Did you know a whopping 90% of missed revenue opportunities can be linked to denied claims? At a time when providers are working to make up this lost revenue, they are also dealing with patients who are expected to cover more of their medical bills through out-of-pocket expenses. High-deductible health plans, free-care programs and crowdfunding are more prominent, leaving hospitals vulnerable to the patient’s ability to pay. Add in the rise of value-based care, and it’s no secret patients expect an experience that matches their interactions with other consumer services. They’re more engaged in their health and know they have options. Patient collections are down, but expectations are up. Loyalty wavers somewhere in the middle. How should providers respond? Legacy revenue systems aren’t set up for financial models based on value over volume, so providers need to adapt. It’s vital to find ways to help patients navigate the financial side of healthcare and make patient collection processes as efficient as possible. What does value-based care mean for your revenue cycle? Shifting to value-based reimbursements, patient-centric incentives and quality of care programs means your clinical and revenue cycle workflows need to be better connected. Patients must receive consistent and accurate communications throughout their healthcare journey, setting them up for the best possible health outcome and payment options. When the care and finance functions work together, your patient records can be kept up to date and the next admin task will be triggered at the right time. Here are some things your revenue cycle management (RCM) process might be missing: clear and convenient processes for patientsaccurate patient identification from registration to billingability to collaborate with payers to customize workflowsstreamlined workflows to reduce time and resources spent on avoidable tasksautomated processes to support effective collections and spot root causes of denialsreal-time reporting to help improve performance over time [Source: Frost and Sullivan] Data, analytics and automation can help you create more agile processes to minimize revenue leakage and create a better financial experience for patients. 3 ways to close the gaps in a value-based RCM model 1. Use consumer data to help patients make informed decisions A major cause of denied claims stems from patients being unsure about what their treatment will cost. Others are unclear about whether they have appropriate coverage. Help your patients weigh their financial options by providing accurate estimates and working with them to check coverage. Consumer data can support this process by giving you insights into your patient’s social identity, medical history, coverage status, insurance eligibility and propensity to pay. With an intuitive billing process, you’ll improve the patient payment experience and reduce revenue leakage. 2. Use analytics to predict gaps in your revenue cycle Many top-performing health systems use advanced data analytics to predict where the bottlenecks, errors and denials might creep in, so they can take swift action to address them and keep their patients and C-suite happy. For example, with analytics, you can get to know your patients better so you can segment them according to their financial responsibility and ability to pay. Not only does this mean you can focus your collections efforts more effectively, but you’ll have the right insights to help patients navigate the payment process with personalized nudges and relevant messaging. In addition, analytics have a huge role to play in eliminating avoidable denials resulting from unreliable or inaccurate patient data. You’ll be able to spot patterns in denials, so you can implement checks and processes to avoid them in future. 3. Put the right tools in place to close the gaps Close the widening gap between claims and collections starts by ensuring your patients are aware of their financial responsibility. A self-service patient portal could give your patients convenient access to their information in a time and place that suits them. They’ll be able to schedule appointments, enroll in payment plans, and apply for charity. They’ll see real-time, transparent and accurate information about price estimates and their eligibility and coverage. When the financial experience is transparent and frictionless, patients are more likely to feel satisfied and less likely to shop around for care – not to mention being better prepared to meet payment deadlines. And internally, data-driven automated software can help you monitor and manage every step of your revenue cycle. You can make life easier for clinicians and management teams with EHR-integrated dashboards, web-based financial reporting and timely alerts for the relevant teams. Schneck Medical Center used Experian Health’s Denials Workflow Manager to automate tedious manual processes, freeing up staff time and optimizing claims follow-up and collection: “No longer are we waiting 30 to 45 days to review denials. We can review them on the day of [submitting] if we choose to.” (McKenzie Smith, Director of Patient Financial Services)  It’s simply no longer viable to use RCM processes that aren’t integrated across your entire digital ecosystem. Providers that can offer a convenient and personalized consumer experience, automate collections workflows and join the dots between clinical care and revenue management will have the competitive advantage in the era of value-based care. Learn more about how your organization can use data to predict and close gaps in your revenue cycle.

Did you ever have someone tell you, “there’s no magic pill” for reaching a goal? It’s a somewhat ironic analogy, given that so many people struggle to take their meds as prescribed. Following a medicine schedule actually takes a lot of organization and discipline, never mind the financial and emotional cost of having a daily reminder that you’re not well. It’s estimated that 50% of patients don’t take medications as prescribed. Sometimes a patient is busy and misses a dose. Maybe they forget whether they’ve taken it already and accidentally take double. Perhaps they feel better and decide to stop a course of meds early. Or maybe they can’t get to the pharmacist to get their refill on time. Unfortunately, medication non-adherence (MNA) can have a more direct impact on a patient’s condition than the specific treatment itself, according to the World Health Organization. Non-adherence is thought to contribute to nearly 125,000 deaths and 10% of hospitalizations each year. It costs the health care system between $100–$289 billion each year, and according to a study by Walgreens, for every 1% improvement in adherence, $50 can be saved in healthcare spending. The causes are varied. Of course, patients have a role. But healthcare organizations operating at various points along the care continuum can also play a big part in helping or hindering patients in sticking to their prescriptions. Doing so is in everyone’s interest, as tackling non-adherence can help reduce readmissions and avoid more serious medical conditions, improve patient loyalty, yield financial savings and create a better experience all around. Here are three ways different healthcare organizations can help patients stay on track with their meds: 1. Keeping accurate patient records from hospital to home When a patient is hospitalized, it’s fairly easy for them to stick to a medicine schedule. Drugs are dispensed in the same building and brought right to the patient’s bed at the appropriate time. The problems arise when the patient goes home. They may leave hospital with new prescriptions which can be confusing and if they already have a prescription, the admission itself can disrupt their usual routine. As things stand, hospitals tend not to be reimbursed for interventions to improve adherence, so these are less likely to be prioritized during care transitions. But given the likely improvements to patient outcomes and consumer loyalty, and the fact that hospitals could save $37 for every dollar spent tackling MNA, these interventions are worth a second look. A simple but effective place for hospitals to start is in improving patient identities. When your clinical teams know they have a 100% accurate and up-to-date record for each patient, including their current prescriptions, they can help the patient stay on track and prescribe new medicines with confidence. New identity management platforms such as Universal Identity Manager can help you keep track of patients and their meds, reducing the risk of medical errors and avoiding billing mistakes associated with duplicate prescriptions and preventable readmissions. This ‘golden thread’ of patient information can also improve communications within and between providers in your health system, such as Accountable Care Organizations (ACOs), pharmacies and other community providers. 2. Understanding and addressing wider barriers to adherence Common barriers to adherence often relate to a patient’s circumstances at home, such as not being able to get to the pharmacy because of a lack of transport, or because the opening hours don’t fit with their work schedule. For patients juggling work, childcare and other responsibilities, refilling their prescription can easily slip down the to-do list. Pharmacies can help by offering logistical support such as automatic refill programs, home delivery and help with organizing medication into pill boxes. But how do you know which intervention will be most relevant? This requires a wider understanding of the make-up of your patient population and their needs, preferences and behaviors. Understanding the social determinants of health can help you identify the specific barriers to care for your healthcare consumers, so you can put in place the right response. 3. Develop patient engagement strategies to help patients take their meds It’s not just those directly involved in providing care who can help improve MNA. Payers can help in two major ways: firstly, by supporting members to overcome barriers such as cost and confusion, and secondly, by working with hospitals and pharmacies to help them develop effective strategies to reduce non-adherence. For example, Blue Cross Blue Shield of Arizona (BCBSAZ) has introduced a text messaging service to send reminders to members about their prescriptions, with a $45-50 discount on copays for those that refill on time. It’s hoped this program will tackle behavioral barriers to adherence such as procrastination or forgetfulness, while also addressing price concerns. Chris Hogan, Chief Pharmacy Officer at BCBSAZ described the program “as being a very high tech, modern, simple and effective addition to our overall initiative to improve medication compliance.” This kind of personalized patient engagement can be very effective in helping patients to stay on track. With ConsumerView, you can access a wide range of high-quality demographic, psychographic and behavioral consumer data, to help you offer personalized support such as digital reminders to your patients. You can develop engagement strategies tailored to the specific needs of your patients in just a couple of clicks. Could one of these strategies help your organization do more to improve medication management? Learn more about how we can help you help your patients – and your bottom line.

When it comes to value-based care, there’s really just one measure that matters: patient satisfaction. As CMS incentivizes providers to help patients find better care, improve population health and lower healthcare costs, more top health systems are seeing patient engagement as the path to value-over-volume success. Patients are finding themselves footing more of the bill for medical expenses, so elevating the patient experience is essential. If they’re not satisfied, they’ll simply take their dollars elsewhere – not what your CFO wants to hear. Helping patients feel more engaged in their health creates a more satisfactory experience, and in turn, boosts patient loyalty. And what’s more, by giving them opportunity to make informed decisions about their care, you can also reduce preventable admissions, avoid no-shows and fix the revenue leaks in patient collections. It’s beneficial for everyone. Here are four strategies to help you boost patient engagement and create a more consumer-friendly experience in your organization. 4 ways to boost patient engagement 1. Use segmentation and customization The first route to consumer-friendly care is about treating each patient as an individual. With advances in data analytics, it’s now possible to group your patients according to risk (whether that’s risk of a particular disease, exposure to a social determinant of health, or likelihood of non-attendance at follow-up). This allows you to be more targeted in your marketing efforts, provide patients with information that’s more relevant to them, and help each patient move to the next stage of their healthcare journey. Stanford Medical School sees this data transformation as central to its vision of “‘Precision Health’ – a more preventive, predictive, personalized and precise” approach to healthcare. Analytics give you a wealth of insights about the clinical, financial, behavioral and social factors affecting your patients, so you can personalize your patient engagement strategy to each member’s specific preferences and needs. As noted in research undertaken by Frost and Sullivan on behalf of Experian Health: “Analytics help us select patients who will respond to engagement strategies and de-select patients who won’t respond are needed. Not everyone responds to engagement in the same way.” By prioritizing precision marketing, you can create a culture of precision care. 2. Help patients take ownership of their health journey Value-based care is an opportunity to empower patients to be active players in their health. Greater transparency into the billing process, access to healthcare data and consumer-friendly tech can all help patients see what’s happening at each stage of the process. When they’re more informed, they’re more likely to adhere to care plans, turn up to appointments and successfully navigate payments. Your patient portal is a good place to start. Research shows that use of portals enhances patient engagement, satisfaction and health outcomes. Patients can access their records, view test results, schedule appointments at a time that suits and sort out bills with less of the stress. It helps patients ask the right questions and builds a trusting patient-provider relationship. 3. Improve the patient financial experience When two-thirds of Americans are worried about being able to cover unexpected medical bills, any way you can make the payment process more transparent is a big plus. Help your patient navigate the financial side of their healthcare experience with clear, real-time information about their coverage status, estimated co-pay calculations and appropriate payment plans based on their specific circumstances. Putting them at ease will help them meet their financial obligations without leaving a bad taste. In this way, you can build consumer trust and optimize your revenue cycle at the same time. 4. Use SDOH data for proactive outreach Research shows that medical tests and treatments alone are not enough to determine the outcome of a patient’s healthcare journey. We should be paying more attention to the social and economic factors that can get in the way of care. Because when patients struggle to access care, it’s harder for them to follow treatment plans or show up to important follow-up appointments. In a value-based world, tackling social needs is a growing priority for providers seeking to improve population health. When you have a more complete grasp of each patient’s motivations, support networks and personal circumstances, you can create a more efficient patient engagement plan. You’ll avoid wasting resources on patients who aren’t in a position to respond and instead can adopt outreach strategies to help those patients access the care they need. This might include offering alternative payment plans, signposting to logistical support such as childcare or transport, or referring to local community services, such as cooking classes or social clubs. To do this, you need reliable, relevant and accurate consumer data and the capability to draw actionable insights. Experian Health’s unrivaled consumer marketing data can help you better understand your patient population so you can communicate with them and support them in the most effective way. Consumer-friendly care is the new currency in value-based accounting – and the key to positive patient engagement. Find out more about how Experian Health can help your organization lift your patient engagement strategies for greater patient satisfaction, better health outcomes, and a healthier

  Recently I had the opportunity to present at a regional chapter of the National Association of Healthcare Access Management about the growing need for business intelligence to improve patient access functions, as well as revenue. In speaking with attendees, it became clear that automating the patient access workflow with real-time data can create a more efficient and accurate process. Here’s how. As the responsibility for paying healthcare bills increasingly falls to patients themselves, patient access can make or break the revenue cycle. From registration and verifying insurance details, to scheduling appointments and collecting cash payments—this is the front line for the financial side of the patient experience. When you consider that half of denied claims occur earlier in the revenue cycle at the point of registration, improving those early-stage patient access processes is the obvious place for providers to look when seeking to minimize lost revenue. Revenue loss in patient access is mostly due to errors in patient identification, inadequate data analytics and inefficient workflows. If front and back office teams were better connected and able to work together quickly to communicate and resolve issues, many of these errors could be prevented. Without reliable tools and workflows to support this, those teams often must resort to manual fixes for any errors that arise. Unfortunately, this takes time and effort, blocking opportunities to find new ways to improve decision making and business performance. Healthcare is becoming more competitive. Providers must work to leverage the right data in the right way to safeguard profits and offer a better patient experience. That said, where should you start? Doing more with less requires the right data insights There are two sides to the solution: first, you need to be sure your data is accurate from the start. Around a third of denied claims are caused by inaccurate patient identification, while 12% of patient records are duplicates. Cleaning up your data with high-quality demographic data can help eliminate preventable denials. Secondly, you need to be able to draw insights from your data to help make smarter decisions in the future. Let’s say you notice a spike in late payments from a certain population. Why is that? Looking at historical data on patient and payer behavior can point to emerging trends and help you figure out where to focus your efforts in response. Or perhaps you’ve recently added a new function to your patient portal. Analytics can help you see if and how patients are using it and evaluate its overall performance. Once you have your data and analytics in place, you can start to use it to make improvements. Automating the patient access workflow with real-time data can create a more efficient and accurate process. It will also help link front and back office staff with shared systems that minimize errors and wasted staff time. 3 ways to use data analytics to streamline patient access For providers looking to streamline their early revenue cycle processes using the power of data, three areas to focus on are: Creating a better patient experience Increasing numbers of self-pay patients means patient loyalty is a growing priority for providers. Creating a positive, straightforward patient financial experience is essential for hospitals and health systems looking to reduce the stress and anxiety many patients feel when dealing with healthcare bills. Using data insights to identify the sticky parts in your patient access processes can help you spot opportunities to improve the consumer experience. For example, are patients receiving duplicate communications because the system is failing to update demographic information? Are there bottlenecks or backlogs that are creating stressful delays for patients? A business intelligence tool such as Revenue Cycle Analytics can help you pinpoint the root cause of delays and errors so you can work to fix them—and level-up your patient experience. When Martin Luther King Jr. Community Hospital (MLKCH) realized patient registration in their busy Emergency Room was a bottleneck and source for claim denials, they implemented an automated platform to streamline their registration process and improve the data being captured at the point of registration. Lori Westman, patient access manager at MLKCH says: “We get fewer denials because we’re getting true verification data, and our patient volumes continue to increase. So the fact that we can take off two to three minutes, at least, on half of our registrations is speeding up the work for the team, and the turnaround time is much better for the patients.” Uncovering potential revenue loss Analytics can show you exactly where your revenue cycle is losing money. Using appropriate benchmarks and custom KPIs, you can analyze accounts across the entire cycle to make sure your existing revenue cycle solutions are performing optimally and identify new opportunities for improvement. By gathering together multiple data streams into a single dashboard, you’ll get an at-a-glance view of your revenue cycle performance, so you can drill down to the root cause of denials. This also helps link up your front and back office staff. Rather than working retrospectively to address issues as they happen, your back office team can use insights from whole system data reporting and analytics to give front office staff immediate feedback on where denials are occurring. Monitoring payer rules and performance With American hospitals footing the bill for more than $620 billion in uncompensated care over the last two decades, it’s vital to verify a patient’s insurance options as soon as they set foot in the hospital. With up to date information on payer rules and a robust process for finding missing coverage, you can avoid protracted negotiations with payers and focus on denials, rejections and exceptions. A payer dashboard can also help you assess how payers are performing against one another, so your discussions around timely payments will be based in fact. By analyzing performance around pre-service, point of service and post-service, you’ll be better placed to work more closely with payers to minimize the risk of both late payments and denied claims. Learn more about how data analytics and an automated patient access workflow can help eliminate costly denied claims, boost revenue cycle performance and improve the patient financial experience. Steven Thiltgen is Director of Analytics Consulting for Experian Health

    In today’s fast-evolving healthcare industry, consumer expectations are changing. Individuals are footing an increasing portion of medical bills, so they’re paying closer attention to their healthcare options. And with digital technology enabling choices for everything from where to bank to what to eat (and even who to date!), patients are now expecting a similar consumer-centric experience when it comes to their health. But what exactly are they looking for? Providers should respond to this rising consumerism with two things: convenience and engagement. Many patient tasks are time-consuming, tedious and repetitive. The use of outdated technology draws unfavorable comparisons with the intuitive apps used in other industries. And all too often there’s a one-size-fits-all approach to marketing. The opportunities to improve the patient experience are huge. As the competition for consumer business heats up, providers should look for ways to step up their patient engagement strategies to attract new consumers and inspire loyalty among existing members. Consider how to make it as easy as possible for patients to access the care they need, whether that’s through frictionless scheduling, simplified registration processes or proactive communication about free transportation options. Data-driven technology and automation can help drive improvements in both convenience and engagement. Here, we look specifically at how automation could help you meet changing consumer expectations in the world of patient access. How can automation make patient access more convenient for consumers? Patients hate administrative and financial tasks that take them away from family, friends and other priorities. When looking for an easy, streamlined patient access experience, they might ask: Can I make appointments online? Can I get an out of pocket estimate for my cost of care? And can I price-shop my services? Can I do my pre-registration work before I show up for my appointment? Can I manage my bills and all my health information online? Can I do all of this from my mobile or tablet device at a time when it’s convenient for me? Automation can help you deliver against these expectations and remove stress and hassle from many patient access tasks. By using consumer data and technology to trigger the next stage in the process, you can help patients navigate the complex healthcare system, making registration, billing and payment more convenient. For example, online self-scheduling lets patients plan appointments when it suits them. You’ll increase appointment and referral rates, improve call center efficiency, reduce no-shows and enhance the overall patient experience. Or how about offering patients a one-stop-shop for managing all their healthcare admin, through a digital patient portal? This makes it much quicker and easier for them to get price estimates, set up payment plans, update insurance information and stay on track with appointments and treatment plans. By automating the registration and billing processes, you’ll improve self-pay collections and decrease bad debt. If you can say “yes” to the above questions, you’ll be making life easier for your patient access staff too. Reliance on manual data entry processes means staff are constantly battling bottlenecks and dealing with avoidable errors and duplicate records. Not only does this waste employee time, it opens the door to major safety issues and lost revenue: patient identification errors can cost up to $2,000 per patient and are associated with a third of denied claims, costing the average hospital $1.5 million each year. How can automation support better patient engagement? This isn’t just about removing obstacles or introducing speedy tools. You can use automation to improve patient engagement at various touchpoints during the patient access process. Consumer data paired with automation can help you nudge patients by text or email to make appointments, so they don’t miss out on important checks. You can deliver personalized updates, reminders and offers, so your patients feel taken care of and know exactly what’s happening throughout their healthcare journey. Using lifestyle, demographic, psychographic, and behavioral data from the highest quality sources, you can also use automation to segment your audience into groups based on all sorts of variables, in order to communicate with them about the right services, at the right time. Now is the time to leverage technology for a better patient access experience. It’s clear that awareness of the potential ROI in automation is growing. Still, many providers have only scratched the surface when it comes to integrating automation within their revenue cycle operations. Given that 66% of patients would switch providers for more convenient access, it makes sense to consider how you can leverage technology to simplify all sorts of patient tasks, from pre-registration to payments. Learn more about how automation could help your organization create a better patient access experience for consumers.

Flu season came early to Australia this year, with more influenza hospitalizations compared to last. And 93% of reported cases were the more dangerous Influenza A strain. If you’re wondering what this has to do with your healthcare organization, the answer is that generally speaking, flu season in the U.S. often mirrors what’s just happened in the southern hemisphere. In short, get ready. The number of cases in Australia has U.S. health officials gearing up for a challenging flu season over the next few months. Although flu activity is currently low in the US, the Centers for Disease Control and Prevention (CDC) expect this to increase in the coming weeks, particularly as Australia experienced an unusually severe early flu season this year. For healthcare organizations, this will likely translate into extra demands on staff and services, crowded emergency rooms and higher rates of admission. Your organization most likely already has a robust winter health contingency plan in place. Still, there may be new ways to use data analytics and technology to increase efficiency, so you’re as prepared as possible. Are you ready? Three ways technology can help providers prepare for flu season Create a flu-preparedness patient engagement strategy At this time of year, patients can be exposed to many misconceptions about flu and how to prevent it. A helpful way to make sure your patients are informed about how to protect themselves against illness is to communicate the risks, encourage vaccinations and promote preventative behavior. Consumer data can help you to deliver personalized messages to patients in a time and format that suits them best, segmenting your patient groups according to risk status. Whether you’re contacting them through their patient portal, email or in-person touchpoints, a tailored approach will create a more reassuring patient experience, while allowing you to target your information campaign to the right people at the right time. Promote telehealth services More hospitals and pharmacies are turning to telehealth systems to help manage flu season. Patients can log on to watch information videos and have virtual consultations with physicians without being exposed to germs in the doctor’s office. Reducing the number of patients showing up to access services in-person can help relieve pressure on services, while minimizing the risk of infection spreading. Check in with your telehealth provider to make sure everything is in place to provide your patients with the virtual care and advice they need. Streamline patient registration With more patients likely to be coming through the doors, the last thing you need is a time-consuming registration process hindered by lengthy and often unnecessary eligibility checks. Automating registration, financial clearance and other patient access processes can eliminate many manual tasks, save time and reduce errors so there are fewer denied claims. At such a busy time of year, your patients, staff and bottom line will thank you! How one Los Angeles hospital streamlined patient registration to manage flu season  Martin Luther King, Jr. Community Hospital in Los Angeles worked with Experian Health to streamline patient registration and insurance verification. With a high-traffic emergency department and limited front-line staff, manual quality assurance and multiple payer website checks were creating bottlenecks and inaccuracies that took up more time to fix. Using Coverage Discovery, the hospital was able to improve efficiency in insurance verification, while Registration QA saved time in validating patient and payment information. In addition, eCare NEXT® helped automate workflows and generate data insights for further improvements—integrating seamlessly into the hospital’s existing Cerner® system. Speaking about the improvement made ahead of last year’s flu season, Lori Westman, patient access manager at MLKCH, said: “We have a lot of returning patients to our emergency room, so once we check that patient in, their eligibility automatically runs in the background and our staff doesn’t have to go into another website to check their eligibility. This has saved us two to three minutes of our registration time.” “We average about 300 patients every 24 hours. Heading into flu season, they’re expecting to hit a 400-per-day volume, so the fact that we can take off two to three minutes at least on half of our registrations is going to speed up the work for the team that much faster, to have a turnaround time that much better for more patients to come through.” Find out more about how we can help you streamline your Patient Access processes, so your organization is fighting fit for this year’s flu season.

  Healthcare consumerism is on the rise. Your patients no longer see themselves as passive participants in their healthcare journey—they’re active consumers, who have come to expect the same frictionless experience they might find in other industries. They have options. If they’re dissatisfied with their experience, they can go back to the menu of providers and choose something different. But when patients feel supported and respected through their healthcare journey, they’ll remain loyal to your organization, even becoming brand ambassadors. Following the Medical Group Management Association’s (MGMA’s) Annual Meeting in New Orleans a few weeks ago, it became clear that nurturing patient loyalty remains at the top of the list for medical groups looking to stay competitive in an increasingly consumer-driven market. For providers wanting to create an outstanding patient experience (and encourage greater patient loyalty), a good place to start is improving access to care. Win patients’ hearts and minds before they’ve even set foot in your facility. The goal should be to leverage advances in digital technology to make it as easy as possible for patients to find physicians, access schedules, book appointments and take control of their health. Improving patient access through digital care coordination Medical groups should look at how they are using data and digital technology to improve the patient experience in three key areas: Scheduling Laying the groundwork for a positive patient experience starts with making sure the appointment process is as painless as possible. Imagine a mother is woken during the night by her sick infant. Using a traditional scheduling model, she’d have to wait until the next day to call and schedule an appointment with the pediatrician. But if she could schedule an appointment there and then through the pediatrician’s website, this would not only be more convenient and reassuring for her, it would reduce operational strain on the medical practice, who would have fewer calls to handle. Online self-scheduling is the most convenient way for patients to both find a physician or specialist and access care, all on their own terms. By implementing online scheduling, medical groups will see higher rates of patient satisfaction and engagement and an increase in patient acquisition and retention. Care referrals The referral process is another common pain point for patients. For such a crucial process, it’s surprisingly consumer-unfriendly. Patients struggle to connect with recommended specialists and when they do, they often can’t get an appointment for weeks. Many organizations don’t realize how much revenue they could be losing when frustrated patients look elsewhere for care. With a more sophisticated referral process, providers can transform the discharge experience and ensure patients get the follow-up appointments they need—within the same network. One health system in the south east has generated tens of millions of dollars simply by booking follow-up appointments before patients even leave the facility, so they’re less likely to be lost to out-of-network referrals. Decision support Most providers have scheduling rules that determine which patients their clinicians should see and when. What they don’t always have is a way to automate the process so that patients can book online or seek a referral, while still following these scheduling criteria. The provider needs to be confident that if a patient with knee pain wants to book an appointment with an orthopedic specialist, they need to be sure they don’t inadvertently choose someone who specializes in shoulder injuries or pediatrics. The problem isn’t solved by booking by phone. Securing referrals through a call center can be a cumbersome process, eroding patient trust and contributing to scheduling bottlenecks and staff dissatisfaction. But when scheduling is digitized, providers no longer have to worry about these challenges. Automating decision-making creates a simpler process for everyone and most importantly, ensures the patient connects with the right specialist in the least amount of time. How analytics can help you create a consumer-centric organization For leaders considering how to create a more consumer-centric health system, re-imagining patient access should be a top priority. A tool such as Patient Schedule gives your patients a convenient and simple way to manage their appointments and follow-up, so they see the right clinician at the right time, without any of the usual hassle that comes with the scheduling process. On the flipside, automating your patient access protocols also gives your team the intel required to increase capacity to see patients and boost revenue through better acquisition and retention. You’ll be able to track how many patient visits turn into booked appointments, identify the points at which patients drop out of the process and spot bottlenecks in your scheduling. These insights could reveal endless opportunities to make simple tweaks that will give both patients and staff a smoother ride through patient access. Data analytics mean you no longer need to be operating blind when it comes to unblocking the bottlenecks in patient access. You’ll know exactly where to focus your efforts to improve the experience for your patients and grow your competitive advantage at the same time.

  When a doctor pulls up a patient’s record, it should be a safe assumption that the information on the screen relates to the patient sitting in front of them. It should contain every detail of the patient’s medical history, along with their current address and accurate personal information. It certainly shouldn’t contain anyone else’s data! Yet all too often, patient records are plagued with inaccuracies. Around 30% of patient data in electronic health records is incomplete or inaccurate, and up to half of records are not linked to the correct patient. The ONC estimates that around a fifth of patients may not be matched to their entire medical record within an organization, while more than a half of records shared between organizations contain errors. Despite all of modern medicine’s ground-breaking achievements and our increasingly digitized world, the ability to share information between different payers and providers in a reliable and secure way remains frustratingly out of reach. Could a universal patient identifier unlock interoperability? Imagine a healthcare ecosystem where administrators and clinicians can safely exchange information without worrying about whether it’s inaccurate, incomplete, or incompatible with each other’s systems. Interoperability could make life easier for healthcare staff and patients alike. While regulations such as the Affordable Care Act introduced many carrots and sticks to drive up adoption of electronic medical records to support interoperability, they also revealed a critical gap in healthcare: the need for a universal patient identifier (UPI). This is an identifier that would help manage patient identification across the whole healthcare ecosystem. A UPI would allow providers and payers to follow patients throughout all their major medical and life events and be sure that the information they hold for their member or patient is 100% accurate, current and complete. Instead, the absence of a UPI, compounded by the sheer volume and fluidity of patient data, has created significant issues downstream. Billing errors, unnecessary treatment and testing, HIPAA breaches, prescriptions filled for the wrong patients and many other issues all play a role in the growing number of preventable medical errors (estimated to be the third leading cause of death in the US). Striving for truly interoperable patient information should be a priority across the entire healthcare industry. Still, while federal funding for a UPI is currently being considered by Congress, we’re seeing more and more industry-led responses to help improve patient identity management. 5 benefits of using a universal patient identifier for interoperability Improve patient safety How can physicians be sure they’re recommending the right treatment for a patient, when there could be a vital piece of information missing from their medical history or allergy list? How can a pharmacist feel confident handing over a prescription, when there’s a chance the patient in front of them isn’t the same patient named on the script? A UPI can help avoid ‘wrong patient’ events and allow providers to share information to spot trends in recurring errors so that action can be taken to prevent them in future. Lower healthcare costs The West Health Institute found that that medical device interoperability could save the U.S. healthcare system more than $30 billion per year. For individual providers, UPIs could improve productivity by reducing the amount of time clinicians and hospital staff spend trying to sort out inaccurate records. And with nearly a third of claims denied as a result of patient misidentification, this could mean savings in the region of $17.4 million for the average hospital. A better patient experience Patients are right to be frustrated when their physician doesn’t have up-to-date records about them, or their provider sends appointment reminders to an old address. Expecting patients to fill out multiple forms (often multiple times) is inefficient and hardly contributes to a positive patient experience. A tool such as Universal Identity Manager can help providers exchange timely data, eliminate duplicate records and coordinate care, so the patient is supported throughout their healthcare journey. Stronger privacy Electronic records linked with a UPI allow healthcare organizations to phase out manual processes—which is not only more efficient, but also helps minimize the risk of patient data falling into the wrong hands. It’s much easier to keep the data secure when it’s contained in a single record, compared to multiple versions of a record filled with scribbled notes and random updates that could easily end up attached to the wrong record. Experian Health’s Precise ID gives healthcare organizations a HIPAA-compliant way to authenticate patients and reduce the risk of a data breach during enrollment. Better data to tackle the social determinants of health As consumer data opens up new opportunities to improve population health, a network of shared data will be essential for identifying trends in the social and economic factors that affect medical outcomes. Interoperable data sets and technologies can enhance the way public health data is collected and used, for better patient outcomes and population health. Interoperability currently remains a challenge, but the tools exist to improve the way information is shared and used across the healthcare ecosystem. By integrating clinical data into the patient access workflow, you can increase productivity, reduce costs, and ultimately improve the patient experience. Contact our team to find out how this could help your organization achieve more efficient, accurate and actionable data sharing.  

  It’s almost time to say goodbye to Health Insurance Claim Numbers (HICNS). Earlier this year, the Centers for Medicare and Medicaid Services (CMS) began the process of removing HICNs from Medicare cards, replacing them with a new Medicare Beneficiary Identifier (MBI). From January 1, 2020, CMS will only consider claims bearing the patient’s MBI number. With 150 million numbers issued to active and archived beneficiaries, the scale of the change could have a major impact on providers and their billing processes. Here, we look at how healthcare organizations can ensure they’re as prepared as possible. Why change to a Medicare Beneficiary Identifier? The shift to MBIs is an effort to protect patient information and address the vulnerabilities that come with relying on Social Security Numbers (SSN) to verify patient identities. HICNs are tied to an individual’s (or their spouse’s) SSN, which, according to cybersecurity experts, is an increasingly lucrative route to stealing someone’s identity. In 2018, over 1200 data breaches were reported, with over 400 million records exposed. Of these, SSNs were the most commonly exposed piece of data across all industries, with the exception of the healthcare and medical sector (which is affected nevertheless, given the industry’s widespread use of SSNs). Once a fraudster has their hands on someone’s SSN, it’s all too easy for them to create a fake identity and wreak havoc on that person’s life. What’s more, criminals can currently use SSNs in this way to access medical services or drugs under someone else’s name. Medical fraud is thought to cost between $80 and $230 billion annually in the U.S. If SSNs are no longer a means of confirming medical identities, the emotional and financial costs of medical fraud can be avoided. So, while plans for funding a national patient identifier may have been stalled for now, the MBI represents a significant step forward to protect patients from identity theft, keeping their information safe and reduce the likelihood of medical fraud. What does the transition to MBIs mean for your organization? Like the implementation of ICD-10, this is a huge transition for CMS and providers alike. Most providers are already using both numbers to manage patient claims, with 76% of fee-for-service claims submitted using the MBI for the week ending July 5, 2019. You can continue using the HICN for Medicare transactions such as billing, confirming eligibility status and checking claim status until the end of this year, but after that, Medicare will deny claims that don’t include the MBI. There are some exceptions, but the general rule is that claims must be submitted with the MBI, no matter when the service was provided. How should providers prepare for the MBI transition? The lower your denial rate, the healthier your revenue cycle will be. To avoid unnecessary denials as a result of the MBI transition, providers should consider the following strategies to ensure a smooth transition: Check systems and procedures Your software systems, automated processes and patient-facing procedures should already have been adapted to accept MBIs. Ensure your staff have processes in place to check and add new MBIs for existing and current Medicare patients. Remember, you’ll need to continue tracking HICNs alongside the new MBIs for the lifecycle of current claims. Appeals will use whichever identifier was used to submit the original claim. Reach out to existing patients The MBI won’t affect Medicare benefits, but recipients should all have received their new number and will need to use it to access services. Make sure existing patients are aware of the change and encourage members to update their details via their patient portal. Remind them to bring their new Medicare card to future appointments. Obtain an MBI for new patients When new patients register with you, ask for the new MBI. If they don’t have it, you should be able to look it up using your Medicare Administrative Contractor’s (MAC) web portal. Train staff so they know what to ask, how to use the MBI and how to answer patients’ questions. Alternatively, for about the past year, when a claim has been submitted to Medicare with a HICN, Medicare has returned the MBI on the remittance (835 file). This is something that can be used to create crosswalks. Optimize for cleaner claims One major effect of the change is that your existing method for carrying out Medicare scrubs, where SSNs could be used to check for Medicare eligibility based on demographic information, will no longer be possible. Consider a solution such as Claim Scrubber and Registration Quality Assurance to improve the accuracy of Medicare eligibility information. Encourage good data protection hygiene This is a chance to review your data protection practices. Consider whether there are additional steps you could take to safeguard your patient data and prevent medical theft. Are you ready? Experian Health’s Coverage Discovery tool already contains many patient MBIs through its historical repository, which grows every day. This historical repository contains a dataset of MBIs, which will allow us to continue searching for and presenting Medicare coverage to our clients when the transition period ends. Are you ready for this change to take place? Let’s schedule some time to review your coverage solutions and see if we can help improve your collection process.