Price Transparency

According to the most recent figures from the Centers for Disease Control and Prevention, around 8.8% of Americans are without health insurance. While this has dipped since the pandemic high of 10.3% towards the end of 2020, it still leaves nearly 30 million people facing the often-difficult decision of what to do when they need healthcare. A further 40 million underinsured individuals could find themselves in the same position.  Do they pay for it themselves, avoid care altogether or seek financial assistance? With inflation on the rise and government pandemic support coming to an end, even those with coverage may need additional charity care support. Several regulatory efforts have been made to address healthcare affordability and increase transparency around charity care, particularly at the state level. For providers, the challenge is to find efficient ways to screen for charity care eligibility as more patients become eligible for support, and remain compliant as these new regulations come into effect. Why screen for presumptive charity? Eligibility for charity care depends on a hospital's financial assistance policy and relevant state regulations. Uninsured patients may be offered a full or partial discount on their medical bill, while insured patients may be awarded a discount on the cost of care. Without charity care, these unpaid bills would be tagged as bad debt, which could lead to patients being chased for payments they're unable to make and affect the provider's cash flow. To qualify for charity care, patients are often asked to share their household size and income, among other details. Often a provider will ask patients if they'd like to fill out financial assistance forms during patient intake, but many patients decline or are unable to provide the necessary information. Some may feel embarrassed about needing support or worry about how the information will be used. There may be language or literacy barriers. Some may assume they're not entitled to support and decline the forms. To get around this, providers use automated screening software to identify patients who may be eligible for charity care. This pulls together credit information, demographic data and financial details to determine whether the patient qualifies. Patients get the support – and thus the care – they need, and providers can focus their collections efforts on those who are most likely to be able to pay. Regulation 501(r) permits this type of presumptive screening by a reputable third party. What does the legislation say about charity care? As the use of presumptive eligibility screening has grown, several federal and state regulations have been introduced to encourage clarity, consistency and best practice. Providers must keep pace with changes to charity care policy or risk civil penalties or the loss of tax-exempt status. Under the Affordable Care Act, Regulation 501(r) requires hospitals that offer charity care to have a written financial assistance policy, specify maximum amounts that eligible patients can be charged, and determine a patient's eligibility before sending their bill to collections. Again, it allows for this process to be automated using a third-party vendor. Individual states also have their own requirements around eligibility screening, for example: In Washington, the legislature has recently voted to expand charity care eligibility as of July 1 2022 for patients who meet federal poverty level thresholds and have exhausted third-party coverage options. The new rules require hospitals to identify patients that might be eligible for retroactive Medicaid support and support them in applying for coverage. In California, the AB 1020 rule raises the income level for charity care eligibility to 400% of the federal poverty level. Hospitals must display online notices explaining their policy for financially qualified and self-pay patients. They must also wait 180 days before assigning unpaid patient bills to collections, and provide information to patients before doing so. AB 532 requires hospitals to give patients written details of patient charity care and discount policies at the time of service or at least before they are discharged. How can providers streamline the presumptive screening process? Automated presumptive screening can help providers comply with these new rules and implement their own financial assistance policies in the most efficient way. For example, Experian Health's Patient Financial Clearance uses current financial data to screen patients for Medicaid, charity care and other financial assistance programs in line with the provider's unique charity policies. It incorporates customizable logic that helps providers adhere to regulatory requirements and internal rules around charity care and billing. Screening happens automatically prior to or at the point of service, generating an estimated Federal Poverty Level (FPL) percentage for each guarantor.  A healthcare-based propensity to pay score can also be calculated, giving providers a further data point to work best with patients. This makes it easy for patient advocates to connect patients with the most appropriate financial assistance program, and even auto-enroll them. If the patient does have an amount to pay, they can be guided to the optimal payment plan for their individual circumstances. Patients can get direct access to screening qualification tools too, with solutions like Patient Financial Clearance. They can check their qualification status and upload documentation to qualify for discounted or free care via text to their mobile device. In addition to helping providers ensure regulatory compliance and document charitable services, this tool helps maximize collections and deliver a patient-centered financial experience. Providers should also check that their collections partners are aware of their obligations under charity care law, and ensure they're compliant, too. Keeping patients in the loop during charity care eligibility screening Clear communication is at the heart of a compassionate patient experience, fostering loyalty and trust. In the context of charity care screening, this means making sure that patients know that financial assistance may be available (now also a requirement under charity care regulations). In the past, some patients were not informed about how to apply for financial assistance and struggled with bills they couldn't afford. Others were assigned to charity care without their knowledge and spent months worrying unnecessarily about bills that would never arrive. Automated charity care checks solve both situations, by ensuring that no patient misses out on support to which they're entitled and by making it easy for providers to notify them. Patient Financial Clearance generates scripts for patient advocates to use during financial counseling discussions, to help patients navigate the financial process with greater ease. And with mobile text charity screening, the patient gets the information they need, right in the palm of their hand, so they can engage with the process more easily. Patient Outreach solutions can complement these activities by providing timely and personalized prompts and reminders through the patients' preferred communication channels. Not only will this enhance the patient experience and support compliance with charity screening rules, but it also helps improve patient outcomes by keeping patients on track with their care plans and driving down unnecessary readmissions. And for patients who do have an amount to pay, a payment experience that's tailored to their financial circumstances will further boost patient satisfaction and collections. The ROI on these tools can be significant. Let's say a hospital treats 1,460 uninsured patients per month. If just 10% of those patients qualify for Medicaid, at an average reimbursement rate of $1000, the hospital could claim $146,000 per month by ensuring those patients are enrolled – and avoid writing off nearly $1.8 million per year. As economic uncertainty continues to weigh on providers and patients alike, the pressure's on to streamline patient collections and prevent avoidable missteps such as non-compliance with charity care rules. Find out how using an automated financial assistance process with Patient Financial Clearance can create a safety net for providers and patients, increase collections and reduce bad debt as patient financial responsibility increases.

Experian is one of three credit bureaus to remove cleared medical debt from consumer credit scores, as of July 1, 2022. Previously, debts that were sent to collections would remain on patients’ credit scores for up to seven years after they’d been paid, making it harder to secure credit cards, loans and housing. Patients will also have double the time to manage unpaid medical debt before it appears on credit scores (up from six months to one year). Unpaid bills under $500 will no longer appear at all. It’s great news for the millions of Americans burdened by medical debt and financial stress and is one step to improving patient payments. The measures are expected to remove nearly 70% of medical collection debt from consumer credit reports. In a joint statement, Experian, TransUnion and Equifax said: “Medical collections debt often arises from unforeseen medical circumstances. These changes are another step we’re taking together to help people across the United States focus on their financial and personal wellbeing. As an industry we remain committed to helping drive fair and affordable access to credit for all consumers.” Healthcare providers can support efforts to ease financial pressures on consumers (and protect their own profit margins) in two major ways: by introducing transparent pricing and improving the patient payment experience. Help patients plan and understand medical bills with price transparency tools  July 1 also saw the implementation of the new Transparency in Coverage Final Rule, which places new responsibilities on health insurers to share negotiated rates for covered items and services. In theory, providing upfront estimates of the cost of care allows patients to make more informed decisions about their healthcare and plan for forthcoming bills with more confidence. In practice, it’s easier said than done. A report from August 2022 found that only 16% of hospitals are compliant with the earlier Hospital Price Transparency Rule. Non-compliance penalties aside, it makes good financial sense to help patients understand and plan for their medical bills: 9 out of 10 providers recognize that when patients have upfront estimates, they’re more likely to pay in full and on time. Digital and automated tools can make this easier to deliver. With Patient Payment Estimates, patients get a simple breakdown of their expected costs delivered straight to their mobile device, so they can plan – and even pay – in advance of treatment. Of course, estimates are only useful if they’re accurate, so this solution pulls from real-time price lists, payer contracts and benefits data so that estimates are as close as possible to the final bill. Provide an “Amazon-inspired” patient payments experience When it comes to patient payments, consumers want the “Amazon experience” – personalized payment options, easy-access digital payment methods, and above all, choice about when and where to pay. These three trends quickly gathered ground during the pandemic, and are set to outlast it. Providers looking to up-level the patient payments experience can’t afford to omit digital and contactless payment options. To help deliver this, Experian Health offers a menu of self-service, mobile-optimized payment solutions. For example, with Patient Financial Advisor, providers can help patients take control of their financial journey through a simple text-to-mobile experience. Patients get a text message with a secure link to details of their estimated financial responsibility and links to user-friendly payment tools. They can also be advised on appropriate personalized payment plans. Support patients to manage healthcare payments  For some patients, pricing estimates may influence their decision to access care in the first place. A new collaborative report by Experian Health and PYMNTS, released in July 2022, found that nearly 50% of consumers have canceled a healthcare appointment or procedure due to the high cost of medical treatment. The study also found that three-quarters of millennials canceled a healthcare appointment after receiving a high-cost estimate, as have 60% of consumers living paycheck to paycheck. Providers can use digital tools to identify patients who may need more assistance when it comes to paying for care and assign them to the appropriate pathway. Patient Financial Clearance screens patients automatically prior to or at the point of service to see if they qualify for financial assistance or charity support. It determines how likely a patient is to pay out-of-pocket expenses, and can calculate the optimal payment plan based on the patient’s specific circumstances. Another option is PatientSimple, which offers a user-friendly self-service portal to help patients apply for charity care and keep track of balances and payment plans. Of course, a huge amount of financial worry can be eliminated by simply tracking down missing or forgotten coverage, so the patient can relax knowing their bills will be covered. Coverage Discovery runs automated coverage checks across the entire patient journey to minimize accounts sent to collections and charity. In 2021, Coverage Discovery tracked down billable coverage in nearly 3 out of 10 self-pay accounts, amounting to more than $66 billion in additional revenue. Providers that create a patient-centered payments experience will not only deliver a better service to those needing care, but will be better placed to meet changing legislative requirements and strengthen their own revenue cycles. Find out how Experian Health’s digital patient payments solutions can help healthcare organizations transform the patient financial journey from a maze of dead ends and obstacles to one that’s clearly mapped out and simple to navigate.

Patients hit with a double whammy of rising costs and soaring inflation need to know where they stand when it comes to medical bills. Financially stretched patients often prioritize other household bills over healthcare payments, but delays can quickly spiral toward debt. When patients know their bills in advance, they’re better positioned to avoid medical debt – which is the thinking behind the No Surprises Act and other price transparency rules. Despite the benefits to providers, implementing accurate upfront price estimates is proving to be tricky. As of August 2022, only 16% of hospitals were found to comply with the federal price transparency rule, with the first financial penalties for non-compliance reported in June 2022. New measures that were recently announced will continue to address medical debt, and enforce price transparency rules more stringently. These turn up the heat on providers to find ways to simplify the patient payment experience. In a recent conversation with PYMNTS, Victoria Dames, Vice President of Product Management at Experian Health, highlighted three smart investments providers can make to help tackle the challenges associated with price transparency rules. Investment 1: Delivering accurate estimates Patients who do not see cost estimates before treatment are less satisfied than other patients. A study commissioned by Experian Health and PYMNTS found that patient satisfaction increased from 78% to 88% when estimates were available. But as Dames notes, estimates are useless if they’re inaccurate: “it's common to get an estimate today. It's less common to get a very accurate estimate.” She says that the renewed political focus on medical debt is likely to prompt investment in billing technologies to generate and deliver more accurate estimates. One such technology is Patient Payment Estimates, which offers patients a clear, accessible and easy-to-understand breakdown of what they’re likely to owe. It pulls from current chargemaster data and payer contracts and applies real-time benefits data for maximum accuracy. There’s no need for providers to manually upload price lists or call the patient to explain their estimates. It can even connect to convenient digital payment methods and provide payment plans, placing the patient in the driver’s seat when it comes to managing their financial responsibility. Investment 2: Implementing cutting-edge payment technology Dames says that once accurate estimates have been generated, the next big task is to enable consumer-friendly payment technology. She says, “Making the payment process simple and convenient will increase your likelihood for payment… it makes it easier for us as consumers to meet our financial obligations in a timely manner. A lot of providers are already in the process of reviewing and integrating technology to help support this.” Patients expect a variety of payment methods, similar to the convenient digital methods they use in retail environments. More than half of consumers say the pandemic changed how they pay for healthcare, with more choosing contactless cards, mobile wallets, online portals, and online peer-to-peer transfer services. Dames has noticed that “buy now, pay later” options are also entering the healthcare marketplace, which she believes will help to create a positive and transparent patient experience. Experian Health offers a suite of payment tools so that providers can collect all forms of payment anytime, anywhere. For example, Patient Financial Advisor brings together pricing estimates with user-friendly payment methods, so patients know what to expect and can make payments directly through their mobile devices. Investment 3: Optimizing collections with advanced data analytics Finally, Dames recommends that providers review their investments in collections optimization technologies. The goal should be to use a broad set of data to paint a picture of each patient’s past medical payments, recent financial situation, and current propensity to pay. Better data and analytics can help direct patients to the right payment plans. With more insights into each patient’s individual situation, providers will be able to see who needs more time to pay and who may be eligible for charity care. Data-driven tools such as Patient Financial Clearance can screen patients and assign them to the appropriate pathways, while PatientSimple helps patients manage their payment plans and apply for assistance if necessary. Experian Health works with more than 60% of US hospitals to improve revenue cycle management, so Dames knows that it’s a tough time for providers to update their workflows, systems and practices. When it comes to transparent pricing, Dames notes that regulations may be challenging for providers and payers. However, the subsequent investments will be instrumental in complying with price transparency rules and create patient-centered financial experiences: “The immediate path to better billing and payment processes may escalate pressures on providers right now, but it will yield better financial outcomes in the future for patients.” With the right technology partner, providers can tackle price transparency and increase patient collections. Find out how Experian’s data-driven patient estimates solutions can help healthcare organizations deliver more accurate pricing estimates and tackle price transparency rules.

New research from Deloitte reports that healthcare costs for the average American could jump from $1000 to $3000 per year by 2040, putting pressure on households that are already feeling financially squeezed. Concerns about healthcare bills could push patients to delay or even default on payments. With inflation on the rise, providers must find ways to create a compassionate financial experience for patients to maximize collections. That's where Patient Financial Clearance comes in. While inflation and economic pressures are systemic challenges, the impact is individual. This should galvanize healthcare providers to find out exactly how patients may be affected. Using that knowledge, providers can then tailor the financial journey to make it as straightforward as possible for patients to manage their healthcare bills, whatever their specific circumstances. With data on patients' ability and likelihood to pay, providers can tailor charity care checks and maximize collections by building a collections process with the patient at its heart. Create a compassionate collections experience with Patient Financial Clearance Improving patient collections starts with identifying patients that are unlikely to be able to pay and checking their eligibility for extra support. Traditionally, providers might use manual processes to calculate a patient's propensity to pay or entitlement to financial assistance. This might involve asking the patient to fill out a form with their financial details, calling the patient and the patient's employer multiple times to understand their income, manually checking their information against the Federal Poverty Level to see if it meets the threshold for full or partial charity support, and then having the patient fill out yet more forms. Such labor-intensive work is a drain on staff resources, and often a stressful experience for patients. Patient Financial Clearance helps create a more positive financial experience by automating eligibility checks. That way, patients can be assigned to the right payment pathway without delay. This solution also empowers patients with mobile text-based financial screening and provides them with updates on their charity status. It uses current financial data to screen patients to see if they're eligible for Medicaid, charity support or other financial assistance programs, prior to or at the point of service. Armed with this data, providers can offer the best possible support to these patients and even auto-enroll them in the right program. For those with medical bills, Patient Financial Clearance calculates an optimal payment plan based on how much the patient is likely to be able to afford, so patients are clear about what they'll owe and when. It can also suggest upfront fee collection when a patient can afford to pay but has been historically slow to do so. Personalizing the payment pathway with digital financial solutions Making sure patients don't miss out on financial assistance is just one way to use data and automation to personalize the payment process. Data-driven personalization should be a thread that runs through the entire financial experience, including: 1. Personalized upfront payment estimates Price transparency remains high on the agenda. Patients want to know their bills in advance so they can plan. Surprise bills lead to delays and frustration, to the detriment of both patients and providers. With Patient Payment Estimates, self-pay patients can generate personalized pre-service cost estimates so they can get their financial ducks in a row before treatment even begins. These estimates are based on the patient's individual insurance status, current payer rates and the provider's chargemaster data. The tool also incorporates any applicable financial assistance, applies prompt-pay discounts, and suggests convenient payment plans that fit the patient's individual circumstances. 2. Tailored payment plans for all Once the patient has their estimates, they'll want to know exactly when and how to pay. Some will be able to pay the full amount upfront, while others may need to spread out payments into more affordable chunks. Providers can maximize swift collections by ensuring that individual patients are directed toward the most appropriate option. Oftentimes, it may make sense to collect more payments upfront to alleviate collections costs downstream. One way to deliver this is through a self-service portal such as PatientSimple, which provides a one-stop-shop for patients to view their estimates, consider pricing plans and keep credit card details on file. Being able to plan in this way gives patients more control and avoids any confusion about payments. 3. Consumer-friendly payment methods When it's time to pay, patients want options. Not everyone wants to come into the office, send credit card details in the mail, or exchange details over the phone. Online payment portals, contactless payments and mobile wallets are increasingly popular. Therefore, providers need to offer convenient digital payment options to remain competitive.Offering a menu of payment options early in the patient journey means patients can “frontload” their financial admin, get payments out of the way, and focus on medical treatment. By giving patients control over how they pay, providers can reduce the risk of late and missed payments. 4. Timely and relevant communications If there's one action that can make or break a patient's perception of their financial experience, it's how their provider communicates with them. If information about medical billing is accurate, timely and compassionate, then the patient will feel more positively than if messages seem aggressive or contain errors. Getting this part right will improve patient engagement, drive faster patient collections and boost patient loyalty.Healthcare marketing data can be used to underpin a personalized communications strategy and help providers send the right message at the right time, based on the patient's preferences. When it comes to delivering the message, patient outreach solutions can send automated text and voice messages with bill reminders and links to payment methods to encourage prompt payments. Use Patient Financial Clearance to automate patient financial assistance Building a patient financial experience around the principles of personalization, empathy and convenience puts providers in a stronger position to maximize patient collections than with a one-size-fits-all approach. Find out how Patient Financial Clearance and other digital patient financial solutions leverage data and automation to identify and deliver what each patient needs, to improve patient satisfaction and increase the number of bills paid in full.

According to Jason Considine, Chief Commercial Officer at Experian Health, mounting financial pressure on consumers could lead to more patients missing healthcare payments. “Federal aid packages are being unwound, the country’s opening back up so people are spending money on things they weren’t spending money on before, and to compound that problem, we have inflation coming in at levels we haven’t seen in decades,” Considine said in a recent interview with PYMNTS. “That’s going to have an impact on consumers.” As households continue to feel the strain from rising inflation and other factors, providers need to embrace price transparency and move quickly to implement digital patient payment solutions and get ahead of growing medical debt. Expedite payments with transparent pricing The first task for providers is to make it easier for patients to plan for their medical bills by sharing cost information in advance. Among Experian Health’s clients, Considine has noticed increasing investments in tools that provide clear, upfront patient estimates. “Historically, this has been an area where providers haven’t met the needs of consumers. As patients, we’ve always wanted estimates. This is not a new thing… but providers are getting better at this, and regulation is helping. We’ve seen an acceleration, though there is certainly a long way to go.” Patient demand and price transparency regulations (like the No Surprises Act) are driving faster adoption of patient estimate technologies. However, providers need to go further than simply providing price estimates. Providers need to be proactive in helping them access and understand those estimates. In a recent survey by PYMNTS and Experian Health, 15% of patients said they run into challenges when obtaining accurate cost estimates for appointments and procedures. While the technology is there, patients aren’t always using the tools. Only 6% of patients with access to patient portals (that included access to cost estimates) said they knew the cost of care in advance. Providers need to cater to their customers and help remove hurdles that stand in the way. Experian Health’s patient estimate solutions go beyond simply providing estimates. These solutions give patients clear breakdowns of their expected out-of-pocket expenses, delivered online or by text message. They also connect patients to information about financial assistance options and payment plans and close the payment loop with direct links to pay. Clear up coverage confusion by identifying insurance early Another way to eliminate consumer confusion is with tools that help identify any missing or undisclosed insurance coverage, so payers and patients are billed correctly the first time. Considine says, “Oftentimes patients don’t understand their healthcare insurance. It’s quite complex and they may not know if it covers certain services. There are also a number of reasons why providers don’t collect the right insurance information during the registration process. There are tools available to make sure you’re actually billing the insurance when insurance coverage is available. That’ll increase the likelihood of payment and reduce pressure on consumers.” One example is Experian Health’s Coverage Discovery solution, which checks for any coverage eligibility early on and often throughout the patient journey. Providers get paid faster, avoid the collections challenges of self-pay receivables, and ease consumer frustrations about confusing coverage arrangements. Cater to consumers with patient-centered payment plans Considine says patients will gravitate towards the most convenient financial experiences, where they can get an understanding of what they owe before coming in, easily enroll in payment plans, store credit cards on file, and find easy ways to pay and engage with their provider online. When it comes to payment plans, the data is available to help providers guide patients toward the most appropriate financial pathway. Considine notes that leveraging data to make smarter decisions helps consumers and patients alike. If the data shows that a patient is eligible for financial assistance, they can avoid unnecessary bills, which makes for a great patient experience. “And if the patients do need a payment plan, we can know that ahead of time and offer the right payment plan based on their financial disposition.” By simplifying the financial journey with patient-centered payments, providers can ease pressure on consumers, avoid lost revenue and foster patient loyalty. Get paid faster by providing easy ways to pay After clarifying the amounts to be paid, checking for available coverage, and determining the right payment plan, the final piece in the patient payments puzzle is the payment process itself. COVID-19 accelerated the use of digital payment tools. According to Experian Health and PYMNTS research, a quarter of consumers used digital methods to pay for their most recent healthcare visits, with 14% choosing to pay through patient portals. Providers that offer a range of flexible payment options and give digital-first patients a seamless consumer experience are going to stand out from the competition. Digital patient payment solutions are now table stakes. Act now to protect against a wave of medical debt While the impact of inflation over the coming year remains to be seen, Considine says that providers should move now to invest in technologies that offer convenience, flexibility and transparency to patients. “All of those things are going to expedite payments for providers and help reduce pressure on consumers, but I wouldn’t wait. These solutions can typically take a little bit of time to get implemented, and then adopted by patients, so the time is now for providers to get ready, prepare and implement these technologies.” Download Experian Health and PYMNT’s joint report, Accessing Healthcare: Easing Digital Frictions in the Patient Journey, to discover more about how patients are using digital patient payment solutions and opportunities to expedite healthcare collections.

Recent data suggests that implementing transparent pricing has been a bumpy ride for some healthcare organizations. The federal hospital price transparency rule, which took effect in January 2021, requires hospitals to provide “clear, accessible pricing information” to make it easier for healthcare consumers to compare prices before going to the hospital. But a recent survey by Patient Rights Advocate found that fewer than 15% of hospitals are fully compliant with the requirements for machine-readable files and consumer-friendly shoppable lists. The Centers for Medicare and Medicaid Services (CMS) confirmed that around 345 warning notices and 136 corrective action plan requests were sent to non-compliant hospitals between January 2021 and March 2022. Providers that fail to improve healthcare price transparency not only risk hefty penalties, they also alienate patients who want a financial experience without surprise medical bills. It’s not an unreasonable request – how can patients take control of their health finance decisions without upfront, accurate and accessible pricing information? Proceeding with treatment without knowing the cost and then waiting months for a bill is a far from satisfying patient experience. Providers that want to satisfy both patients and policy-makers must do more to ease frictions in patient billing. Regulatory change is only part of the solution. With the right digital payment tools and strategies, providers can eliminate many of their patients’ price transparency pain points and improve their financial journey. Pain point 1: finding accurate price estimates prior to care One of the biggest pain points for patients is not having advance knowledge of the cost of care. In a survey conducted by Experian Health and PYMNTS, 15% of patients said they struggled to obtain accurate cost estimates before appointments and procedures, which curbed their satisfaction with their overall care experience. This figure rose among the most active users of digital services, with 21% of digital-first patients saying they faced challenges receiving a breakdown of estimated medical bills. Given that this group also said they would be more likely to switch providers based on the quality of digital services, getting transparent pricing right is high stakes. Providers can improve healthcare price transparency and solve this pain point by giving patients easy-access pricing information upfront. Patient Estimates can offer patients clear and easy-to-understand personalized estimates of their financial responsibility. This is done by drawing on key provider data sources and including the patient’s current insurance benefits information. Patients get estimates and payment options directly to their mobile devices, so they can choose the pathway that suits them best. This puts them in control of their payments, so they’re less likely to hit roadblocks as they move through their financial journey. Pain point 2: complex payment systems are difficult to navigate Another way to allow patients to feel in charge of their own financial journey is to offer a choice of convenient and flexible digital tools and services. A little over 20% of digital-first patients said they’d experienced difficulties when viewing invoices, setting up payment plans and making payments. As younger patients form a greater portion of new patient cohorts, there’s likely to be an increasing push for digital payment methods. Providers can engage patients before and after treatment using a text-to-mobile service such as Patient Financial Advisor, which shows patients their estimated responsibility and points them toward best-fit payment plans. This works well alongside PatientSimple, a self-service portal that puts the power in patients’ hands, allowing them to generate their own price estimates, apply for charity care and set up payment plans. Pain point 3: understanding medical bills (even with estimates) Unfortunately, many patients struggle to make sense of medical bills, even when estimates are available. Seven out of ten consumers say they would like to know the cost of care in advance, but more than half also say they’ve never thought to look for that information. A Health Affairs study found that utilization of a price transparency tool increased by 600% following marketing efforts – but patients largely chose the same clinicians as before. Even with upfront pricing information, most consumers don’t have the time or resources to assess quality and piece together fragmented bills. Providers can support patients by implementing a price transparency strategy that combines accurate pricing estimates, user-friendly interfaces and easy ways to pay with clear communications. Hospitals are turning to third-party solution providers like Experian Health to help solve their price transparency problems. Find out more about how Experian Health’s solutions can help healthcare providers improve healthcare price transparency and deliver more accurate price estimates, reduce administrative and financial pain points, and create a more satisfying patient experience.

Healthcare’s digital transformation promises patients ever-growing choices in how to access, experience and pay for care. Providers know that opening their digital front door is the key to attracting and retaining loyal consumers. However, deciding on the exact technologies and services to offer can be challenging. A good place to start is to follow the patients’ lead: what digital tools do they say they want? How are they using existing services (or not)? By understanding patients’ attitudes and behaviors, providers can design a digital patient journey that leads to increased patient satisfaction. A new collaborative report by Experian Health and PYMNTS provides fresh insights to inform digital patient engagement strategies. This survey, conducted in January 2022, interviewed over 2000 patients to understand how they’re using digital methods to access healthcare services and their biggest pain points. The findings revealed a need for digital services that foster convenience and choice. Digital-savvy consumers expect user-friendly online options across the care continuum, from scheduling and registration to final payment. Improving these services is also likely to encourage the less digitally confident consumers to try alternative methods and increase access to care. This article offers a snapshot of the key findings that will help providers identify gaps in their digital offerings and build a digital experience that meets consumer expectations. Finding 1: Patients are looking for digital methods to perform most healthcare activities. Patient portals are the most popular method for obtaining test results, with 44% of patients choosing this option. A quarter of patients have used digital methods to pay their medical bills. Digital methods are widely used across the patient journey, from scheduling appointments to receiving test results. Patients expect convenience, flexibility and choices, with many reporting frustrations when they can’t access the digital services they desire. Providers that offer a broad selection of digital patient engagement solutions will be best placed to respond to changing consumer demands. Beyond patient satisfaction, digital tools facilitate better care plan adherence, improve workforce efficiency, and contribute to higher patient collections rates. Finding 2: Patients are satisfied with their healthcare experience but find it challenging to confirm costs and select new providers. 15% of patients report difficulties when obtaining accurate cost estimates for appointments and procedures. Predictably, digital-first patients have the highest expectations of digital systems. They are accustomed to convenient and accessible digital processes elsewhere in the consumer world. Healthcare organizations with an open digital front door will be more attractive to these potential new patients. Digital payments could be a worthwhile investment in this regard. A previous PYMNTS survey found that 63% of patients would consider switching providers if the payment experience wasn’t up to par. To improve the payment experience, providers should consider offering upfront pricing estimates to make it easier for patients to understand and plan for their bills. A tool such as Patient Financial Advisor can act as an online financial concierge for patients, by connecting them with appropriate payment plans and contactless payment methods directly through their mobile devices. Finding 3: Two-thirds of patients use patient portals, but many find portals lack essential payment features. While 62% of patients use portals, this rises to 82% among digital-first consumers and drops to 19% among non-digital consumers. 64% of patients say cost estimates are very or extremely important, but only 24% say they receive estimates. Closing the gap between what patients expect of portals and what’s actually delivered could help narrow the differences in portal usage between different patient groups. Credit and debit cards are currently the most popular payment methods, but patients would use them less often if their preferred digital payment methods were available. Providers should consider combining high-performing patient portals with a range of payment options. Finding 4: Frictionless patient portals could prevent patients from switching providers. 61% of patients say they would switch to a healthcare provider that offers a patient portal. Improving patient portal capabilities is likely to be an important driver in attracting new patients. However, it’s also essential to retain existing patients. More than six in ten patients say they’d switch to a provider that offers a patient portal. This number rises to nearly eight in ten younger patients. A digital-first experience is no longer simply a preference, but an expectation for many consumers. To better engage and retain consumers throughout the patient journey, providers must explore the use of patient portals and other digital solutions to remove digital pain points and meet consumer expectations for a frictionless patient access experience. Download the full report to learn how healthcare providers can relieve digital pain points to offer improved patient care and satisfaction.

Patient experience may not be the first consideration that comes to mind when you're looking to improve revenue cycle management (RCM). However, a positive patient experience can benefit RCM. It can make the complicated process of understanding and managing healthcare finances simpler and more seamless for patients—and facilitate an easy-to-navigate continuum of care that includes RCM. Financial transparency plays a significant role in building trust and confidence between patient and provider. Patients who may find it difficult to understand medical billing and health insurance coverage—and who are paying more out-of-pocket costs thanks to high-deductible health plans—appreciate accurate estimates and a range of convenient payment options. By optimizing back-end claims, billing, payment and collections processes, providers free up staff to provide individualized help to patients who need it. Strategies to bolster patient experience and RCM Patients who have grown accustomed to using digital platforms for everything from online shopping to food delivery, travel, managing finances and entertainment gravitate toward digital tools and expect a high level of functionality. In a Salesforce survey of 15,000 consumers, 68% of respondents said their expectations of companies' digital capabilities increased after COVID-19 drove more of their activity online. Providing a superior digital experience is now synonymous with good service, but healthcare is lagging behind other service sectors. For providers, automation and data analytics can streamline workflows and improve efficiencies. These factors are critical as staff find themselves under increasing pressure to provide accurate patient estimates upfront and to submit claims accurately to reduce denials. How can providers use the patient experience to improve RCM? Here are a few areas of focus to consider: 1. Offer consumer-friendly front-end technology Patients are looking for seamless digital experiences, where they are empowered to search out what they want, choose from a menu of options and pay effortlessly online. In a healthcare setting, they want to find and schedule their own appointments quickly. Providing new and existing patients with 24/7 mobile access to online patient scheduling is critical to early engagement. In fact, a new report from Experian Health and PYMNTS revealed that 61% of patients interested in using patient portals say they would switch to a healthcare provider that has one. Providing patients with an accurate estimate they can review in advance improves transparency and builds trust. This allows patients to ask questions and make decisions about how to pay on their own time and without pressure. Pre-appointment estimates might also offer patients the opportunity to pay conveniently online before their appointments or at the point of service, minimizing the need for post-treatment collections and reducing RCM costs. 2. Simplify and automate in-office technology Automation can boost the experience on both sides of the front desk. Automated processes simplify patient-facing tasks like registration and check-in while making back-office operations like data entry and authorizations more efficient. “When a patient submits photos of their insurance card and identification, software scrapes that information and inputs it into the system,” Serie explains. “This process is more convenient for the patient, faster and more efficient for staff, and reduces the potential for human error.” As healthcare providers continue to experience staffing shortages, automated systems can offer greater workplace flexibility. That's helpful for providers that need to flex their resources, but also for employees who want more options on where and when they work. 3. Provide price transparency and financial information to improve the patient experience In a Policygenius consumer survey, 26% of respondents said they have avoided care or treatment because they were unsure what their insurance covers. Patients might be forgiven for feeling confused and frustrated – healthcare bills are not always patient-centric. In fact, many consumers report a low level of insurance literacy and, unless told, don't know in advance what medical procedures are likely to cost. At the same time, out-of-pocket costs are rising, raising the stakes and increasing the likelihood that medical bills will pose a significant financial challenge. Outlining estimated costs prior to service can help patients understand their expected out-of-pocket payments. Accurate patient payment estimates take away some of the sticker shock and give patients an opportunity to discuss coverage with their insurance companies, choose the right payment methods, or arrange for payment plans before treatment happens. 4. Allow for online bill payments Frictionless payments are now the norm, online and in-app. Experian Health's PatientSimple solution offers healthcare organizations a suite of tools to simplify payment. Using a healthcare-specific algorithm, PatientSimple provides personalized, data-driven insights that help providers deliver the right messaging and payment options, including: Price estimates based on insurance coverage and payer's negotiated rates Guest payment option for patients who don't want to set up an account Online payments and payment plans E-statements, online account access and email payment reminders Qualification for financial assistance A smoother path to payment increases the chances that patients will pay pre-appointment or at the point of service. By offering patients more and better payment options providers can increase up-front revenue and reduce the need for collections. 5. Enable self-service Frictionless payments are just one facet of helping patients help themselves. Enabling the tools that create a “digital front door”—including the ability for patients to register and check-in online, access a virtual waiting room and make “contactless” payments—can boost engagement and give patients greater choice, control and convenience. By mapping a patient journey that flows seamlessly between virtual and in-person interactions, providers can set the stage for receiving payment earlier in the process. This can also help with outreach to patients post-care for follow-up and payment, if necessary. 6. Ensure coding and billing accuracy Clear, accurate patient billing is the goal, but keeping up with changes across multiple payers is an ongoing challenge for healthcare providers. New products, mergers and acquisitions, policy and procedure changes all create the potential for errors, denials, delay and lost revenue. Experian Health's Payer Alerts helps notify providers of payer policy and procedural changes with a daily digest email and an online portal. A simplified estimate process with fewer revisions streamlines the RCM process; it also helps patients avoid confusion, which degrades the patient experience and may cause patients to delay payment. 7. Optimize bill collections Collections can be one of the most difficult parts of healthcare RCM. On the patient side, post-treatment collections feel like a hassle; they may also become a source of significant financial problems. For providers, collections can be costly and time-consuming. Optimizing collections with automation and data analytics can streamline the process and improve outcomes. Experian Health's Collections Optimization Manager uses specialized scoring algorithms to segment and prioritizes accounts based on the likelihood they'll be able to pay. Automated billing and outreach make collections less onerous for staff, while automatic updates keep accounts and communications current. For patients, providing convenient digital payment options takes some of the friction out of the payment experience and removes at least one barrier to bringing an account current. Patient experience and RCM go hand in hand Improving healthcare RCM is certainly not the only reason to work on improving the patient experience. Enhancing the patient journey across the care spectrum can help providers engage new and existing patients, offer the digital tools and seamless experiences they've come to expect, and reduce their anxieties over medical costs. At the same time, using RCM solutions to bolster the patient experience means new efficiencies for staff and, along with this, expanded opportunities for work flexibility and greater success at managing the revenue cycle. Contact Experian Health to learn more about optimizing your patient experience and improving RCM at your organization.

Inflation is giving the cost of healthcare a run for its money. The Consumer Price Index rose by 8.3% year-over-year in August 2022, compared to a rise of just 2.9% in the Health Care Price Index. However, slower price increases do not necessarily mean healthcare will get an easier ride than other businesses. Healthcare contracts are agreed in advance with government and commercial payers, so any effects of inflation could simply be delayed. How should providers factor such economic unpredictability into their revenue cycle management strategies? Healthcare is usually more resistant to wider economic shocks than other service sectors, so rising inflation doesn’t necessarily mean there’s an urgent need to change course. Providers are always working to maintain a healthy revenue cycle and will continue to do so now. That said, the lingering financial effects of the pandemic, staffing shortages and increasing operational costs mean that provider cash flow is sensitive to any added pressure. While there’s currently no sign that patient collections have been significantly affected by inflation yet, patients may assume that health costs will increase too, along with everything else. This might lead them to delay elective care, which could affect providers’ bottom lines. As non-COVID patient traffic slowly returns and state and federal aid ends, rising inflation presents an additional hurdle to providers’ financial health. Providers will need to tighten their patient collections process and safeguard their bottom line. Download the white paper to learn how inflation is impacting healthcare and get strategies to optimize collections and avoid revenue loss. Providers that want to bolster their revenue cycle against the potential impact of inflation should focus on increasing workforce efficiency to manage costs and mitigate the risk of deferred care, to maintain a steady inward cash flow. They’ll also want to be prepared for any potential shift in patient payment reliability that could occur if inflation persists. Automated solutions and self-service digital tools can help to solve these issues. Minimize workforce inefficiency with automation and self-service solutions Questions to consider: How can digital technology and automation improve efficiency and ease pressure on staff? Where can patient self-service solutions help reduce the need for staff input? Inflation is likely to hit providers hardest in relation to payroll expenses. Staffing shortages lead to increased costs as providers raise salaries to attract and retain new staff, pay overtime costs, and hire more temporary workers. Reduced purchasing power will only exacerbate these challenges. Automation and digital tools can help address staffing shortages and keep a lid on payroll costs by increasing efficiency in existing workflows. For example, digital technology can allow patients to take care of many administrative tasks themselves, thus reducing the demand for staff input. Online self-scheduling and registration allow patients to book appointments and fill out pre-service paperwork without taking up valuable staff time. These tools leverage data and automation to pre-fill patient information, which reduces the risk of costly errors and saves time for patients and staff. Further along in the patient journey, automated collections can eliminate much of the manual work that puts pressure on understaffed teams, while increasing the likelihood and speed of payment. Collections Optimization Manager helps increase workforce productivity to make better use of staff time and avoid unnecessary revenue loss. Advanced analytics are used to prioritize accounts by payment probability, which will be increasingly useful should ongoing inflation increase the risk of patient bills going unpaid. Consumer data helps identify the most appropriate communications method for each segment, so the right message can be sent at the right time to boost the chances of collecting a greater percentage of money owed. Automation also helps reduce staff costs to collect, while bumping up the amount of money that comes in the door. As hospital operations become more expensive on the whole, maximizing efficiency in collections is increasingly important. Maximize revenue by removing friction for patients worried about the cost of care Questions to consider: How can providers help patients better understand their bills? How can digital technology make it easier for patients to access and pay for care? The second step is to make sure that dollars keep coming in the door. Managing household bills can be challenging for patients, and there’s no suggestion that the rise in inflation during 2021 has added any new pressure to patients’ ability to pay for healthcare. Experian Health’s clients also continue to see very low levels of delinquency. However, despite pay raises, many consumers are worried that price inflation will overtake any increase in household income, especially as energy and food prices go up. They may decide to cancel or postpone elective care until they’re sure of their financial situation or move their medical bills to the bottom of their priority list. In reality, costs for patients haven’t increased, because of the delayed effect of inflation in healthcare. That’s why it would make more sense for patients to seek elective care sooner rather than later. Given reports of pricing concerns, providers should consider ways to reassure patients about their financial obligations and make sure they don’t miss out on the care they need. Here are some ways that providers can support their patients: Providers can help patients get a better understanding of their medical bills and payment options, by incorporating solutions that offer greater price transparency. Upfront patient estimates delivered directly to their mobile device, with links to appropriate payment plans and payment methods, can help them plan with confidence. This will help to reassure patients that prices have not increased drastically due to inflation, so they are dissuaded from deferring care. Finding missing or forgotten insurance coverage is another strategy to give patients certainty around how their bills will be covered. A tool such as Coverage Discovery can run repeated and automated checks for previously unknown government and commercial coverage, using multiple data sources. Self-service patient access and patient payment tools can help to reduce friction during scheduling, registration and billing, so patients see fewer reasons to postpone care. Liz Serie, Senior Director of Product Management at Experian Health, says, “Automation and patient self-service features can help address the risk of patients choosing to put off visiting their doctor or getting a procedure they need. Many patient access and patient payment activities that would normally require staff attention can be easily pivoted to an innovative patient-facing experience. This will reduce friction for patients and help providers manage staffing shortages and cost pressures.” “Automation and patient self-service features can help address the risk of patients choosing to put off visiting their doctor or getting a procedure they need. Many patient access and patient payment activities that would normally require staff attention can be easily pivoted to an innovative patient-facing experience. This will reduce friction for patients and help providers manage staffing shortages and cost pressures.” - Liz Serie, Senior Director of Product Management Find out more about how Experian Health’s digital tools and solutions can help healthcare organizations create a financial safety net and protect their revenue cycle against the possible impact of inflation.