As patient expectations shift, providers that offer a personalized healthcare marketing experience will be more likely to attract and retain satisfied consumers. The pandemic accelerated this shift. As a result, the traditional ways of healthcare marketing are starting to fall short. For example: A healthcare marketing strategy that’s designed for an “average consumer” results in a one-size-fits-all model that doesn’t always meet a patient’s individual needs. Communication options with fixed hours and channels don’t reflect “patient first.” Outreach messages blasted to an entire patient email list miss the mark for individuals who don’t speak the language or might prefer a quick text message instead. A study by Dassault Systèmes and CITE Research found that 83% of consumers expect products and services to be personalized within moments or hours. They’re accustomed to the “one-click” digital retail experience, which offers instant access to relevant recommendations and flexibility about how and when to buy. They’re also suffering from information overload, thanks to the sheer volume of emails, messages, articles and videos flooding their digital devices. Personalized communications can remedy that and help consumers feel respected and empowered, which drives connection and loyalty. But personalization isn’t just important for patient outreach. Personalized healthcare marketing can also help ensure patients get the treatment they need, by anticipating individual needs and highlighting relevant services at the right time. With the COVID-19 pandemic continuing to influence access to care, personalized healthcare communications can also be tailored for different patient segments. This can help reassure or remind individuals to book vaccination appointments or reschedule deferred care. Improve patient engagement with personalized outreach As digital offerings grow, consumer engagement expectations evolve. Providers must keep pace and communicate accordingly. Incorporating information about patients’ lifestyles, behaviors and preferences enables providers to deliver the right message at the right time. It also helps providers select and use the most effective channel of communication. Patients are more likely to respond and are empowered to manage their healthcare journey. For example, a Gen Z patient may prefer to receive appointment reminders by text, while an older patient may prefer a physical letter. One patient may prefer to get prescriptions mailed to their home while they’re at work, while another may be content to visit a pharmacy and pick up their medication while shopping nearby. Some patients will want a text message with a payment link to clear outstanding bills immediately, while others will appreciate a customized payment plan. Experian Health’s State of Patient Access survey 2.0 found that patients welcome proactive outreach by providers, though many say this doesn’t happen. Providers recognize the value in proactive patient engagement, but many say they lack the data to reach out effectively. With reliable consumer data and analytics, providers can create holistic profiles and deliver improved marketing to better serve new and existing patients. ConsumerViewSM pools data points on core demographics, behavioral insights, psychographic information and financial data to help providers understand their patients. This data can then be analyzed using Mosaic® USA and TrueTouchSM to segment, identify and reach the target audience with the most relevant message and format, and adapt based on consumer response. ConsumerView also adheres to consumer data privacy regulations, so providers can actively engage patients and build patient loyalty while confident in the knowledge that they have permission to use the data. Reduce readmissions and improve patient outcomes with better segmentation Personalized healthcare marketing isn’t just about messaging and channels. Providers that have a holistic picture of a patient’s lifestyle, life events, geographic changes and socio-economic challenges will be in a stronger position to anticipate their evolving wants and needs. For example, social determinants of health (SDOH) data can tell providers which patients may need extra assistance when visiting a doctor’s office, so that appropriate measures can be put in place. They might help identify patients with potential comorbidities that warrant proactive reminders about preventive check-ups. Similarly, providers can segment patients according to their financial situation. This can help with creating custom payment plans and sending timely payment reminders through targeted communications channels. Effective post-admission engagement can also help patients access the support needed to adhere to care plans, thus minimizing the risk of readmission and reducing unnecessary costs. A McKinsey & Co study found that around a third of patients with unplanned, high-cost follow-up care reported reasons that were considered avoidable, such as receiving unclear post-discharge instructions. Boost retention and recruitment with patient-centric and personalized healthcare marketing As rising medical costs and pandemic-related lifestyle shifts prompt more patients to shop around for care, providers must take action to create a healthcare experience that’s truly patient-centric. With data-driven healthcare marketing tools, providers can differentiate their services from other health systems vying for the same market. Find out how Experian Health can help your organization use consumer insights to build a patient-focused, personalized health marketing strategy to attract and retain satisfied consumers.

Experian Health works with many of the largest, most sophisticated collections teams in healthcare that consistently strive for high-performance by innovating and adopting best practices. Our consultants are often asked to define “high-performance”. What separates high-performing collections teams from the rest and how do they impact the bottom line? Being a leader in data and analytics, we used our expertise to conduct an in-depth analysis to answer these questions, quantify the impact of high-performance, and identify best practices common to high-performing collections teams. Here is what we learned: 1. Spend time collecting on the right accounts Many health systems have developed collections workflows by segmenting self-pay accounts into varying buckets depending on the propensity to pay. However, not all segmentation models are created equal and ultimately a model is only as good as the data driving the decisions. Segmentation models are supposed to identify high and low propensity-to-pay accounts so that resources can be focused on collecting from accounts likely to yield revenue, building out custom workflows when possible. In fact, in a head-to-head comparison, a health system using a segmentation model based solely on patient payment history significantly underperformed a health system using a comprehensive, multifaceted segmentation model built using our Collections Optimization Manager. Here are the results: $60,000 in additional revenue generated from accounts in low payment likelihood segments 25% higher recovery rate in highest payment likelihood segments 100 more accounts worked in low payment likelihood segments Multi-faceted segmentation models increase recovery rate an average of 76% for the highest payment likelihood segments Using patient payment history within a single health system forces a decision to be made based on limited information. This leads to more time being spent on accounts that yield little to no revenue. Patient financial situations change rapidly and being able to see additional factors such as credit payment history, household income, and financial stress signals improves the ability to assess propensity-to-pay. This is particularly important for both new patients and those that visit infrequently. Utilizing a comprehensive segmentation model enables collections from the accounts and increases recovery rates for segments with a high propensity-to-pay. 2. Use automated dialing Imagine a world in which every collections call reaches the intended recipient. When comprehensive segmentation models are used in tandem with automated dialing technology, like Experian Health’s PatientDial product, the hypothetical can turn into reality. High-performing teams take output from their comprehensive segmentation models and use it to focus call center activity. The logic is simple; more contact attempts are made to reach accounts likely to pay and fewer attempts are made for low yield segments. For example, if a health system with 100,000 new monthly accounts uses a data-driven call strategy, call volume can be reduced by up to 20,000 calls per month. The highest-performing teams go a step further by pre-loading call lists into agent software and only allowing agents to join calls that successfully connect. This is where the real magic happens – valuable time is saved, and agents actually connect with more patients, ultimately increasing collections success. 3. Monitor agency performance It is no secret that some agencies perform better than others. In fact, even a trusted agency’s performance can vary over time as portfolios are rotated between different collection teams. So, what do high-performing collections teams do to influence consistent agency results? They use robust reporting to monitor and track agency performance over time. This helps direct account allocation decisions in a way that impacts the bottom line. It is Monitoring agency performance gives revenue cycle leaders the information needed to make better portfolio allocation decisions. Another benefit of monitoring agency performance is that agencies perform better just knowing they are being monitored, per an Experian Health analysis of agency performance across similar portfolios. Here are the key metrics: Monitoring agency performance enables better account allocation decisions, pushes agency partners to perform at a higher level, and significantly increases collections. 4. Reduce bad debt through presumptive charity Best-in-class providers automate the financial assistance process for low-income self-pay individuals. This has a significant impact on both patient and provider. Patients no longer receive statements or calls for an outstanding debt that they are unable to pay, and providers are able to save on variable expenses, such as statement and call costs, in addition to staff time spent manually inputting and verifying financial assistance applications. Automating the charity award process enables health systems to reduce bad debt expense, regardless of when awards are granted. In a comparison between health systems using an automated financial assistance process and a similar portfolio of health systems without automated financial assistance, we discovered that automation could reduce bad debt expense by as much as 10-12% on a similar demographic mix of consumers. [1] 5. Identify accounts that require special handling One of the most common mistakes that collections teams make is dedicating time and resources to accounts that are unlikely to yield revenue. Deceased or bankrupt accounts make up anywhere between 1 percent to 2 percent of self-pay portfolios. This means that for a monthly portfolio of 100,000 accounts, collections teams are unnecessarily calling or mailing statements for up to 2,000 accounts that require special handling and might produce no results at all. High-performing collections teams have automated processes in place to identify these accounts and either remove them from the AR file completely or place them with a specialty vendor as soon as possible. High-performing teams also focus on identifying and resolving incorrect patient addresses. Although mailing patient statements is a key part of nearly every collections workflow, undeliverable mail often remains unworked. Since accounts are less likely to yield revenue over time, it is imperative to identify and resolve address discrepancies quickly. Returned mail typically impacts 1 percent to 4 percent of a self-pay portfolio. This means in a situation with 100,000 new accounts each month, an additional $30,000 can be recovered using an automated process to identify and update undeliverable addresses. Interested in learning more? For more information on our healthcare collections products, click here.    [1] Data Study Methodology: In June of 2021, Experian Health performed an analysis on a nationwide sample of health systems to define industry best practices and quantify their impact.

The No Surprises Act, effective Jan. 1, 2022, requires that healthcare providers include a “Good Faith Estimate” that covers all relevant codes and charges. This was established to increase price transparency for patients. For a summary of the No Surprises Act, read our previous blog. In our recent webinar, hosted on December 15, 2021, industry expert Stanley Nachimson, principal of Nachimson Advisors*, answered our audience’s most pressing questions about “Good Faith Estimates.”** To read the FAQs from our first webinar, click here. Experian Health can help your healthcare organization navigate the regulatory landscape  and implement solutions ranging from transparent, patient-friendly estimates to our all-new FREE No Surprises Act (NSA) Payer Alerts Portal.  Here’s what Nachimson had to say: Q1: What are the top things to do now to prepare for the No Surprises Act by Jan. 1? SN: Set up processes to avoid out-of-network billing for emergency and in-network facility services Out-of-network providers need to make sure they have the right processes set up to avoid surprise billing patients. Evaluate in-and-out of network status for all providers Implement Good Faith Estimate for Uninsured/Self Pay from a single provider Make sure to have a process in place for self-pay or uninsured patients Prepare patient notice documents Train staff and ensure they’re aware of new rules and changes Q2: What must be included in the Good Faith Estimate starting 1/1/22? SN: Starting Jan 1, 2022, the only Good Faith Estimates required are for “self-pay” or uninsured patients. These are the only ones that will be enforced/mandated on January 1st. CMS has created forms that show what GFEs should include. This includes individual services that will be provided in an encounter, line-item descriptions of services, procedure codes, diagnosis codes, and more. Estimates should be within $400 of the final bill for any provider or facility that was included, assuming there are no extenuating circumstances. Q3: How should providers deliver the Good Faith Estimate to the patient? Payers? SN: For patients, Good Faith Estimates should be delivered in a written document. This can be done through email, USPS, or delivered in person. Currently, providers do not need to worry about sending anything to payers. Regulators put this requirement on indefinite hold until they have more clarity on the technical delivery/transition of this data. CMS expects to provide a ruling clarification on this in 2022. Experian Health is now offering a FREE comprehensive, updated list of No Surprises Act (NSA) payer policy alerts for United States hospitals, medical groups, and specialty healthcare service organizations. Q4: What are the differences between Insured & Self-Pay Good Faith Estimates that providers should consider starting Jan. 1? SN: There will probably be no significant difference in the GFEs for self-pay vs insured individuals. However, the GFEs will be sent to health plans for the insured individuals. At this point, there is no standard electronic delivery method. Individual providers/organizations may come up with their own paper or electronic form, assuming it contains all the required information. At some point in the future, the GFEs will be sent to health plans for insured patients, and that will most likely be a standard transaction. CMS is currently waiting on guidelines for what this transaction will look like. Q5: How does an estimate get calculated when there are multiple providers involved? Who is the “convening provider?” SN: A convening provider is the provider that (1) is responsible for scheduling the primary item or service(defined as “the initial reason for the visit”), or (2) receives a request from an individual shopping for an item or service)—must determine at the time an item or service is scheduled or when a patient is shopping for care whether the patient is a self-pay patient, as defined above. This will not be enforced on Jan. 1, 2022. In 2022, each provider will be expected to provide the GFE for their own services. Because there aren’t any processes in place, the healthcare industry will have at least 1 year to develop a standard guideline for gathering this information. The requirement that the convening provider combines all provider GFEs into one GFE will not be enforced until 2023.This means that over the course of 2022, the convening provider will not be required to include estimates from other providers.  The industry will need to create a standard guideline and establish communication processes first. Until then, patients will need to ask every provider involved for a Good Faith Estimate.  Providers may wish to consider how they will accomplish this during 2022. Q6: Does the Good Faith Estimate apply to all services – even office visits? Labs? Urgent care? Drop-ins? SN: It applies to all types of services. However, depending on when the service is scheduled, the timeframe will vary on when the Good Faith Estimate can be sent out. Q7: If the actual charges are more than $400 greater than the Good Faith Estimate, what consequences will be there for providers starting Jan. 1? SN: The latest rule established an independent dispute resolution process.  The patient must initiate the process within 120 days of receiving the bill, file the required documentation and pay a $25 administrative fee. Webinar Series: Unpacking The No Surprises Act and Q&A with an expert Industry expert Stanley Nachimson, Health IT Implementation Expert, recently hosted a series of webinars to help providers get up to speed on what they need to do to comply with the No Surprises Act. Learn about the Good Faith Estimate, how NSA will apply in different care settings, and more. *Stanley Nachimson is not an employee or representative of Experian Health. **The scope and details of the No Surprises Act are evolving. The information provided here is up to date as of December 23, 2021. This content is intended for information and education purposes only.  Experian Health cannot and does not provide legal and compliance guidance.  It is recommended that all organizations review the regulation thoroughly and seek appropriate legal and compliance guidance to determine an appropriate strategy for compliance. Experian Health offers solutions across the healthcare journey – including patient engagement, revenue cycle management, identity management, care management and analytics – that may contribute to meeting compliance requirements.  

The recent discovery of the Omicron variant has placed the world on high alert. As COVID-19 continues to transform and evolve, erupting as “new” pandemics within the existing pandemic,  it is becoming clear that digitally-enabled clinical care and access to that care are some of the world’s tools to mitigate its spread. Should infection rates rise, providers can anticipate fluctuations in patient volumes, which may trigger a return to the scheduling complexities seen earlier in the pandemic. Streamlining patient access with digital scheduling to minimize wait times, free up hospital beds, and ensure efficient intake workflows is going to be crucial. New variants could also exacerbate existing healthcare staffing shortages, which is a major concern for providers whose capacity is already at a “tipping point.” With a winter flu season “twindemic” looming on the horizon, and more people traveling over the holidays, this challenge may only get tougher. One route through this uncertainty is to continue the digital pivot seen in the early days of the pandemic. Here, we look at how flexible self-scheduling tools and other digital services can continue to help providers maintain operational efficiency as they navigate the implications of this new coronavirus strain. Uncertainty about Omicron – and future variants –  could trigger patient scheduling complexities The new variant could trigger a rise in patient numbers, as seen with the Delta variant. In parallel, some providers and states may follow New York’s lead to try to manage non-urgent care and postpone certain elective treatments. Patients, too, may decide to hold off on booking appointments if they’re worried about contracting the virus while visiting their doctor. This means that the scheduling (and rescheduling) challenges seen throughout the pandemic could resurface. Providers should be ready to offer easy and convenient self-scheduling options. Digital patient scheduling platforms allow patients to book essential care and reschedule deferred appointments from the comfort of their own home, using whatever channel suits them best. Not only will this ease pressure on busy staff and reduce the number of people sitting side-by-side in doctors’ waiting rooms, but it’s also a quicker and more reliable way for patients to plan their care. Providers can augment these operational efficiencies with digital scheduling and registration tools. Registration Accelerator can reduce the burden on patient access teams by allowing patients to create user profiles and fill out pre-treatment information from home. Double down on convenient vaccination scheduling New variant outbreaks also add a layer of urgency and complexity to the ongoing vaccination program. Boosting the country’s vaccination rates is a crucial defense against existing strains of COVID-19. Patient-friendly digital scheduling tools can make it as easy as possible for people to arrange an appointment, thus helping to bump up vaccination rates. Of course, if more people are encouraged to seek vaccinations and boosters, the scheduling process could get even more complicated. Again, digital self-scheduling tools can ease the pressure, by using real-time databases and automation to ensure that patients book appointments within the requisite vaccination window. Automation can also be used to deliver personalized patient outreach reminders, nudging patients to schedule their vaccine appointment if they haven’t made one already. Comprehensive consumer data can help identify the most appropriate messages and channels for different patients, to make it as easy as possible for them to plan and book their appointment. The federal response to new outbreaks has included provisions for vaccine outreach campaigns and education initiatives. Providers should consider how their own outreach campaigns are performing, as well as ensure that their scheduling platforms are ready to meet the increase in demand that’s likely to follow. Automation and digital scheduling tools could help alleviate staffing shortages Behind the scenes, providers are still wrangling with ongoing staffing shortages. According to an analysis of US Bureau of Labor Statistics data, hospital employment declined by nearly 100,000 between February 2020 and September 2021, amounting to a financial cost of around $24 billion. New variants could make this worse. If more staff are infected, healthcare organizations may find it more difficult to handle the increase in patient volume. Automating manual tasks can free up capacity by helping to manage the growing demand for services and reduce call volumes. These automated tools and systems are designed to be user-friendly for busy staff, and for patients looking for a stress-free patient access experience. With streamlined self-scheduling options and more efficient staff workflows, providers can feel more prepared in the face of uncertainty. Contact Experian Health to find out more about how digital scheduling tools can help your organization prepare as the Omicron situation unfolds.

Healthcare providers could be losing up to $265 billion each year on avoidable administration costs. A recent investigation by the Washington Post and McKinsey & Company found expensive inefficiencies in several areas of healthcare expenditure, with financial transactions such as prior authorizations among the main culprits. How can healthcare organizations adjust to streamlining prior authorizations? Prior authorizations (or pre-authorizations) are intended to provide financial certainty to patients and providers, by confirming in advance that a payer will cover the cost of a particular test or treatment. However, securing pre-approval isn’t always a tidy process. The criteria are complicated and frequently change. In April this year, the American Medical Association reported that 85% of physicians found the burden associated with prior authorizations to be very high. The consequences are severe – hold-ups and errors can lead to delayed care, poorer outcomes for patients, and more unnecessary costs for providers. Securing pre-authorizations has always been challenging, but as with many healthcare operations, the COVID-19 pandemic exacerbated the problem. Experian Health’s State of Patient Access 2.0 survey revealed that more than half of providers find it difficult to keep track of changing pre-authorization requirements. Two-thirds expect to encounter roadblocks when seeking authorizations for rescheduled elective procedures. In fact, prior authorizations have overtaken patient payments as the biggest area of concern when it comes to collections and reimbursements. In our "Interview with the Expert,” Ellie Henry, Experian Health’s VP of Implementation, discusses the challenges around pre-authorizations and offers some immediate actions healthcare providers can take in response. Watch the interview below: Why are providers increasingly concerned about pre-authorizations? Pre-authorizations have been a hot topic for a while, but Experian Health’s State of Patient Access surveys, taken six months apart in November 2020 and June 2021, show a significant increase in provider concerns. Is this purely down to the “pandemic effect,” or is there more to it? Henry suggests that while the pandemic has been the main driver of recent authorization challenges, manual processes and changing payer rules have played a major role, too: “Hospitals had to restructure operations during the pandemic, which led to a lot of care being rescheduled. But it wasn’t always clear if existing authorizations would apply to that rescheduled care, which led to more reworking. Payers were continuing to adjust their rules, and understaffed organizations had to do more with less, which made it even harder to function effectively.” Many states also released their own pre-authorization requirements. For example, in September 2021, New York released an executive order to suspend prior authorizations for 30 days. While this may have been intended to ease pressure on staff and accelerate patient care, it also raised numerous questions. Providers had to determine if preapproval was needed for care that was planned during these 30 days or deferred until later and whether these changes overruled national payers’ requirements. How should providers address current pre-authorizations challenges? Henry says that providers can mitigate these challenges and focus on streamlining prior authorizations by dedicating limited resources to the most important problems first. This means using technology and automation to alleviate pressures on staff: “Providers need to streamline hand-offs and eliminate accounts that don’t need to be touched. With the right automation and technology, you can eliminate manual work and optimize workflows to manage demand. No matter how good you are, there’s always room to improve.” The growing administrative burden, exacerbated by increasing patient volumes, is an uncomfortable equation for healthcare organizations with reduced workforces. The traditional methods for managing patient accounts and checking for changes in payer policies are no longer sufficient. Instead, providers should look to automated prior authorization solutions that can ease the strain and ensure that more accounts are processed faster and more accurately. These should encompass both back-end automation and patient-facing digital tools that support self-service and reduce call volumes. What new opportunities lie ahead for streamlining prior authorizations? In the longer term, patient volumes will continue to increase as rescheduled care ramps up, and as patients begin to think about healthcare “maintenance” again. Providers have several options available to them to manage the pre-authorizations that will follow suit. Henry suggests that a good starting point is to invest in the right technology: “Technology can reduce manual tasks and keep the process manageable. The more tasks you can streamline and automatically update within your system, the better. Reach out to technology vendors and ask if their tools can help to make the process more efficient.” With prior authorization software, payer rules can be automatically updated so staff always know they’re looking at the latest information and don’t need to input data by hand. For example, Experian Health’s SmartAgent feature can sign the user into the appropriate payer website and auto-fill relevant patient information, saving time and reducing the risk of error. Dynamic work queues can help staff navigate the process with confidence and reconcile all the relevant data points within each patient’s specific situation. Henry also recommends doing knowledge-based checks to determine whether a patient’s planned procedure needs pre-authorization. Having records and supporting documentation in place can help handle rework and prevent errors from occurring in the first place. Engaging with payers to build stronger relationships is another strategy to support smoother authorizations. Again, reliable solutions and digital tools can simplify each of these tasks. Watch the full interview and download the State of Patient Access 2.0 white paper to find out more about how automation and digital tools can ease the burden and help with streamlining prior authorizations. By streamlining prior authorizations, providers can reduce unnecessary costs and deliver faster, high-quality care to patients.

The final blog of our post-COVID-19 patient journey series explores how patients have come to expect convenience, flexibility and transparency when paying for healthcare. How can providers ensure the real-life patient payment experience delivers? Read the full white paper here. Despite creating a more transparent approach to healthcare pricing, medical bills remain a major concern for many Americans. Nearly three in ten worry about the cost of healthcare. The prospect of an unanticipated and unaffordable final bill looms large over their entire healthcare experience, exacerbated by the job losses and insurance changes that left many on unsteady financial ground during the pandemic. Patients aren’t only looking for greater certainty about what they’ll owe, they also want the payment experience to be easier. The pandemic created a new baseline in digital patient access and pulled healthcare closer to other service experiences, where digital and contactless payment methods are the norm. To ease patients’ concerns and meet consumer expectations, providers should focus on redefining payment operations through the eyes of the patient. Patients want to know about their medical costs upfront so they can prepare. Experian Health’s State of Patient Access 2.0 survey found that nine out of ten providers agree that this also increases the likelihood that bills will be paid. They want quick and convenient ways to pay and utilize digital apps with user-friendly interfaces. They don’t want a one-size-fits-all approach to their healthcare experience ­– and that includes the payment process. Personalized estimates, payment plans and proactive reminders can all help patients feel confident about their medical bills. The right tools exist to help providers create a great patient experience and reduce the amount of revenue lost to bad debt – it’s all a matter of integrating those tools into existing systems. Help patients plan for bills with transparent pricing According to a study by Pew Research, around half of nonretired adults feel the pandemic has made it harder for them to reach their long-term financial goals. Many patients are keeping a closer eye on household finances in the wake of COVID-19, so helping them to understand their bills from the onset is key. This can help providers enroll patients in the right payment plans, and will lead to smoother patient collections. Accurate, upfront estimates should be utilized to improve the patient payment experience. Patient Payment Estimates give patients a clear cost breakdown straight to their mobile, so they can plan accordingly for out-of-pocket payments. Providers that implement these solutions now will be better prepared as price transparency legislation continues to evolve and grow. Offer flexible payment methods for faster payments Accurate estimates are just the first step: next, providers should make it as easy as possible for patients to pay their bills. Healthcare has typically lagged behind other industries when it comes to quick and convenient digital payment options. However, the pandemic nudged consumers and providers alike to embrace alternate payment models for medical bills. Many patients want to continue using digital and contactless payment methods – including credit cards and mobile payment apps. With a service such as Patient Financial Advisor, providers can direct patients to an appropriate and flexible payment plan, as well as secure ways to pay, without the need for multiple patient calls. Create a personalized payment experience with third-party data and analytics These tools are effective because they enable personalized experiences for every patient. Some patients may prefer to pay in full before they come in for care, while others may need to pay in installments. Some may prefer to pay via a mobile app, while others may choose to pay in person with their credit card. Certain patients may prefer to receive statements and other communications via email, while others will want to speak to an advisor on the phone. A personalized approach not only creates a better patient experience but also increases patient payments and reduces providers’ cost to collect. Achieving this requires access to accurate and reliable third-party data that paint a fuller picture of an individual patient’s needs and preferences. With consumer data that draws on lifestyle, demographic, psychographic, behavioral and financial information, providers can tailor the payment experience to make it as accessible and frictionless as possible. Similarly, Collections Optimization Manager draws on multiple datasets to check coverage information, segment and prioritize patient accounts, and use staff resources efficiently to maximize revenue recovery. Heather Grover, VP of Product Management and Consulting – Patient Payments and Collections, says, “Clients seek processes that are not only tailored to each patient’s unique situation but one that helps automate their collections and payments workflow. Minimizing the use of resources in today’s environment – whether IT, operational or call center – helps lower the cost of collections while delivering a positive patient experience.” Find out more about how Experian Health’s suite of patient estimates and payment tools can help your organization offer a personalized and compassionate financial experience. Missed the other blogs in the series? Check them out: 4 data driven healthcare marketing strategies to re-engage patients after COVID-19 How 24/7 self-scheduling can improve the post-pandemic patient experience COVID-19 highlights an acute need for digital patient intake solutions Automated prior authorization: getting patients the approved care they need Getting a holistic picture of patients with social determinants of health 3 data-driven denial management strategies for faster claims processing

As the digital healthcare revolution takes hold, do assumptions about a generation gap still hold true? Do Millennials and Gen Z have different expectations of healthcare providers compared to Baby Boomers and Gen X? In today’s hyper-connected world, the differences are a matter of degree. We’re all Gen C now. Futurist Brian Solis coined the term “Gen C” in 2012 to describe the rise of the “connected consumer,” a generation of active participants in the digital-first economy. Recently, the term has come to be associated with everyone living through the age of COVID-19. This includes pandemic babies whose early months have been shaped by quarantines and virtual playdates, and consumers of all ages who have reimagined their lives through digital tools and services. Gen C transcends the usual generational divides. Experian Health’s State of Patient Access 2.0 survey shows that patients of all ages embraced self-service technology and virtual care during the pandemic. Younger groups may be in the majority, but demand for a consumer-centric digital patient experience crosses demographic lines. Forget Millennials and Gen Z – it’s Generation COVID that’s driving the healthcare revolution. In this article, we look at what healthcare providers need to know about the attitudes and expectations of Gen C consumers. How does healthcare need to adapt to successfully engage the connected generation? Gen C: it’s an attitude, not an age Think With Google describes Gen C as a “powerful new force in consumer culture… people who care deeply about creation, curation, connection, and community. It's not an age group; it's an attitude and mindset defined by key characteristics.” Understanding the Gen C mindset will give providers the competitive edge when it comes to patient engagement. What might that look like? Gen C is constantly connected. Nearly nine in ten have a social media profile, with two-thirds updating it daily. They’re accustomed to organizing their life through apps and digital technology. Younger Millennials and Gen Z have grown up with the digital world in the palm of their hand, and have come to expect quick, flexible, and convenient app-like access to real-life services. Gen C values authenticity and transparency. Recent political, economic, and environmental turbulence has created a group of consumers who choose brands and services according to their personal values. There is also a greater emphasis on convenience and price. Instant access to information means they may be more likely to question healthcare advice and compare services. And news reports of data breaches and corporate scandals mean providers may need to work harder to gain their trust. Gen C chooses brands that embrace the power of personalization and community. Gen C expects personalized patient experiences. However, they’re also looking for community. Health and wellness brands that facilitated connection through online groups grew in popularity during the pandemic, especially when people were unable to work out together. As influencer culture continues to evolve, more brands are inviting real consumers to act as brand advocates. This includes utilizing social media to give consumers an opportunity to engage directly in product development. Healthcare services that can offer ways for consumers to connect with like-minded communities will be particularly attractive to Gen C. How does Gen C feel about health? It’s no surprise that the pandemic has made consumers more health-conscious. Gen C takes a more holistic view of health than previous generations and is more likely to use wearables and fitness apps to track their health goals. They’re also more comfortable talking about previously taboo topics, such as mental health or sexual wellness. Digitally fluent consumers are also more comfortable seeking answers to health questions online. A study by Gartner found that 41% of consumers with a health issue would talk to friends or family, and 38% would search for information on their own, before contacting a physician. There’s an opportunity for providers to position themselves as the first and best resource for reliable, engaging and accessible health information. As Gen C’s influence grows, it pays for providers to invest in understanding their needs and expectations. How should providers adapt the healthcare experience for Gen C? Offer convenient, flexible and self-service access to care Flexibility, speed and convenience are woven into Gen C’s expectations of the healthcare experience. The State of Patient Access 2.0 survey found that around seven in ten consumers said they wanted to be able to schedule their own appointments online, and a similar number wanted the option to contact their provider through a patient portal. Gen C is less likely to use a desktop computer or make a phone call, so enabling mobile-friendly apps is key. Online self-scheduling allows patients to find and book available appointments using their mobile devices. Integrations with scheduling rules and up-to-the-minute calendar checks mean patients are only shown the most relevant provider booking information. It’s a closer match to their other consumer experiences, as opposed to long phone calls and wait times with a call center representative. Similarly, automated registration tools can simplify patient intake and give consumers the option to check their details on their mobile devices. Rather than filling out multiple paper forms that are labor-intensive and error-prone, patients can simply complete the process on their phone or tablet. And for the 39% of patients who worry they’ll catch an infection at their doctor’s office, being able to complete intake tasks without sharing clipboards and pens in the waiting room will be a huge relief. In a recent podcast interview with Beckers Hospital Review, Jason Considine, Chief Business Development Officer with Experian Health, said: “With COVID-19, digital tools and data-driven solutions introduced more streamlined processes into our healthcare system. The expectation is that they’ll remain. Providers must embrace this digital transformation. Invite patients to self-schedule online, leverage digital outreach tools, simplify the registration process, and provide a transparent cost of care with flexible payment options… We need to create a simple consumer experience that matches what patients have in other facets of their lives.” Use consumer data to offer personalized outreach and boost patient loyalty Understanding Gen C requires providers to rethink patient loyalty. In the past, patients might choose a physician and stick with them for much of their adult life. Now, they’re more likely to shop around. Research published just before the pandemic showed that 73% of consumers expect companies to understand their needs and expectations, and 62% expect those companies to adapt according to the consumer’s actions. Experian Health’s survey also showed that patients welcome proactive outreach by providers, though many providers fail to do so. Nearly half of providers said that inaccurate or incomplete data prevented this. Providers know that a personalized healthcare experience is good for their bottom line, but without reliable data about each patient’s needs, preferences, and lifestyle, delivering this is a challenge. Consumer healthcare marketing data can pull together reliable data sources to allow providers to communicate the right message in the right channel for different patient segments. For an even richer view of patients’ individual non-clinical needs, providers should consider including social determinants of health (SDOH) data. COVID-19 revealed gaps in healthcare providers’ capacity to leverage data to support economically and socially vulnerable groups. With this type of data, providers can personalize their outreach strategies in a way that truly supports individual patients and underserved communities. Make it easy to pay with upfront estimates, coverage clarity, and digital payment methods Household financial concerns were felt even more acutely over the last two years. Younger generations say they’re more likely to consider cost when it comes to making healthcare decisions, with almost 60% saying it’s now the main consideration. Gen C expects upfront, transparent cost estimates, with two-thirds of younger consumers saying they’re more likely to seek out medical care if they know the cost beforehand. The State of Patient Access 2.0 survey confirms that price transparency remains high on the list of patient demands. To this end, there has been a major regulatory push toward price transparency at the federal and state levels. Many providers are deploying transparent pricing strategies and payment estimate tools to make it easier for patients to navigate the costs of care. Demonstrating a commitment to price transparency can be a powerful marketing strategy to attract and retain loyal consumers – especially for those who are most affected by fluctuating employment and financial circumstances. Watch our interview with Dan Wiens, Product Director for Patient Estimates at Experian Health, in which he describes how price transparency and patient estimates will evolve in 2022. Patient payment estimates give patients clear, accessible, and easy-to-understand estimates before they come in for care. A cost breakdown is delivered straight to their mobile device, with the option to pay right away. In addition to payment estimates, Gen C is looking for payment plans and payment mechanisms to be available at their fingertips, anytime, anywhere. In a world where they can order food and pay household bills at the tap of a button, it can be frustrating to have to wait a month for a medical bill. In fact, 70% of consumers say healthcare is the industry that makes it hardest to pay. Providers that can offer a choice of simple payment methods, pre-and post-service, will be likely to attract more Gen C patients. An integrated solution such as Patient Financial Advisor can help these tech-savvy consumers see their estimated cost of care, and make payments right from their mobile device. For providers, the benefits of making it easier for patients to pay are clear. As demand for transparent and contactless payment methods continues to grow, investing in these digital innovations could be an effective route to recouping some of the financial shortfall experienced during the pandemic. Don’t forget – more healthcare staff are Gen C, too Digital transformation isn’t just a consumer issue. Many of the digital tools and services that enable providers to meet the needs of connected consumers will offer benefits at the organizational level too. Automation and advanced analytics lead to more efficient processes, better use of staff resources, fewer errors and more meaningful workflow insights. Time and money are saved, profits increase and staff enjoy a more satisfying working experience. Investing in incremental innovations on back-end systems is even more relevant, given that growing numbers of healthcare staff are Gen C themselves. Just like consumers, they are accustomed to using digital apps and tools to run their lives, and they’re looking for similar efficiencies while at work. Failure to provide staff with the tools they need to do their jobs in the digital age could lead to wasted time, revenue loss, and the adoption of less reliable and secure workarounds. With the right digital tools and systems, providers can equip staff to fulfill their roles safely and effectively -- attracting and retaining a high-performing workforce. Providers must open their digital front door to secure patient loyalty now and in the future The pandemic has cemented a cultural and practical shift in the way healthcare is delivered. Now that more patients have had a taste of a digital patient experience, they expect it to continue. Gen C is pushing the healthcare industry to catch up to convenient, connected, consumer-centric services that are the norm elsewhere. Providers that can engage with Gen C in their digital language now will attract more satisfied consumers over the long term. Contact us to find out how we can support your organization bring together all the digital tools at your disposal, to create a healthcare experience that’s in line with Gen C’s evolving expectations.

There are a number of topics that draw a full house for a webinar, but the recent “Unpacking the No Surprises Act” presentation produced by Experian Health was exceptional in its attendance. Participants listened intently to the general parameters and compliance criteria that make up the regulation and what it is intended to accomplish. More than 130 questions poured in during the 1-hour webinar and they were still coming in as the event closed. Read our blog to learn more about the No Surprises Act. Webinar Series: Unpacking The No Surprises Act and Q&A with an expert Industry expert Stanley Nachimson, Health IT Implementation Expert, recently hosted a series of webinars to help providers get up to speed on what they need to do to comply with the No Surprises Act. Learn about the Good Faith Estimate, how NSA will apply in different care settings, and more.   The Big Takeaway: there are a lot of questions from across the spectrum of healthcare participants. We looked through those that were submitted during the webinar, pulled together the ones that were similar, and grouped them into categories. Then we asked the expert we’ve worked with to better understand the No Surprises Act – Stanley Nachimson, principal of Nachimson Advisors* – to shed more light on some of the most common inquiries.** In another blog, Nachimson also answers your FAQ about the Good Faith Estimates. Experian Health is now offering a FREE comprehensive, updated list of No Surprises Act (NSA) payer policy alerts for United States hospitals, medical groups, and specialty healthcare service organizations. GENERAL SCOPE Who does the regulation apply to? Insured? Uninsured? The No Surprises Act is meant to protect the uninsured, self-pay patients and those covered by commercial insurance. It DOES NOT apply to government-reimbursed care, i.e., Medicare and Medicaid – essentially because balance billing is already prohibited by these payers. On the other side of the coin, the regulation generally applies to all providers of healthcare. Is this restricted to “emergency care” and has emergency care been defined? The regulation was established to make sure patients are only responsible for in-network charges related to emergency services or scheduled services, in any hospital. As for the definition of “emergency,” the regulation defines that in the Prudent Layperson language, which defines an emergency medical condition as manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in: a) placing the patient’s health in serious jeopardy; b) serious impairment to bodily functions; or c) serious dysfunction of any bodily organ or part. Does the No Surprises Act supersede state laws? The federal regulation is the default in states where there are no similar laws to protect against balance billing. In states that do have laws addressing this, NSA takes priority when the state law provides less protection to the patient. Also, in states with No Surprise regulations already in place, the federal law defers to state law as to how much fully insured plans must pay a provider for surprise OON services, rather than requiring arbitration mandated by the federal regulation. Is there an explanation of how this will be enforced? Enforcement procedures are still being worked out, as several entities are impacted. Three levels of enforcement have been proposed: State enforcement – states will have primary enforcement responsibility and CMS would step in for states that will not enforce the law or “fail[s] to substantially enforce” the law Civil penalties (at $10,000 per violation) Possible mechanisms that could initiate enforcement actions, which have been discussed, include patient reporting tools and market conduct investigations initiated by CMS. OPERATIONAL IMPACT What are the primary provider workflows impacted by the No Surprises Act? The most impact will be around scheduling, estimates and producing a good faith estimate (GFE). The systems and solutions in place to determine eligibility and coverage will have additional pressure for accuracy. At this point, if necessary or desired, the mechanism for securing patient consent for OON services will come into play, too. The timing requirements of the law’s expectation of when a GFE will be provided put the front-end operations under a microscope. The “convening provider” challenge of which entity will be responsible for assembling the GFE is a major issue.  The convening provider must present the GFE in a standard format to either the health plan for insured patients; or to the patient in a manner that is clear and understandable stands to require substantial modifications to workflow. The most recent guidance from CMS states that there will be a one-year postponement in enforcing the rules, for uninsured patients, requiring a provider to get estimates from other providers involved in the care. Are office visits included in the regulation? Radiology? Lab work? It appears to be so. The industry is questioning the required range of services.  Any Advance Explanation of Benefits that contains out-of-network providers must include information on how to find in-network providers for those services.   This is definitely one area of the law that the healthcare community is looking to help shape. Is there a best practice for identifying OON status? Most providers should be aware of their network status for any health plan.  That is going to be a question answered at the medical system and very likely individual provider facility level. However, determining the network status of other providers may be a problem.  Most health plans have provider directories available for their members or on their websites.  There won’t likely be a “standard” other than the very clear expectation of the law that no one will be balance billed for any care received that is OON, unless that is consented to by the patient. The systems and communications with the payers and protocols required to meet this compliance standard are going to be unique to different facilities. It sounds oversimplified, but the best practice may be not to balance bill a patient for the care they receive without their consent. SPECIFICS Will there be standardized documentation provided by CMS and, if so, will they be required? No matter the document format, there is a set of requirements for patient notices. These include: A statement that the provider or facility is OON (if that is the case) An itemized, good faith estimate of the cost of care Information on prior authorization and utilization management limitations The notice must be in a format the patient can understand and is accessible (i.e., preferred language and apart from other documents). A variety of model forms and notices are available on the CMS “Overview of Rules and Fact Sheets” page: Standard notice & consent forms for nonparticipating providers & emergency facilities regarding consumer consent on balance billing protections: Download the Surprise Billing Protection Form Model disclosure notice on patient protections against surprise billing for providers, facilities, health plans and insurers: Download Patient Rights & Protections Against Surprise Medical Bills Paperwork Reduction Act (PRA) model notices and information collection requirements for the Federal Independent Dispute Resolution Process: Download Model Notices and Information Requirements Paperwork Reduction Act (PRA) model notices and information collection requirements for the good-faith estimate and patient-provider payment dispute resolution Download Model Notices and Information Requirements Additionally, The Department of Labor published a Model Notice link on its No Surprises Act overview page. Which entity is considered the “lead” and responsible for coordinating the GFE, consent forms and other documentation required to show compliance? The “lead”, or “convening provider” entity is widely expected to be the scheduling provider but that has not been established officially. This is another of the areas where input is needed from multiple stakeholders. What parts of the law have been postponed? Good faith estimates to INSURED individuals have been postponed "until rulemaking to fully implement this requirement…is adopted and applicable." The delay for insured individuals was the result of a general expectation that it is not possible for payers and providers to stand up necessary systems to achieve this by Jan. 1, 2022. The distinction was made that insured patients have means of recourse if they receive an incorrect estimate. Similarly, advanced explanation of benefits (AEOB) is expected to be delayed until the data transfer systems and other requirements to provide an accurate AEOB to the patient are in place. It is expected that short-term remedies to this will be put into effect by HHS. It is important to note that these delays in enforcement do not change the core of the rule, which prohibits balance billing of OON care and services that a patient is unaware of and does not consent to. On-Demand Webinar: “Unpacking the No Surprises Act” - October 20, 2021 Listen in as Roger Johnson, VP of Payer Solutions at Experian Health, and Stanley Nachimson, Health IT Implementation Expert, help providers get up to speed on what they need to do to comply with the No Surprises Act in this 60-minute session. This on-demand webinar will help your organization make sense of the new regulatory requirements and provide strategic recommendations on how to prepare. *Stanley Nachimson is not an employee or representative of Experian Health. **The scope and details of the No Surprises Act are evolving. The information provided here is up to date as of November 18, 2021. This content is intended for information and education purposes only.  Experian Health cannot and does not provide legal and compliance guidance.  It is recommended that all organizations review the regulation thoroughly and seek appropriate legal and compliance guidance to determine an appropriate strategy for compliance. Experian Health offers solutions across the healthcare journey - including patient engagement, revenue cycle management, identity management, care management and analytics – that may contribute to meeting compliance requirements.

Being able to settle bills anytime, anywhere, is one of the reasons why 110 million Americans switched to “digital-first” payment methods last year. Today’s consumers can pay household bills with their mobile devices while cooking dinner or waiting in the school pick-up line. They can pay for their morning coffee by tapping their phone at the point of sale. Imagine their frustration when paying for healthcare still involves paper bills, multiple phone calls, and limited payment options. But the healthcare industry can make the same “anytime, anywhere” payment promise. Berenice Navarrete, Director of Product Management for Patient Payments at Experian Health, says: “We’ve seen healthcare make great strides in using automation and digital tools for scheduling, registration, and telehealth, fueled in no small part by the pandemic. As consumer payments are constantly evolving, there are huge opportunities for improvements in the patient payment experience too.” “We’ve seen healthcare make great strides in using automation and digital tools for scheduling, registration, and telehealth, fueled in no small part by the pandemic. As consumer payments are constantly evolving, there are huge opportunities for improvements in the patient payment experience too.” -Berenice Navarrete, Director of Product Management for Patient Payments Experian Health’s recent Payments Predictions white paper identifies seven emerging healthcare payment predictions and trends heading into 2022. This blog offers a preview of the top three insights that will be of interest to providers intending to leverage – or considering – digital tools that simplify payments and speed up healthcare collections. Prediction: Patients want fast, secure and smooth payments to match their experience in other industries. According to Experian Health’s State of Patient Access 2.0 survey, providers are feeling more confident about collecting payments from patients now, compared to a year ago. However, the collections landscape is always changing; providers should continue to find ways to match consumer expectations with tailored communications, flexible payment options and automated payment methods. Listen in as Matt Baltzer, Senior Director of Product Management at Experian Health, explains why providers feel more confident about patient collections. He also discusses how automated healthcare solutions can help providers shore up these gains and optimize healthcare collections – especially as consumer behavior returns to pre-pandemic patterns. As cash usage declines, patients are looking for a wider variety of payment options – a trend that’s likely to gather steam as digital payment platforms like Apple Pay and Google Pay continue to gain traction. Providers must keep pace with these advances in consumer payment technology. Utilizing Patient Financial Advisor is one way to give patients the flexible experience they want. This solution sends personalized text messages with links to convenient and contactless ways to pay.  Patients may have different preferences about payment methods, but they all want to feel confident that their payment is secure. With PaymentSafe, healthcare providers can collect any form of payment securely and quickly, regardless of the payment option a patient chooses. Prediction: Patient loyalty will be tied to a convenient and compassionate payment experience. A poor payment experience will leave a bad taste in the patient’s mouth, regardless of how good the rest of their healthcare journey has been. With 70% of consumers saying healthcare is the industry that makes it hardest to pay, any provider that offers a smooth, supportive and transparent payment experience is going to stand out from the competition and foster greater patient loyalty. Comprehensive consumer data can give providers early and accurate insights into a patient’s specific financial situation. This information can help providers direct the patient to the most appropriate financing options. Automation can then be leveraged to send timely reminders of open balances, improve patient engagement and minimize the risk of missed payments. Tools such as Patient Financial Advisor and Patient Payment Estimates can help providers give patients transparency, control and reassurance from the very start of their financial journey, so bills are settled quickly and easily. Prediction: Automation will be used for an increasing number of payment-related tasks. Artificial intelligence and automation aren’t just for cars and the metaverse. Technological advancements are opening up a wide range of benefits to healthcare providers, from faster patient payments to fraud prevention. Automation also enables operational efficiencies in reporting and reconciliation, while protecting and processing unprecedented amounts of patient data. For example, Collections Optimization Manager uses extensive datasets and advanced analytics to segment patient accounts according to each individual’s specific financial situation. Patient satisfaction will improve because patients receive the right support at the right time. Additionally, providers will be able to use monitoring and benchmarking data to spot previously unseen opportunities and further improve collections. Keeping that “anytime, anywhere” promise COVID-19 was a catalyst for the evolution of healthcare payments. Digital payment solutions that give patients easy, convenient, and safe ways to pay not only help meet changing consumer expectations but will also allow providers to boost loyalty and revenue for years to come. Download the white paper to discover a full list of healthcare payment predictions and find out how to create a modern payment experience that meets patient expectations.