providers.

Could the era of manual claims processing be coming to an end? Experian Health's State of Claims 2022 survey revealed that more than half of healthcare providers have embraced advanced automation, freeing up staff from time-consuming and inefficient manual tasks. Automation has dominated as the key strategy used by providers to reduce denials in the previous 12 months. This evident optimism about technology's ability to address challenges in the claims process suggests that automation is here to stay. However, while automation has cracked open the doors to more efficient claims processing, the predictive power of artificial intelligence (AI) in claims processing can unlock exponentially higher rates of reimbursement. Providers may be increasingly aware of the benefits of automation, but many have yet to step into the world of AI. This article considers the advantages to be found in layering AI technology on top of automated claims processing and looks at how two new AI solutions are helping providers reduce denials and expedite payments.  How automation helps with claims processing Healthcare organizations with automated claims processing report improvements in speed, accuracy, financial performance and patient experience. For example: Automated claims management solution ClaimSource® helped Hattiesburg Clinic in Mississippi accelerate cash flow, reduce denials to 6.1%, and expedite claims from secondary and tertiary payers. Summit Medical Group Oregon used Enhanced Claim Status and Claim Scrubber to reduce accounts receivable days by 15% and achieve a first-time pass-through rate of 92%. These tools improve efficiency across the entire claims cycle by automating repetitive tasks, executing effective workflows and generating data-driven insights into root causes of denials so staff can prioritize high-impact tasks and errors are far less likely. Industry reports corroborate these positive results: CAQH reports that the medical industry could save as much as $22.3 billion per year through further automation. Unlocking the untapped potential of AI in claims processing Despite automation's impressive results, claim denials remain a thorn in the side of many revenue cycle leaders. This is where AI can help, thanks to its ability to predict and respond to payer behavior and claims data. But while 51% of survey respondents were using automation, only 11% had introduced AI-based technology to their claims process. For the AI-curious, combining automation and AI could be a good starting point to supercharge claims processing. AI technology can predict potential issues before they even occur by analyzing claims and denials and making suggested corrections or interventions in real-time. It can also assist in identifying fraudulent claims and denials, leading to improved claims processing accuracy and revenue cycle management. By using automation and AI together, healthcare providers can gain better insights into their claims and denial data, resulting in improved financial performance and greater efficiency. What does that look like in practice? More efficient and accurate claims predictions Automation can relieve staff of manual data handling activities, increasing the speed and accuracy of claim processing, from patient intake through scrubbing, submission and adjudication. AI enables staff to perform remaining tasks with greater confidence and accuracy. They no longer need to wonder, “which claim should I rework first?” – AI has the answer. Without AI, the logical approach would be to rework what appear to be the highest-value denials first. But in many cases, these aren't the ones most likely to result in reimbursement. AI can help staff prioritize by analyzing historical payment data and undocumented payer adjudication rules to flag denials that are most likely to be paid. This is exactly how AI Advantage™ – Predictive Denials works. Experian Health's new AI-based solution checks for any changes to the way payers handle denials and assesses these against previous payment behavior. Providers can set their own threshold for the probability of denial, and if the solution determines that a claim will exceed this threshold, it alerts staff so they can act quickly and decisively before the claim is submitted. Schneck Medical Center was an early adopter of this tool and used it to complement their existing claims workflow (built around ClaimSource®). Within six months, they saw average monthly denials drop by 4.6%. Predictive alerts allowed staff to focus efforts on submitting clean claims the first time, so both the number of denials and hours spent reworking them were drastically reduced. “Learning” from denials data to drive financial performance By definition, automated claims processing systems will repeat the same tasks over and over. This is great for operational efficiency but has limited capacity to handle variation. A major advantage of an AI-based solution is its capacity to “learn” and predict, so each claim can be individually assessed and directed to the most appropriate workflow. AI Advantage™ – Denial Triage uses advanced algorithms to identify and intelligently segment denials so that providers can prioritize accordingly. Just as Predictive Denials uses historical payment data to predict the claims that may be at risk of rejection, Denial Triage learns from payers' past decisions to predict the denials that are most likely to be reimbursed if reworked. Read more about Schneck Medical Center's experience with AI Advantage. How does using AI benefit healthcare staff? The use of AI in claims management can be met with different reactions: some staff are enthusiastic about the prospect of having manual tasks taken off their plate and being able to use their time more effectively. Others may be concerned about the impact of AI on jobs and recruitment. The reality is that many providers face ongoing staffing shortages, and therefore have little option but to augment their existing teams with new technology. Maintaining pre-pandemic headcounts in light of post-pandemic work patterns and budgets may not be possible. Automation and AI can resolve these short-term challenges while generating a positive ROI in the long term, as the volume and complexity of claim denials continue to grow. As noted in the State of Claims 2022 report, technology should no longer be viewed as a threat to jobs, but as a way of making life easier for staff. Automation and AI work hand in hand to execute tasks that many staff find time-consuming and laborious, leaving the more stimulating and high-value tasks for the human workforce. Improving operational performance can therefore have a positive effect on job satisfaction and retention. The integration of AI in claims processing is not about replacing human expertise, but about harnessing the power of AI-powered algorithms to enhance efficiency and minimize denials. The optimal approach lies in combining the strengths of automation, AI and staff. Automation handles repetitive processes, AI expedites decision-making, and human expertise brings contextual understanding and empathy to the process. Learn more about how Experian Health can help organizations utilize AI in healthcare claims processing with AI Advantage.

American consumers may be more optimistic about the state of the economy, but concerns about healthcare costs are always top-of-mind. A survey by Experian Health found that 40% of patients would cancel or postpone care if they were not informed of costs in advance. Planning for medical expenses can be a struggle for families facing rising costs and increasing deductibles. With profit margins under increasing pressure, providers must make constant improvements to patient collections processes to help patients navigate their financial obligations more easily. Finding new ways to maximize patient collections and increase efficiency while reducing friction in the patient experience is more important than ever. Technology and patient collections software offer a way to bridge the gap. This article looks at two case studies that involve leveraging automation and digital technology to create better patient collections processes. Case Study 1: how UCSDH improved patient collections with Collections Optimization Manager Patients are footing more of the bill for healthcare, leaving providers more exposed to each individuals' ability to pay. If patients are unable to pay in full and on time, providers will be left with growing ­– but avoidable – collections costs and an escalating risk of uncompensated care. Given that patients can have different financial circumstances, mailing out uniform statements and hoping they will be paid is a futile effort. Instead, providers should look for opportunities to proactively engage patients with personalized information, delivered earlier in the process. This can help maximize patient collections. One way to determine the most suitable collections strategy for each patient is to use data-driven software like Collections Optimization Manager. This tool helped the University of San Diego California Health (UCSDH) score and segment patients according to their propensity to pay so that each account was dealt with in the most appropriate way. For example, patients with a high likelihood of payment could be sent billing information automatically via inbound call campaigns, and offered self-service options to manage payments. Collections Optimization Manager also enabled UCSDH to automate the presumptive charity process, quickly identify patient accounts eligible for Medicaid or charity support, and direct them to the correct work queue to maximize workforce productivity. As a result, UCSDH increased collections by 250% in a single year, from $6 million to $21 million between 2019-20 and 2020-21. UCSDH also used Coverage Discovery® to track down active commercial and government coverage that patients were unaware of. More than $5 million was found in 2021 that would otherwise have been written off. For UCSDH, being able to provide a compassionate patient collections experience has been central to this success: “We serve our patients well when we can explain their bills, what's been covered by their insurer and what payment options they have, so they feel confident in what is owed and why.” Terri Meier, System Director of Patient Revenue Cycle, UCSDH Case Study 2: how Kootenai Health streamlined eligibility checks with Patient Financial Clearance Another way to provide early clarity is to make sure patients aren't missing out on Medicaid assistance. However, this can be a time-consuming and labor-intensive exercise when attempted through manual processes. Because Kootenai Health needed a more streamlined workflow to screen patients for financial assistance, they implemented Patient Financial Clearance to assess and assign patients to the right pathways and programs, based on their specific circumstances. Patient Financial Clearance uses credit and non-credit data to identify patients missing out on Medicaid or charity assistance in real-time. It automates screening and document-gathering, reducing the manual burden on staff while improving the patient experience. Verifying Medicaid eligibility early prevents patient accounts from being sent down long and expensive collections pathways that would never result in payment. Kootenai's Financial Counseling manager reported that thanks to Patient Financial Clearance, “One of our patients with a $200,000 bill answered a few questions and was found eligible for Veterans benefits. With our previous vendor, we would have written the account off to charity.” In just 8 weeks, Patient Financial Clearance saved Kootenai 60 hours of staff time by automating the presumptive charity process and eliminating unnecessary applications. It also maintained an 88% accuracy in determining the right financial assistance program for the right patient. As Medicaid continuous enrollment under the COVID-19 public health emergency declaration comes to an end, uncertainty around eligibility is likely to increase. Taking steps to verify patients' status quickly and efficiently will be even more important. Bottom line: Maximize patient collections by making it easy to pay These are just two examples of how providers are using automation and digital technology to improve patient collection processes. In addition to screening and segmentation, providers can further tailor the financial experience by offering patients realistic payment plan options to make bills more manageable. Patients are provided with a range of convenient, self-service payment options to settle their bills according to their preferred method. Tools like Patient Financial Advisor allow patients to receive a text message with a link to a clear breakdown of their bill and the option to make a payment right from their mobile device. Find out more about how Experian Health's patient collections software and payment tools can help providers stop chasing the wrong accounts and deliver a proactive and personalized financial experience for patients.

To improve the patient journey, providers need to think like consumers. Patients are accustomed to convenience and choice in industries such as retail and banking, and expect the same of their healthcare experience. How quickly can they see their doctor? How easy is it to book appointments? Are they going to be handed a stack of paper forms when they arrive? From scheduling appointments to making payments, every touchpoint in the patient journey is an opportunity to meet and exceed expectations. To improve the patient journey, providers will need to utilize digital tools. Providers that put themselves in the patients’ shoes and find ways to make patient access as frictionless as possible will secure a competitive advantage. Learn how digital technology can enhance healthcare providers' ability to deliver flexible, efficient, and supportive care throughout the patient journey. This article draws upon the insights of Experian Health's State of Patient Access 2023 report to explore the benefits of utilizing digital tools and solutions in healthcare. In 2023, Experian Health surveyed more than 1,000 U.S. patients & 200 healthcare providers to learn about the state of patient access. Get exclusive insights: Before the appointment: how easy is it for patients to schedule care? The patient journey should begin with a welcoming “digital front door”. Demand is clear: according to the State of Patient Access 2023 survey, 56% of patients want more digital options to manage their healthcare. Specifically, 76% say they would like to schedule appointments online or via a mobile device. Creating an inviting, convenient and user-friendly online presence will encourage patients to book more appointments. A multi-purpose online portal gives patients the flexibility to take care of appointment bookings anytime, anywhere. Automated patient scheduling also reduces pressure on call center staff, who are then able to offer extra support to individuals who need it. Real-time status updates and automated appointment reminders ensure patients see their doctor as soon as possible and reduce the risk of no-shows. By creating a seamless transition between a provider’s online presence and physical office, tools like Patient Schedule can create an efficient experience for both staff and patients. Arriving for care: is pre-registration simple and streamlined? Patients deserve a seamless and stress-free experience when arriving for their appointment. Unfortunately, traditional paper forms can be tedious and redundant. Incomplete forms can also lead to delays in treatment. Online self-check-in options and virtual waiting rooms allow providers to move registration out of the waiting area and into the patient’s home or mobile device. With a digital front door, patients can complete pre-registration tasks, get accurate price estimates and even pay their bills before their appointment, via text or online portal. Automated tools can prefill identity information to keep errors and gaps at bay, and avoid claim denials and delays further on in the patient journey. A painless, paperless registration experience is easier and quicker for patients and saves time and resources for providers. Planning for bills: are patients getting upfront pricing estimates? Providers have many opportunities to improve the patient financial journey. Experian Health’s survey found that 40% of patients would cancel or postpone care without accurate estimates, yet 65% did not receive them. That price transparency isn’t the norm is surprising, given the legislative push in recent years. Medical bills can be extremely complex, so providing a detailed breakdown of expected costs is a great way to improve the patient experience. Patient Estimates is a web-based tool that allows patients to generate accurate estimates using their current insurance and benefits information, before or at the point of service. Patients can also be offered personalized financial assistance options including payment plans and charity care. For patients that prefer to take care of business via their mobile device, Patient Financial Advisor offers a similar service via secure text message. Patients get a clear cost breakdown and a link to make secure payments. When financial management is easier for patients, providers are more likely to get paid. Paying for care: do patients have a choice of payment methods? In addition to clear and upfront pricing, providers can enhance the financial experience by offering multiple convenient payment options. Digital-first consumers are looking for the same self-service, secure, one-click payment options that they use for other purchases. Providers that enable digital patient payment tools earlier in the process are not only delivering a more satisfying patient experience, but they’re also more likely to be paid sooner. With Experian Health’s Patient Payment Solutions, providers can collect payments 24/7 via mobile, web and patient portals. Leveraging digital technology to improve the patient journey Alex Harwitz, VP, Digital Front Door, at Experian Health, says that patient loyalty is increasingly tied to digital offerings: “Whether we’re talking about scheduling, registration or payments, the message from the State of Patient Access 2023 survey is clear: patients are looking for transparency, convenience and a significant amount of control. They’re more likely to choose providers that offer these benefits and switch away from those that don’t. For example, nearly a quarter have considered looking for a different provider because of a poor payment experience.” The realization that a better patient access experience results in better business outcomes is almost universal among providers. And with advancing patient access technology, providers now have more ways to deliver a consumer-friendly experience that allows patients to focus on their health, and not on the admin of care. Download the State of Patient Access 2023 – the Digital Front Door, to find out more about patient and provider perspectives on how to improve the patient journey.

Has patient access gotten better or worse? According to the State of Patient Access: 2023 report, many healthcare providers believe that patient access has gotten worse, and many patients agree. This report is based on a new survey, fielded in December 2022, that gathered responses from 202 healthcare professionals responsible for patient access and 1,001 patients who engaged in care for themselves or a dependent in 2022. What is the challenge around patient access and how can providers overcome these hurdles? Both healthcare providers and patients want patient access functions that are optimized for efficiency, can accommodate a high capacity of patients, and reduced wait times for non-clinical aspects of care. Across the industry, there is widespread acknowledgment that an improved patient access experience is linked to better business outcomes for providers. Digital front door solutions that can enhance patient registration, scheduling and payment processes are the key to overcoming the challenge of better patient access. In fact, 46% of providers plan to invest in digital capabilities in the next 6 months.* Download the State of Patient Access: 2023 report for the full survey results, or contact us to see how Experian Health helps healthcare organizations improve and streamline patient access with digital front door solutions. *survey fielded in Dec. 2022

Millions of patients and their healthcare providers face challenges as State Medicaid agencies unwind coverage rules enacted as part of the COVID-19 public health emergency (PHE) that ended in April, 2023. The Kaiser Family Foundation estimates that 5.3 to 14.2 million people will lose Medicaid coverage as the continuous enrollment provision of the PHE ends. Meanwhile, providers may find themselves in an extended state of flux over the next year as Medicaid members have their eligibility re-evaluated and, in many cases, dropped. Kate Ankumah, Principal Product Manager, oversees  Insurance Eligibility Verification solutions at Experian Health. She shares some of the ways providers are managing new demands as they work to keep themselves—and their patients—up to date on coverage changes while navigating Medicaid redetermination and helping patients explore new financial options. Q1: When does the Medicaid redetermination process begin? “Some states have already started the Medicaid redetermination process,” Ankumah says. “Five started in April [of 2023], another 14 states started in May, and we expect many more to start in June. It's going to be a rolling process. Most states are saying this will be a 12- to 14-month effort.” Q2: What can providers expect from their state Medicaid agencies while the renewal process is happening? “State agencies will be going back through their rosters on a monthly cadence to determine who still qualifies for Medicaid,” Ankumah explains. “State Medicaids will start by using internal information to determine eligibility, whether that's eligibility for SNAP benefits or other government data they have access to. If they can't qualify members automatically, they'll reach out to members for more information. If they determine a person is no longer eligible—or they don't get information back by the deadline they've set—that member will be dropped from Medicaid coverage, possibly without ever knowing that they were supposed to respond to an email or other communication to keep their coverage.” Q3: What impact does Medicaid redetermination have on provider workflows? Ankumah sees three major areas of concern: changes to coverage, communication challenges, and downstream impacts on revenue and collections. “Providers should expect to see the hit rate for finding active Medicaid coverage to dip over the next 12 to 14 months. Normally, when reporting shows a decline in Medicaid eligibility, you might think that the payer was down or that the clearinghouse wasn't making the connection. Right now, we know that these are more likely people who don't have coverage,” Ankumah says. “I think providers can also expect to see a lot of very confused patients,” she continues. “Providers are going to need to make phone calls and have difficult conversations with patients who had no idea that this was happening and are frustrated and flustered by this change. “And then ultimately, there are going to be more self-pay patients. Many of these patients will be people who didn't know that they were at risk of losing their Medicaid coverage and aren't sure how to proceed.” Q4: Are there ways to optimize eligibility to mitigate some of the issues being created as redetermination rolls out? “One thing we're seeing is providers utilizing the batches they run through state Medicaid(s) to get a bit of a heads-up about coverage changes. If the provider's state Medicaid is dropping people from its rosters on the first and the 15th of the month, the provider might send everyone they're seeing for the first half of the month through on the first. If they find out a patient has been dropped, they have time to reach out and talk about coverage before the patient comes in for their appointment.” Dealing with the potential fallout is better with advance notice—for providers and patients. “It's a terrible patient experience to walk in thinking you have coverage and finding out you don't,” says Ankumah. “It's not the provider's fault, but patients can feel blindsided learning they'll have to pay out of pocket for care.” “Some clients are also running more frequent batches to try to get a better idea of when [during the month] their state is dropping members. Are they always dropping on the first of the month? Are they dropping on Mondays? It's a bit of an iterative process trying to understand the timing of it, but clients want to learn as soon as possible when a patient is dropped from the roster so they can reach out and have a plan before they walk in to be seen by a doctor.” Q5: Are states including redetermination dates when they send back eligibility transactions? “Some state Medicaids are indicating redetermination dates, but so far there's no standard for doing this. There's no specific field for redetermination dates in the 271,” says Ankumah. “Some states are picking a field and using it: Often they'll use the certification date, or they'll add a message segment to an open field at the end of the 271.” “As states begin to communicate if and where they are sending the redetermination dates in the 271s—and as we can verify that in our system—we can let our clients know that they can start to leverage this information to let patients know when their coverage is ending." “It may seem strange that we can't point to one field that state agencies are using to communicate redetermination dates,” Ankumah says, “but we're dealing with 50 different agencies, each doing it their own way. We're continuing to look for patterns and to work with clients to puzzle this out.” Q6: What can providers do to support patients that are being dropped from Medicaid? If providers learn that a patient has been dropped from Medicaid, Ankumah suggests directing the patient to their state Medicaid website to try re-enrollment. If their organization has a Medicaid enrollment team, they can be an excellent resource for patients. Additionally, providers may want to leverage tools that help patients navigate their financial responsibility. Finding alternative coverage: “For patients who have lost Medicare, Coverage Discovery can help find coverage that they don't know or aren't sure about,” says Ankumah. “They may have signed up for new coverage but aren't sure of their plan information and details. Or they may be covered under an employer's policy without realizing it. Coverage Discovery lets providers search for coverage with the click of a button.” Exploring coverage and payment options: “Patient Financial Clearance helps sort out which patients may qualify for Medicaid re-enrollment, presumptive charity, or—if needed—payment plans that can help manage self-pay balances." Optimizing collections: “Finally, our Collections suite of products can scan patient balances and score accounts to help providers prioritize accounts that are most likely to pay.” Q7: How is Experian Health helping individual clients deal with Medicaid redetermination? “When we talk about these issues generally, we tend to give a lot of 'it depends' answers,” says Ankumah. “That's because a lot of what's happening is state dependent. We really want to make sure that we offer guidance that gives our clients the most value and fits their individual circumstances. “With that in mind, one of the best things a client can do is to work with their relationship manager. They can offer real insights into how their state Medicaid is addressing redetermination, including dates and timing.” Relationship managers can also help providers navigate workflow changes efficiently. “For example, a provider might think sending through daily batches to see who qualifies for Medicaid is a good idea, but they'll be charged for those transactions and can very quickly go over their budget. Our team is here to help providers develop protocols that keep them up to date without overdoing it. “We also have a team dedicated to monitoring payer updates,” Ankumah notes. “We're following what our clients are hearing from their state Medicaid agencies, but we're also looking closely at updates and querying our databases to leverage information and return it back for the benefit of all our clients.” Find out how Experian Health's Insurance Eligibility Verification solution can help connect providers with more than 890 payers, including state Medicaid agencies nationwide.