Any kind of identity mix-up is disturbing, but when it occurs within the healthcare system, the fallout can be severe. At best, misidentifying patients leads to lowered consumer confidence, but at worst it can compromise a person’s essential medical treatment. As a healthcare professional, you want to be absolutely certain that comprehensive and correct data is associated with each person who comes in for care, and that you’re utilizing the most advanced measures to make it happen. Universal patient identifiers are an integral part of that goal.  Patient Safety Awareness Week is the perfect time to convey that message clearly and positively. What is Patient Safety Awareness Week Patient Safety Awareness Week, organized by the Institute for Healthcare Improvement, is an annual recognition event dedicated to boosting the public’s knowledge about health care safety. In 2020, it runs from March 8th to the 14th. Patient Safety Awareness Week is your ideal opportunity to proactively inform and reassure patients of your commitment to safety. New systems, such as universal patient identifiers (UPI) developed by Experian Health, were created to ensure that patient demographics are as complete and error-free as possible through patient matching. Impact of patient identity problems Many patients may already have concerns about their records, having heard about problems from the news, friends or relatives, or have personally experienced identity misidentification. According to an ECRI Institute report, approximately 30% of the patient data that’s held in electronic health records is either incomplete or inaccurate. So how bad can the damage of patient misidentification be? The Ponemon Institute reported that roughly 86% of all clinicians witnessed a medical error that was caused by patient misidentification. And most disturbing: a study by the National Institutes of Health discovered more than half of all the deaths attributed to medical errors are a result of identity errors. Identification mistakes don’t just lead to unnecessary patient suffering either. These unforced errors undermine the very foundation of healthcare organization: trust. The organization that makes them suffers a serious blow to their brand. How patient identity mistakes are made Human error has been most often to blame for patient identity mistakes. Every day, healthcare providers handle an astonishing influx of information, as hundreds of thousands of electronic patient records flow in from a vast number of different systems and departments. All the while patients’ names and addresses change, which in turn requires updates. Inputting all that data manually is a major challenge, and inconsistencies typically occur in the data entry process. In fact, the National Center for Biotechnology Information found that the greatest proportion of mismatches are centered around a patient’s middle name and their Social Security numbers. Misspellings and entering first, last, and middle names into the wrong fields are also common. Once identity mistakes are entered, a patient can have duplicate records and disparate facts, matching past diagnoses and prescribed medications. Billing problems, too, can result. A patient’s statements might not be sent to the correct mailing address, resulting in them experiencing unnecessary credit troubles. Solutions to identity problems In order to consistently and correctly match patients with their medical records, innovative technology has been developed. UPIs use Experian’s consumer demographic information and methodologies to identify record matches and duplicates in a patient’s file. Once a unique UPI is created for the patient, the potential for identification mix-ups is vastly reduced. More, UPIs lead to efficiencies that drive costs down for all concerned. It’s expensive and laborious for healthcare provider employees to record and update such a high volume of patient data by hand. Rectifying mistakes is not only time-consuming, it can cause insurance issues to arise. Certainly, obtaining the best treatment is paramount to patients, but keeping healthcare costs to a minimum is also important. 79 million Americans are struggling with overwhelming medical liabilities, found The Commonwealth Fund. However, a survey conducted by Black Book found that patient matching discrepancies can lead to nearly $2,000 in extra inpatient costs per person. No one should pay more than they have to for their healthcare, and UPIs can make sure bills are appropriately assessed.  For this year’s Patient Safety Awareness Week, spread the word to your patients that measures have been put into place to protect their identity. As of the end of 2019, every person in the U.S. has been assigned a UPI, and correct and complete information will be associated with each patient. Everyone should be aware that you are taking steps to ensure the accuracy of their medical records — which keeps them safe and their financial obligations down.

Recovering underpayments from commercial insurers costs the healthcare industry billions every year. When payments come up short against what the provider expects, it’s not just the missing revenue that puts a dent in the bottom line – the staff time spent on reprocessing bills takes an extra bite out of the organization’s margins. Underpayments can be attributed to confusion around changing payer policies, inadequate claims data and simple human error. But when providers are focused on creating the best possible patient experience, keeping track of payer behavior is a task that’s easily crowded out. Unfortunately, failing to spot underpayments or keep tabs on those policy changes could lead to bigger revenue loss further down the line, in the time-suck that is collections recovery. From the payer’s perspective, it can be hard to understand why providers don’t just fill out claims according to the agreed rules. For providers, those rules seem to be in constant flux and different for each insurer. Ultimately, it’s a lack of communication that’s at the heart of the problem. Clean claims are only possible when payers tell providers exactly what they need, and providers have the systems in place to deliver that and check that payers are themselves following those rules. Within the industry, we already measure so many aspects of the revenue cycle, but are we paying enough attention to the payer-provider relationship? Is communication the missing metric? Three essential ingredients for a healthy payer-provider relationship Managing payer contracts can often be time consuming, complex and costly. Many healthcare providers are focusing on three strategies to help build better relationships with their payers, to take the stress out of this process and ensure they get reimbursed quickly and fully: Better communication. When you’re clear about what your payers need, you can make sure all your staff and systems are set up to deliver that. It’s impossible to fix the sticking points in your claims processing if you don’t know where they are. With a method to support better communication with payers, you can negotiate contracts that better suit both parties, keep track of changes to payer policies and move quickly when payers aren’t holding up their end of the bargain. You’ll know when a payer has made a payment at an out-of-network rate or reverted to rates in a previous policy and you’ll have the data your payer needs for a quicker recovery process. Two-way accountability. One way to build a better relationship with your payers is to hold each other accountable. Providers need to have systems in place to be able to hold payers to account for underpayments, but also to hold themselves to account for under billing. With a robust contract management tool, you can monitor payer compliance with contract terms and clarify what’s expected on your side to ensure you submit clean claims every time. Efficient processes: When the payer landscape is constantly changing, you need to have solid workflows to manage your claims processes as efficiently as possible. Automation and software solutions can help you minimize staff time spent manually checking payer policies, as well as generating the data you need to challenge underpayments. With a dashboard showing you real time claims data all in one place, your team will be able to identify, discuss and resolve queries with payers much more quickly than with disparate manual systems. How better payer monitoring saved one practice group $3.5 million in a single year In 2007, UCLA Health System Faculty Practice Group (UCLA FPG) saw $4 million go uncollected, largely down to difficulties tracking payer contracts. As the volume of payer contracts grew, it was harder to catch underpayments and manage the recovery process. Measha Ford, Director of Revenue Integrity at UCLA FPG says: “Before using Contract Manager, we didn’t have a method in place to track under and overpayments so there was a lot of lost revenue.” Without an efficient system in place, it was extremely challenging to manage collections data, monitor payer performance and spot when claims were being paid at out-of-network rates. This put UCLA FPG in a tough position to try to negotiate the best possible contracts with payers. By implementing an automated system, UCLA FPG could keep a closer check on payer contracts, eventually sustaining a recovery rate of 80% and recouping $3.5 million in one fiscal year. The data collected has not only helped to build a more predictable revenue cycle, but also supports more strategic decision-making when modeling new and amended contracts. And for Measha and her team, being armed with up to date, reliable data makes managing the relationships with payers so much easier, saving them time and effort that can be better used elsewhere. Find out more about how Experian Health Contract Manager can help you create friction-free interactions with your payers.

With Google’s acquisition of Fitbit in November 2019 and Apple’s recent foray into smartphone-based clinical research, the ‘big four’ tech giants are ramping up their efforts to take a slice of the $3.6 trillion healthcare industry pie. These investments aren’t new. Between 2013 and 2017, Apple, Microsoft and Google’s parent company, Alphabet, filed a combined 300 health-related patents, while Amazon has been looking to expand into the pharmacy space since the early 2000s. Historically, it hasn’t been easy for new players to get into the healthcare game. Up to now, tech companies have mostly stayed in their lanes, using their expertise in cloud-based computing, artificial intelligence and supply chain management to break into health markets around the edges. What gives them a big advantage now is the rise of healthcare consumerism, especially in the digital realm. Patients expect to be treated as individuals, with communications and services that are convenient and tailored to their needs. The personalization that so delights them is powered by their own health data and a focus on the consumer experience – two of the tech companies’ biggest strengths. Providing a consumer-centric experience has been challenging for the healthcare industry. In fact, it’s been challenging for many legacy industries (banking, insurance, etc.). Amazon and others have a head start in being able to leverage vast quantities of consumer data and turn insights about their customers’ lifestyles, behaviors and preferences into a better consumer experience. How can healthcare providers compete? Understanding consumer data is key to a better patient experience and better population health The buzz around consumer data opportunities isn’t limited to the tech world. Recognizing the role of consumer data in improving both the patient experience and population health, more health systems are investing heavily in data analytics, looking at how they use data to market to their consumers and address the social determinants of health. Mindy Pankoke, Senior Product Manager for Experian Health, says: “Consumer data is becoming more important in healthcare because patients are people. They're more than a clinical chart or claims form. They have lifestyles, they have interests, they have behaviors. This is called consumer data. ‘Social determinants of health’ has become a huge buzzword in the healthcare industry and it's more than buzz. It's data about people's lifestyles that we can use to improve their health.” Over 80% of health outcomes are attributed to the social determinants of health, so knowing who your patients are and what they need is increasingly important if you want to improve their wellbeing. When you understand what’s going on in your patients’ lives, you’ll know whether they need assistance with transportation, understanding their healthcare information, managing a care plan or accessing healthy food. You can communicate with them in the most effective way and point them towards services that could help them access care and avoid more serious conditions. And even better, much of this can be done through time-saving automation tools. Where to start with consumer data Today’s leading healthcare providers are using consumer data in three main areas: 1. Streamlining patient communications Whether a patient is getting treatment for a broken leg or multiple chronic conditions, their healthcare journey probably involves hundreds of touchpoints with your organization. Consumer data helps you cut to the chase and give them the exact information they need to make their next decision or complete their next task, in the most convenient way. Data analytics allow you to create a slicker patient experience, by giving the right message in the right format – whether that’s in marketing to new patients, sending bill reminders, or encouraging wellness checks. 2. Segmenting patients according to social determinants of health In a study of 78 social needs programs published this month, Health Affairs reported that health systems invested more than $2.5 billion in interventions focused on housing, employment, education, food security, community and transportation, between 2017-2019. Clearly, some patients will benefit from these services, while others won’t. There’s no point giving the same information to every patient. Consumer data lets you segment your patient population and target information about social programs to the ones who need them most. 3. Creating bespoke services for your specific patient population Consumer insights tell you exactly what’s blocking your particular patient population from accessing care, now and in the future. You’ll know how many have difficulty attending appointments, how many might struggle to read complicated instructions and how many will be too busy to download and use your new healthy recipe app. Analyzing your population’s needs and tendencies allows you to predict future demand for different services and develop interventions to solve those specific challenges. Future-proof your consumer data strategy by working with a trusted partner As the big tech companies are coming to discover, healthcare data regulations are complex. You need to know where your data comes from, for the sake of both accuracy and permissibility. Working with a trusted data vendor in the health space can help ensure the reliability and integrity of your data, as they will have expertise in the appropriate use of consumer data in healthcare. They’ll help you pull insights from only the most relevant, current data, so you can build a competitive consumer experience on the strongest foundations. Find out more about how Experian Health’s consumer data analytics can give you a holistic view of your patients and the social determinants that affect their health.

For many patients, unanticipated healthcare bills are up there with car breakdowns and untimely home repairs. No one likes a surprise bill. But when your washing machine is on its last legs, you probably do a bit of shopping around to find the best price for a replacement. Are patients doing the same when it comes to their healthcare provider? This is the idea behind recent industry and legislative moves to improve price transparency in healthcare. Recognizing that surprise billing leaves patients feeling stressed out and anxious, lawmakers are working to find a solution that would end ‘balance billing’, where patients are billed the difference between what providers charge and what insurers will pay. These bills often come as a shock, firstly, because the patient didn’t expect the bill in the first place and secondly, because the complexities associated with healthcare expenses create opacity around the actual cost of care. How transparent pricing builds a better patient experience In theory, an end to balance billing in favor of more transparent pricing should improve the patient financial experience. The hope is it leads to more competition and therefore better choice and quality overall. CMS Administrator, Seema Varma, says: "We want to empower consumers and patients to shop around for their health care and pick the provider that works best for them." However, some believe patients don’t yet think of healthcare providers in the same way as other consumer goods. Larry Levitt, Executive Vice President of Health Policy at the Kaiser Family Foundation says: “Most patients don’t think of healthcare as something you can shop around for, and there’s not much incentive when you don’t foot most of the bill directly.” Still, many healthcare organizations are on board. Giving patients greater clarity through more accurate pricing estimates and proactive communication about who pays what should reduce sticker shock, creating a better patient experience. Patient collections are likely to be a smoother and more cost-effective process, while consumer loyalty will be reinforced. All in, transparent pricing is an increasingly useful strategy to improve revenue alongside patient satisfaction. So, how should providers be using transparent pricing to improve the patient experience? How to use transparent pricing to build a better patient experience 1. Provide proactive pricing info to patients Don’t leave your patients to be surprised. Let them know upfront what the cost of treatment is going to be, including their coverage status, so they can plan ahead with confidence instead of heading into treatment with no clue as to what their final bill will be. Digital platforms can help you make this a seamless experience. A text-to-mobile solution such as Patient Financial Advisor gives patients a personalized and simple-to-read cost estimate prior to their healthcare visit and secure links to their bills so they don’t have to chase your collections team for updates. 2. Create a personalized payment experience Transparent pricing isn’t just about providing accurate estimates pre-service. It’s about seeing each patient as an individual with different circumstances, needs and preferences. A price transparency tool can reveal valuable insights about a patient’s specific situation and propensity to pay. With that, you can tailor the information you give them, the way you communicate and any payment plans you might want to recommend. For example, let’s say a patient is due to have an MRI, which will cost $650 with their high deductible health plan. For many, that’s a lot of money. Imagine how much less stressful the experience could be if you’re able to text them in advance to let them know what they owe and give them flexible payment options to manage the cost. 3. Make it easy for patients to pay One simple way to improve collections is to make the payment process as accessible and frictionless as possible. Patients have come to expect a similar consumer experience to what they’d get with online banking, booking travel or online grocery shopping. With the data-driven technology available today, it’s entirely possible for providers to deliver this. Self-service dashboards and tools are a way for patients to see what various procedures might cost and pay their bills whenever is most convenient. These can let patients apply for charity care, update their insurance details and even schedule appointments, giving them greater financial confidence and control over the process. Find out more about how to set up personalized and compassionate pricing estimates and payment options.

When it comes to paying for healthcare, “compassionate” is probably not the first word that comes to mind for patients. As they foot a greater portion of medical expenses, it’s often an experience rife with stress and uncertainty. Providers try to give accurate price estimates, but when patients switch coverage plans or payers change their policies, it’s difficult to be sure the original estimate matches the final bill. And what if a patient simply can’t afford to pay? When 56% of consumers say they would not be able to pay an unexpected bill over $1000, this not only indicates a tough ride for patients, but points to why so many providers are struggling to collect in full – around two-thirds of patient balances over $200 go uncollected. It’s unsurprising, then, that more healthcare organizations are looking at ways to create a better financial experience for patients. Understanding the collections process from the patient’s perspective and moving away from a “one size fits all” approach may be the key to a healthier revenue cycle. Could a more compassionate approach to billing help patients meet their financial obligations? How providers are turning to compassionate billing to help patients and improve revenue Thanks to advances in data analytics and technology, providers have a host of tools at their disposal to improve the patient financial experience. The following three strategies are generating some great results for providers: 1. Use data to give patients the right payment options A common pitfall across healthcare billing is to treat every patient the same. But sending a bill and hoping it gets paid is clearly not a reliable collections strategy. A compassionate billing approach means you look at each patient’s current financial situation and consider their ability and likelihood to pay. With the rich data analytics now available, you’ll know whether a simple statement will be enough to prompt payment from the patient, or whether a little extra handholding will be needed. Are there other payment plans that might be more appropriate? Would they benefit from a call or text to remind them of the next task they need to complete? Data analytics let you tailor the process so you can help your patients pay their bills in the way that suits them best, including finding missing coverage. Novant Health used Collections Optimization Manager to automate and increase patient collections. With this solution, Novant Health saw a 5.8% increase in unit yield year-over-year, and an overall recovery rate of 6.5%. Overall increased revenue and cost savings amount to an impressive rolling average return on investment – 8.5:1. 2. Personalize the way you communicate with patients Data analytics don’t just help you offer payment plans based on the individual, they allow you to determine a patient’s preferred method of communication. Do they prefer to get a statement in the mail or via email? Are there particular communication messages that will resonate with different patient groups? Paying bills can be a sensitive topic, especially if someone is struggling financially. Being able to create personalized messages at each touch point in the process is a helpful way to build compassion and consumer trust into the financial experience, so patients are more likely to engage with the process. The University of California San Diego transformed their patient financial experience by using Collections Optimization Manager to segment patients, as part of a broader exercise to improve collections. Knowing more about individual patients’ circumstances meant they could offer more relevant communications and build a more sensitive patient engagement strategy. 3. Make it convenient and easy to pay Every patient will thank you for a quick and painless payment process. Offering flexible payment options including online, in person and phone is critical. According to Kyle Wilcox of Grinnell Regional Medical Center, this is all about the ‘golden rule’ of patient payments: treating patients as you would want to be treated. He says: “At GRMC, we provide consumers with a range of choices to make payments, such as in person, by mail, electronically online or via mobile technology, and by cash, credit or debit card. Doing so allows them to pay in a way that is most convenient for them, improving their satisfaction and the hospital’s likelihood of receiving payment.” What’s more, efficient payment tools can improve your staff workflows too, giving them more time to help patients who need extra assistance and reducing the cost to collect. Heather Grover, Vice President of Product Management for Patient Collections, Experian Health, said: “We had a small community-based hospital use Collections Optimization Manager product with PatientDial. On average, the cost to collect for many of our clients is anywhere between 7% and 15%. They saw theirs decline to 5% and over a two-year period, their cash collections increased to 42% prior.” Ultimately, there are some patients who can pay and some who can’t. It’s a sensitive topic to navigate, but when patients feel supported, they’re more likely to be able to meet their financial obligations. Collections Optimization Manager lets you figure out who’s who and offer them the most appropriate support to get their healthcare bills paid, so they can get on with life.

Before brands like Apple and Amazon became synonymous with consumer culture, the healthcare experience didn’t have much motivation to change. If you felt ill, you’d go see a doctor. The doctor would check you over, make a diagnosis and set you on the appropriate path to treatment. It was on you to initiate contact: your physician’s only job was to provide whatever care was needed, once you were in the system. Today, the healthcare journey can look quite different. Patients have options. In an increasingly crowded market, it’s now up to providers to reach out and woo healthcare consumers. To stay ahead of the competition, providers must seek innovative ways to attract new consumers and inspire loyalty among existing members. Chris Wild, Experian Health’s Senior Director of Consumer Engagement Solutions, says: “Health systems have started taking a good, hard look at how they engage with patients, whether that’s marketing to new populations or encouraging patients to come in when they are sick. It all comes down to data. With a complete picture of the patient, you can loop together clinical information with insights about their lifestyle and attitudes, so you really know who they are and what they’ll need from your health system.” Three ways consumer data can help you attract and retain patients Data-driven marketing and engagement is a growing opportunity for providers. With the right data platform, it’s easier than ever to leverage reliable, high-quality data and analytics to better understand and serve your patients. In fact, Wild suggests there are three main ways marketing data can benefit healthcare providers (you can watch Wild talk about these on video): 1. Marketing to new and existing members Why should prospective patients choose your hospital or physician’s practice? What would prevent existing patients from being tempted to switch providers? Understanding what makes your patients tick lets you pinpoint the exact benefits, priorities and language that will resonate with them most. As Wild says: “If you’ve got five health systems competing in a town of 1.5 million people, how are you going to differentiate yourself? Once a patient picks up a provider and they’re relatively satisfied, they don’t change a lot. They’re starting to look at things like quality. They’re starting to look at cost and what’ll give them the biggest bang for their buck, but getting to them first is a big first-mover advantage for sure.” ConsumerView bundles up reliable information on around 500 demographic, psychographic and behavioral attributes to help you get to know your target market, so you can get the right message in front of them at the right time. 2. Engaging with patients to improve health outcomes Even if you’re the only health system in town, there’s still a need to engage. You want your patients to achieve the best possible health outcomes and often that requires them to take ownership of their health. You can help them do that by encouraging them to come in when they are sick, or by pointing them toward services that could make it easier for them to access care. To do this effectively, you need to know what your patients need. ConsumerView has around 1500 verifiable data points on 300 million US consumers, covering about 98% of the US population. These can be used to discover how your patients think about their health and how they make their buying decisions. When that’s merged with your own information about their clinical journeys, you can give them a truly personalized healthcare experience. 3. Future-proofing your services Finally, you can use these analytics to better understand your current patient population to make smarter decisions about the investments you need to make in future. Where are the bottlenecks in the patient’s healthcare journey? Where should you put new services? Robust data analytics help you say, “we need to invest here and this is why.” Wild says, “I’m working with one analytics team that’s looking to better understand where they’re going to allocate physical and human resources so they can follow up with their patients more completely. They’re digging in deep to understand what their current patient population looks like, and then using that data to understand what their future population may look like.” Data analytics helps you predict demand for services, so you can direct resources accordingly. You’ll be able to identify trends in patient pathways, so you can engage with patients earlier and make sure they get prompt care and support, giving them a better chance of a good outcome and saving your organization time and resources. Learn more about how your organization can drive marketing results through customer segmentation, targeted messaging and analytics

It’s amazing to look back at how far medical science and digital technology have come – and how those two worlds are increasingly intertwined. Ten years ago, the idea of managing your healthcare bills or making appointments through an app on your phone would have been unthinkable. Now we take it for granted! But having all these tools at our fingertips means there’s more data being shared between different services and platforms. As a healthcare provider, you might be accessing and sharing patient data multiple hospitals, primary care services, pharmacies, patient portal providers, payers and more. It’s vital to make sure that data is accurate. Research by RAND Corporation revealed that between 8-16% of patient records are duplicates. Trying to provide care on the basis of unreliable data is inefficient and expensive for providers, who lose staff time and revenue trying to match up records and reconcile the data on file with the patient in front of them. According to RAND, a mid-size health system absorbs as much as $96 for each duplicate. What this means for patients is even more worrying. According to the US National Institutes of Health, “195,000 deaths occur each year because of medical errors, with 10 of 17 being the results of identity errors or wrong patient errors.” In a value-based system where patients are covering more of the costs themselves, the financial impact of having unnecessary repeat tests or longer-in-patient stays due to delayed treatment is an added pain. Currently, standard health IT products have some catching up to do, as only 10% of duplicates are spotted. But looking ahead, the future of patient identities is promising. Unique patient identifiers are key to unlocking value-based care The twin trends of value-based care and healthcare consumerism are bumping up patient expectations. They expect a seamless experience. They expect their records to be updated immediately. They’re confused when one department doesn’t have access to information that was just shared with another. And they definitely don’t want to see different services working off different versions of the same record. The answer for many high-performing health systems is to introduce unique patient identifiers (UPIs). This allows a patient’s record to follow them throughout their healthcare journey, ensuring that at every touchpoint, clinical and admin staff are confident in the accuracy of the information they hold. But transitioning to any new system can involve a bit of culture shock for those involved, and so careful planning is essential. What steps can providers take to make sure they implement a patient identity management strategy that’s built to last? How to future-proof your patient identity platform 1. Make sure everyone’s on board with the plan First, whatever solution you’re using to manage patient records, it’s essential that your patients, staff, payers and any other parties involved all buy in to the new approach. Changing the way you handle data and introducing new digital tools such as UPIs can often call for a mindset shift in the way your team and consumers think about data. Be sure to communicate the benefits of UPIs to patients, payers and staff. For example, UPIs can: improve patient safety, by preventing duplicate and inaccurate recordslower healthcare costs, by eliminating inefficiencies and errorssafeguard patient privacy, by keeping records securecreate a better patient experience, by supporting patient-centered carehelp staff access up to date information about their patient’s healthcare situation 2. Choose a UPI system that works within and outside your network Some providers use hospital- or practice-based patient identifiers, where a master patient index is used to link all versions of a patient’s record held within a single organization. An enterprise master patient index (EMPI) does the same, but across several facilities or services. A cross-enterprise solution makes it much easier to manage patient identities across your entire network, without having to wrangle disparate records that don’t interface well with each other. When this system is based on ‘referential matching’, which uses wider data sources and UPIs to build a more connected and accurate data ecosystem, you’ll get a much more complete view of your patients and far fewer inaccuracies. 3. Use data analytics to improve decision-making UPIs bring another advantage: they enable you to analyze health, credit and consumer data for a single patient, giving you useful insights about your patient population as a whole. A network of interoperable data can help you spot trends in the social and economic factors that affect health and wellbeing, so you can target your resources more effectively. As the world of public health data matures, it’s highly likely that UPIs will become the norm. Data-sharing remains a challenge, but by using digital tech to your advantage, you can improve the way patient records are managed in your health ecosystem. Learn more about how UPIs could help close the patient data gap in your organization.

At the end of 2019, Experian Health announced that every person in the U.S. population, an estimated 328 million Americans, had successfully been assigned a unique Universal Patient Identifier, powered by Experian Health Universal Identity Manager (UIM) and NCPDP Standards™ (the “UPI”). Universal Patient Identifiers (UPIs), created with a comprehensive view of patients from health, credit header, and consumer data sources, are thought to significantly reduce the challenges that stem from the misidentification of patients which span patient safety, financial, and operational inefficiencies. But what does 100% coverage mean? And what does this mean for the future of healthcare? To take a deeper dive, we sat down with Victoria Dames, an Experian Health leader in the identity management space to learn more. 1. It doesn’t get more perfect than 100%, so tell us more. What exactly does 100% coverage mean? Experian Health developed an algorithmic engine known as our Universal Identity Manager about five years ago. Since this time, we’ve worked closely with many providers, pharmacies and payers to help address their duplicate records. We’ve been monitoring our adoption and enumeration by unique patient identifiers against 328M individuals in the US population (2010 Census) and achieved this milestone at the end of 2019. Through our broad network of provider clients, which include hospitals, pharmacies, payers, and healthcare technology companies, patients who have received care from participating entities over the past few years have been enumerated.  As new patients enter the healthcare ecosystem, this number will continue to grow.  2. Why are universal patient identifiers (UPIs) needed and how do they benefit providers and patients? The Universal Patient Identifier (UPI) helps providers link the right records together, preventing duplicate records from being created. For example, think of all the ways duplicate accounts or variances can occur: address differences, name variations (Katherine, Kathryn, Kathy, Kat), maiden names and potential user entry error. With the UPIs, providers can link records together and have one complete record and view of the patient, ultimately leading to a better patient experience. It’s important to note that the UPI is not something the patient knows or sees, but rather part of the technology. It can be embedded within a hospital’s information system, for example. It simply links a patient’s records together, so a provider has a complete view of the patient’s identity. The flow of communication happens when participating healthcare organizations send Experian Health patient demographic information; the system provides the organization in return with the insights and identifiers that they need to better manage patient identities and prevent duplicate records. The UPI can be attached - if the situational requirement is met - to active claims in real-time transactions effectively improving the integrity of patient records. During this process Experian Health does not rely on or use any clinical information about the patient; Experian Health only leverages the minimum data elements needed to successfully match an identity.  3. How did you get numbers assigned to all Americans? When a healthcare organization enlists our help, we process all their historical records through the UIM, returning a Universal Patient Identifier (UPI). The initial run of this data helps resolve existing duplicates which can date back several years. Working with multiple providers and pharmacies, we were able to get numbers assigned to all Americans. The number will continue to evolve of course, as the population changes with births and deaths. 4. Are there privacy risks with this? Experian Health is a HIPAA-compliant Business Associate when it receives PHI from customers.  It takes its privacy obligations very seriously.  As to UIM, privacy risks are minimized by the fact that the UIM does not leverage any medical records, prescription histories, or provider systems. The purpose of the solution is to assist healthcare professionals to better match an individual’s identity through data assets that would normally be unavailable to a healthcare provider.  5. Does a UPI function similar to a credit report, meaning it provides a singular view of a patient’s medical history? It depends on the situation.  If a provider has a patient in their EHR twice under two spellings of the patient’s name in error, then yes, the UPI would link those two profiles, creating a singular view of the patient in that provider’s system. Additionally, the UPI generated by Experian Health is designed to help facilitate interoperability between healthcare providers.  For example, if your pharmacy has you listed under your maiden name of Smith and your doctor has your married name of Wilson, during the ePrescribing process, your ePrescription might not get associated with your prescription profile. If both providers have the UPI on record and submit it during the transaction, the systems will match the patient using the UPI. It’s important to note that the UPI is technology for entities and is not patient facing. 6. What is the direct benefit to consumers; will it help them control their medical data? Consumers will benefit depending on how a provider implements and utilizes the UPI. For instance, if a provider has two medical records, and they merge this into one record, the patient will see one consolidated record. Imagine two patient profiles for the same individual at a pharmacy.  One prescription is filled under each profile and the two separate prescriptions, if taken together, could lead to a severe reaction. If filled under two different profiles, the automated process to screen for drug interactions would not identify this harmful reaction. But the UPI directly solves for this issue. 7. What are the next steps and goals for Experian Health as it pertains to UIM? Our goal is to continue to partner with healthcare organizations to help prevent and resolve their duplicate records. We are continuing to invest in our technology and capabilities within identity, as we care deeply about patient safety and data integrity. Having a single, unified and accurate view of the patient is a challenge that plagues the healthcare system, and now we have a comprehensive solution that reduces the barriers to make healthcare safer.

The stats are alarming: Up to 80% of health outcomes are not due to medical factors, but to a patient’s social and economic circumstances—such as their income, housing situation and even whether they own a car.68% of Americans are affected by at least one social determinant of health (SDOH).Approximately 24% of hospitals and 16% of physician practices screen for food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence—which means the majority don’t screen for all relevant social needs. The healthcare industry has been talking about the importance of addressing social determinants of health for years, but many struggle with how to collect the insights. For example, if 68% of Americans are affected by at least one SDOH, how do they even discover the one? What is the ideal way for providers to screen for SDOH? Should they simply ask the patient? Do they start a visit with a survey, probing for details that could ultimately impact care management decisions? Providers know these sensitive topics – housing instability, financial instability, food insecurity and onward – can be tough and uncomfortable conversations. So, where to begin? Should you rely on patient surveys to capture SDOH? Patient surveys can be a useful way to find out about many potential barriers to care. However, they bring limitations: Your insights will be limited to the patients who show up—so anyone who has struggled to attend an appointment (and therefore potentially with higher needs) will be left out It can be time-consuming and expensive to give staff the time and space to conduct personal interviewsThey rely on patients to be willing to share openly, but some may not feel comfortable doing soThere is room for error in how questions and answers are interpreted by both the survey team and respondentsSocial circumstances can change over time, so it’s possible that the information gleaned in the survey may not be relevant a few months down the line. Knowing SDOH can have such a huge impact on a patient’s health certainly means clinicians should discuss these topics in the exam room, but relying solely on patient surveys and conversations could lead to gaps in intel. When should you screen for SDOH? Screening for social needs when a patient first registers or engages with your services is a good starting point. But what happens when their situation changes between diagnosis and treatment? What if they disclose a social need to a specialist that wasn’t flagged on their initial intake form? Does your staff know how to discuss sensitive social issues? Can they create a safe space for patients to share? Have you got clear referral pathways when an issue is flagged? Look for possible touchpoints in the patient’s journey where referrals to support services would be appropriate. Looping in the relevant primary care services is a good way to make sure your patients are connected to community-based programs and supported throughout their journey, whenever a new or changed social need is identified. What types of data could offer the SDOH insights a provider needs? Geographical and community-level data can help a healthcare organization understand their patient population’s income, housing situation and employment status. These are useful for population-level care planning but aren’t patient-specific. A better way is to analyze securely collected consumer marketing data for more specific and accurate information. Working with a trusted data vendor that is a compiler of original-source consumer data can help you navigate your options. The real predictive power of SDOH data comes when you combine patient-specific information obtained through screening, with consumer databases. A third-party vendor can help you access data on your patient population’s income, occupations, length of residence and other social and economic circumstances. Your care managers can use this to inform proactive, preventative conversations with patients to solve any non-clinical gaps in care. Bottom line … When healthcare organizations have a holistic view of patients—and the SDOH that play a role in their lives—they can take steps to help prevent avoidable hospital visits, emergency department (ED) utilization, appointment no-shows and worsened conditions by encouraging and facilitating earlier interventions. The key is to start with the right data.