Tag: patient access

  I attended the Fall 2019 Conference of the National Association of Accountable Care Organizations (NAACOS) in Washington D.C. and wanted to share some insights on how top-performing Accountable Care Organizations (ACOs) are using data to drive improved quality and cost of care. Over the last decade, we’ve seen the number of ACOs surge. Propelled by the shift from volume- to value-based care, over a thousand ACOs operate across the U.S., bringing together groups of physicians, hospitals and other providers with a collective ambition to enhance quality of care, reduce healthcare costs and improve patient outcomes. While some ACOs participating in the Medicare Shared Savings Program have succeeded in improving quality and realizing some savings for the program, the value-based model is still evolving, and results can be mixed. More dramatic and holistic moves will have to be made to convert today’s annual incremental savings of 1 to 2% to make a dent in the estimated annual waste of nearly $389 billion in administrative complexity and another $45 billion due to lack of coordinated care. So what separates the top performers from the rest? At NAACOS last week, speakers confirmed that the most successful ACOs are those that effectively shift care towards primary care physicians (PCPs) and away from acute settings and skilled nursing facilities, implement a process for continuous improvement and adopt a performance-first culture. This is easier said than done. Here’s my top recommendations to help ACOs leverage data-driven insights to lower costs while improving patient outcomes. Offering insights into member utilization of healthcare resources in real-time I recently worked with a client that needed real-time alerts of member activity including admissions, discharges, and Emergency Room (ER) visits. These insights enabled this client to proactively manage active member episodes of care, optimizing the setting and deliver of care for the member’s specific needs. For example, a member was frequently visiting the ER with complications from his Chronic Obstructive Pulmonary Disease (COPD) condition that the client’s care team was managing. This was a needlessly costly way to treat the symptoms. To help get their members the right care at the right time, this client started leveraging automated alerts for their members as they presented within the healthcare continuum. The next time this patient sought treatment in an out-of-network ER for their COPD, their primary care physician (PCP) received an alert about her patient as soon as they registered, before a doctor had even seen him, and certainly before an ER workup converted to an admission. The PCP called the attending ER doctor to share the patient’s history and ensured the ER physician that this patient would receive next-day follow-up care in the PCP’s office. Knowing that follow-up was in place and the patient wasn’t in immediate need of care, the ER physician discharged the patient home. Given that the average cost of an admission can run $22,000, and an outpatient visit less than $500, the savings delivered by this kind of care coordination becomes significant. More importantly, the member experience is much improved in that they get to go home instead of an unnecessary overnight stay in the hospital. And this is just one example—multiply this kind of episode management across all member encounters and consider the improved member quality of life across all attributed lives and the savings for the health plan or ACO in the aggregate. Real-time alerts provide a win-win for both patient and ACO by affording care teams the opportunity to optimize the setting of care for quality and cost. Care coordination for episode management To improve episode outcomes and reduce readmissions, visibility into the compliance of a patient’s post-discharge care plan through the duration of the entire episode is critical, so well-coordinated care requires that clinical context be shared between providers. A frequent barrier to this flow of useful data is that clinicians’ electronic health records (EHRs) aren’t always interoperable. To solve for this, some ACOs are attempting to move all their providers to a single EHR and care management module. However, for some this may not be an option. In these cases, ACOs can opt for Care Coordination Manager: a rules-driven, closed-loop messaging and distributed workflow orchestration platform that enables health plans, ACOs, allied health, and community partners to share and assign care plan requests across a diverse provider community. Care Coordination Manager is vendor-agnostic and able to populate EHRs and care management modules at the point of care with key clinical context. This flow of tasks and content supports high-quality coordination of care and management through transitions of care. Proactively address non-clinical barriers to health for improved patient engagement and health Another characteristic of top-performing ACOs is that they utilize a 360-degree view of their members to address potential barriers that prevent members from engaging in their own healthcare. These SDOH factors can include things like housing or financial instability, food insecurity, limited access to transportation or healthy food options, and other non-clinical factors. Only about 20% of costly health episodes are due to medical factors, so it’s vital for ACOs to incorporate a more comprehensive and actionable understanding of the social needs of the populations they serve. For example, medication adherence is a bigger challenge for a patient who may have difficulty getting to a pharmacy or understanding medication instructions. Identifying and mitigating these risks up front gives the patient a better chance of adhering to their prescribed regimen, which in turn gives them a better chance to stay healthy, ultimately lessening the disease burden and thus the cost of the ACO’s membership while improving the patient’s quality of life. ACOs can take a proactive, preventative approach to addressing these challenges by collecting and analyzing member data and using these insights to tailor interventions. Patient-supplied information through surveys, like PRAPARE, is a good starting point, but surveys can be limited by access to the patient as well as the patient’s ability or willingness to answer honestly. Additionally, unless mapped to structured data such as ICD-10 Z codes, survey data is challenging to scale for broader insights into the ACO’s membership. Instead, consider healthcare consumer data that’s sourced directly from a reliable vendor. Analysis of this demographic, psychographic and behavioral data allows you to flag patients based on need, so you can identify the best way to communicate with members to help them own their healthcare journey. For example, in a recent report by the Department of Health and Human Services’ (DHS) Office of Inspector General (OIG), one ACO described how asking patients with chronic conditions to make a daily call to a care coordinator led to 43% fewer emergency room visits and 47% fewer readmissions. As ACOs grow amidst pressures to take on downside risk and manage costs while improving quality—timely data collection, sharing, analysis and action will continue to provide the foundation of high-quality episode and population health management; along with engaging members and community partners in the healthcare journey. What’s clear from discussions at the NAACOS conference last week is that the opportunity exists to work smarter across many emerging payment models. Could data be the key to unlocking that opportunity? McLain Causey is Director of Product Management at Experian Health.

For many patients, the unknown cost of unexpected care is a source of anxiety: two-thirds of Americans are “very worried” or “somewhat worried” about being able to cover unexpected medical bills. No wonder, when around 56% say they wouldn’t be able to afford an unexpected bill over $1,000. In cases where insurance doesn’t cover the entirety of the bill, responsibility for paying the balance falls to the patient. The lack of price transparency leads to confusion and stress for patients, and unnecessary administrative costs for providers, who are left to chase payments from growing numbers of self-pay patients. Moving towards more transparent pricing Traditionally, patient billing has been calculated at the end of the revenue cycle, after insurance adjustments have been made. In recent months, a push for meaningful price transparency is emerging as a result of consumer demands about the cost of care, pressure from governing bodies, and bipartisan support for a legislative solution to surprise billing. In response, healthcare organizations are increasingly looking to move patient billing to the front of the revenue cycle, to give consumers greater clarity about what to expect when their bill arrives. Estimating patient liability is far from simple. It calls on front office staff to make complicated calculations based on insurance benefits, charges, contractual adjustments and provider discounts. If staff are doing this manually, they may find themselves using outdated pricing lists that don’t include current insurance information, rates and discounts. So how should providers ensure their front office staff have the right tools in place to give accurate, personalized estimates for each patient? Data-driven technology can help reduce surprise billing Data-driven technology that automates, simplifies, and unifies the revenue cycle can ensure timely communication on billing between healthcare providers and insurers. This means your front-office team can base estimates on accurate, up-to-date information. To reduce the risk of errors creeping in, price transparency and collection practices should be standardized across the enterprise. A pricing transparency tool eliminates the need for manually updated price lists and removes the guesswork that often leads to mistakes. It can also include reporting features that let you track potential and actual collections, so you have greater insight into the opportunities for revenue cycle optimization. Helping patients navigate the cost of care As patients bear more out of pocket payment responsibility, they expect a better consumer experience. Creating an optimal patient collections strategy and frictionless experience is ever more important. Full transparency calls for accurate and up to date pricing to be available to patients before they receive care, along with a detailed breakdown of what their insurer will cover. When they know what the difference is, they’ll know upfront how much they’re likely to need to pay. Additionally, clear and proactive communication around the billing process can help eliminate the shock factor, improve the patient collections process, and create a better patient financial experience all round. You could provide a text-to-mobile experience that delivers a text message with a secure link to the patient’s estimated bill. Or you might integrate a price transparency tool into your patient portal or mobile app, that lets patients see a personalized cost breakdown based on real-time pricing and benefit information, alongside methods for secure payment. A price transparency tool can also help you gather insights into a patient’s financial situation and propensity to pay, so you can optimize your collection strategies from the start and get them onto the right program. El Camino Hospital in California set an organizational objective to improve price transparency. Terri Manifesto, Senior Director (Revenue Cycle) says: “We decided to do a soft launch of a patient estimator tool, and the very next day, even without advertising it yet, our patients found the tool on the website and started using it. The feedback was excellent. We’re providing a lot more estimates than we could before because it’s 24/7 and patients can use it on their mobile device, their laptop or their desktop. Some advice I’d give other hospitals is to think of the patient when you’re deciding what to do to best communicate your prices. What would the patient want?” Working with a partner such as Experian Health lets you combine industry-leading technical expertise and payment tools with your own knowledge of your patients, so you can create the best payment experience for your consumers. Using data-driven technology, you can work to eliminate the pain of surprise bills and promote price transparency, resulting in greater revenue opportunities and customer loyalty.

Experian Health announced it has acquired MyHealthDirect, a SaaS-based company specializing in digital coordination solutions in scheduling. We interviewed Jason Considine, Experian Health general manager of patient engagement and collections, to learn more about the acquisition, as well as opportunities arising in healthcare due to the rise in consumerism. What led to Experian’s interest in MyHealthDirect and the ultimate acquisition? We’ve had a relationship with MyHealthDirect for several years. Experian Health has been reselling the MyHealthDirect solution since 2017, and we’ve long recognized that their platform’s digital care coordination capabilities would be a great match with our existing solutions. MyHealthDirect's platform links patients with the right providers, offering online scheduling tools and referral coordination to ensure more timely access to care for patients. These solutions have proven to increase appointment and referral rates, improve call center efficiency, reduce no-shows and enhance the overall patient experience. By coupling this technology with our Experian data, we can ensure patients are getting the care they need in the management of chronic diseases and wellness programs. This acquisition evolves our core revenue cycle management capabilities and helps us make gains in the patient engagement space with all-new innovative offerings. You referenced “digital care coordination.” What does this mean and how does it apply to healthcare? Digital care coordination, as it applies to the MyHealthDirect suite, is comprised of self-scheduling, call center, referral coordination and automated outreach solutions, making it easier for people to access healthcare. By combining these scheduling solutions with Experian’s existing digital patient engagement solutions, we can deliver a seamless consumer-centered experience – from serving up an estimate, to streamlining the registration process, to providing consumers with the ability to pay their healthcare bills via multiple channels. Today’s healthcare consumer expects a turnkey, personalized, on-demand experience. When you think about the best engagements we all enjoy in retail, financial services, travel and entertainment, the expectation is that the healthcare experience should be no different. We need to arm consumers with the ability to streamline their healthcare and make it easier for them to access care. Why is the scheduling component so key in the overall patient journey today? Scheduling is the one of the very first steps of the care journey and booking an appointment has traditionally been a poor experience. Common frustrations include not being able to reach the provider, finding out that no appointments are available, or being forced into a time-consuming three-way call between the health plan and provider. Without fast and easy access, patients may not be able to get the care they need. When healthcare plans use technology to better connect patients to needed care, quality scores for patient experience rise and efficiencies are gained. Can you give us an example on how more automated approach to scheduling could lead to better health outcomes for the consumer? Sure. Take for instance an individual who is living with diabetes. It is important for this person to have regular check-ins with their provider to monitor their condition and adjust care plans accordingly. If this person is challenged to see their provider, or doesn’t have regular appointments booked, they could run the risk of becoming an unhealthy diabetic, being faced with additional health challenges. By tapping into digital appointment scheduling, a provider or payer could create an automated outreach plan to make the scheduling hassle-free. Appointments could be streamlined and scheduled directly on the phone via IVR or text, and appointment reminders can be delivered. How do you see providers responding to the rise in healthcare consumerism? It’s no secret that healthcare costs are rising, and consumers are increasingly bearing more of those costs. Providers, therefore, are telling us they need to deliver a better experience. They are asking for digital technologies to gain rich insights into consumer behavior and then adjusting their care delivery plans accordingly. They recognize that consumers have a choice on where to take their healthcare business, so they need to compete. In the case of scheduling, MyHealthDirect conducted some research and revealed 66% of patients would switch providers for more convenient access. In that same study, 77% of patients think the ability to book, change or cancel appointments online is important. My point? Those providers and payers investing in on-demand tools to interface with their consumers will win, simplifying many of the administrative tasks associated with healthcare. — Learn more about scheduling solutions.

Over the last twenty years, American hospitals have provided more than $620 billion of uncompensated care for cases where no payment was made by a patient or insurer. This includes financial assistance, where hospitals provide care at a reduced cost for those unable to cover their full bill, and bad debt, where patients have not applied for financial assistance and cannot or will not pay their bill. Despite extensions to Medicaid coverage under the Affordable Care Act, the number of uninsured people in the United States is still approaching 30 million. For these often-vulnerable populations, safety-net hospitals provide essential care regardless of the patient’s ability to pay. But safety-net hospitals are themselves under increasing financial pressure, experiencing more than double the uncompensated care costs of other acute hospitals. And when safety-net hospitals are closed down or struggle to meet demand, nearby hospitals must cover the shortfall in care. It’s a problem for everyone. A Kellogg Insight report found that when more people are uninsured, hospitals bear the cost by providing uncompensated care to the tune of $900 for each additional uninsured patient. Craig Garthwaite, Assistant Professor of Strategy, describes hospitals as “insurers of last resort”: “People are still going to the emergency room and they are still receiving treatment – so the cost is still there. When governments do not provide health insurance, hospitals must effectively provide it instead.” Hospitals might respond to the burden of uncompensated care in three ways: shifting the cost of care to other payers, cutting the cost of services to all patients and removing unprofitable services, or accepting lower total profit margins. All have the potential to damage quality of care as well as revenue and workflow. But beyond these major systemic responses, there are steps providers can take to reduce their risk of unpaid care and optimize their existing revenue framework. Protect your revenue by finding missing coverage quickly The new reimbursement landscape forces providers to manage more self-pay patients, with high-deductible health plans and health savings accounts. This puts a lot more responsibility and stress on patients themselves, who may not be able to afford their co-payments. Uncovering missed or undisclosed insurance coverage is also costly and time-consuming for providers. Regardless of ability to pay, if your patients are wrongly classified as uninsured or as having only one insurance option, you’re likely to lose revenue. As the financial risk of uncompensated care continues to grow, there are important questions for healthcare executives to consider: How do you decrease your accounts receivable balances and self-pay write-offs? How do you increase cash flow from re-billed claims? Are you missing any opportunities to bill additional payers for services? Are you identifying coverage for emergency department inpatients in time to meet your notice of admission requirements? The answers boil down to having the right processes in place to discover which patients can and cannot afford to pay, ideally before they go through the billing system. When you know this, you can move quickly to direct them to alternative sources of funding. How to find insurance coverage to avoid bad debt and charity write-offs An automated coverage discovery solution could help you identify patient accounts that don’t have sufficient insurance coverage, without the expense and hassle of engaging a collections agency. This proactive software integrates with your revenue cycle to search government and commercial payers automatically, so you can find insurance coverage that may have been missed or forgotten. It relies on multiple data sources and reliable demographic information to detect any inaccurate financial classifications and alternative coverage options. It can also shed light on product usage, productivity and financial results, which may help you fine tune your revenue cycle in other ways. Murry Ford, Director of Revenue at Grady Health System explains how Coverage Discovery allows his team to identify an accurate coverage match for patients without the patient having to share this information: “We use Coverage Discovery when the patient is admitted… the system automatically attaches the coverage to the patient’s account. No one has to get involved – it’s touchless, it’s seamless, and it’s worked really well for us. It’s brought in revenue that we would not have identified otherwise.” Every dollar found in this way is a dollar you’re not writing off to bad debt, or spending on unnecessary patient collections and admin. Mike Simms, Vice President of Revenue Cycle at Cone Health says: “Coverage Discovery is wonderful... After every admission, the next day we get a file which gives us insurance on those that we’ve missed. We can add that insurance to the patient account and bill the insurance company. In the end it helps us resolve accounts in a timely manner. Since we’ve been using Coverage Discovery, we’ve received over $3 million in payments, and that’s more than a 300% ROI.” An automated solution like this can be plugged in immediately to handle unresolved accounts for you, resulting in faster and more accurate collections, greater patient satisfaction, and improved staff workflow – ultimately reducing your organization’s risk of uncompensated care. Learn more about how Coverage Discovery Manager works.

The United States’ health system has become the most expensive in the developed world, and high administrative costs are a big factor. They account for more than 25 percent of spending on hospital care, making American healthcare administrative costs higher than any other country. Much of the problem comes from the complexities of payment. With public health programs, private insurers, and patients themselves all splitting the bill, it’s difficult for hospital administrators to determine who pays what in each situation. Especially during patient registration, they are bogged down by the time-consuming process of verifying patients’ eligibility for insurance and other programs. For these reasons, Martin Luther King, Jr. Community Hospital decided to focus on improving its patient registration process. The private nonprofit safety net hospital in South Los Angeles serves a high-need community and sees about 300 patients per day. Manually checking in all those people meant that MLKCH’s administrative team had an overwhelming workload. The hospital needed an integrated solution. Automation simplifies hospital patient registration The hospital’s staff was spending a significant amount of time checking different payer websites and making phone calls to determine each patient’s eligibility for insurance and various programs. Then, the benefits information had to be copied and pasted into the hospital’s non-integrated platform, which was another slow process that often resulted in inaccuracies. Quality assurance to find and correct those errors was a manual process, too, taking up more of the administrative team’s bandwidth. To free up resources and reduce errors, the hospital wanted to automate its verification processes, streamlining its registration, quality review, and more. MLKCH also needed its hospital patient registration software to work well with the Cerner system it already used. It decided to implement Experian Health’s eCare NEXT® platform. “We decided to use Experian Health’s software within Cerner versus a couple of the products we were looking at, at the same time, because it truly integrated within Cerner,” said Lori Westman, patient access manager at MLKCH. “When we presented this to our CFO, he liked the fact that it was integrated within Cerner; he didn't want us to have to go out to another third-party payer to pull information back. It's all about time and the time we can save on our registrations. That was the biggest selling point — the integration within Cerner and its seamless registrar on the back end. To the team, it's just another program they're working with in Cerner.” The software from Experian Health automates registration and financial clearance, among other patient access processes, which account for up to 80 percent of manual preregistration tasks. The system assesses patients quickly, replacing the information-gathering that staff has traditionally done. For MLKCH, which sees many returning patients, if a patient is already in the system at check-in, eCare NEXT pulls up his or her eligibility automatically when an administrator accesses the account. This saves several minutes, making it a notable patient registration process improvement. The system also eliminates a large portion of redundant tasks. When using the platform to check eligibility with one plan, eCare NEXT also searches for other applicable plans. For example, MLKCH treats a large Medicaid and managed care population, so checking a patient’s eligibility required visits to both the state’s and the health plan’s websites. But eCare NEXT will verify both automatically. Additionally, the fact that eCare NEXT integrated seamlessly with Cerner has improved the hospital’s patient registration process. Because the two platforms work together, patient data has become more accurate and the quality assurance process is less cumbersome. MLKCH was able to implement new QA standards after staff became familiar with the automation tool. The team also found that the enhanced data from eCare NEXT can shape user education and pinpoint areas for further improvements. And while there were some concerns that a new platform would take a long time to adopt, the rollout of the patient registration system was smoother than expected. The administrative team got a robust solution with exceptional support to ensure users have every resource they need. Ultimately, implementing an automation tool eliminated MLKCH’s most time-consuming registration tasks, allowing staff members to focus only on the tasks that needed their attention. This made their jobs easier and more efficient while also reducing training needs and improving compliance. The registration process became much faster. Automating preregistration tasks and eligibility verifications has also ensured MLKCH’s administrators have more accurate eligibility information. This integrates with Cerner to increase the quality of patient records. But the most important benefit of improving the patient registration process has been how it affects patients. These time savings get passed on to them in the form of quicker registration and less hassle proving eligibility. Using eCare NEXT has not only helped the hospital's administrators, but it has also allowed MLKCH to enhance patient service. Westman adds: “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.” Need to streamline your patient access department? Learn more or schedule a demo with us today.

This time last year, the Centers for Disease Control and Prevention and hospitals across the country weren’t quite ready for the flu season, which turned out to be the deadliest in 40 years. The flu and complications arising from it resulted in the deaths of more than 80,000 people.   Hospitals felt the brunt of the 2017-2018 epidemic early. Hospital and medical center staffs were forced to work overtime, setting up triage tents and treating flu patients in recovery rooms. Alabama declared a state of emergency, and doctors in California had to treat patients in hallways.   Experts predict a milder flu season this year, partly due to an updated flu vaccine that protects against H3N2, which was the severe strain that dominated last year’s flu season. While it's hopeful that this year’s flu season will be better, it's always a busy time for hospitals and providers, so they should be sure they're using the most efficient healthcare IT solutions to streamline their workflow.   Greater efficiency is key   When it comes to efficiency, hospitals should take a cue from Martin Luther King Jr. Community Hospital in Los Angeles, which collaborated with Experian Health to streamline patient registration and insurance verification.   Before the collaboration, MLKCH had to consult websites and make phone calls to confirm a patient's insurance eligibility, which was time-consuming. The hospital has a large Medicaid and managed care population, which means employees had to consult both a state website and a health plan website.   The hospital also had a high-traffic emergency department and limited front-line staff to handle the incoming flow of patients. Additionally, employees performed manual quality assurance, which is a time-consuming task.   Understanding its challenges, Experian Health was able to help the hospital streamline its system to improve efficiency in insurance verification through Coverage Discovery. It also helped the hospital improve patient registration with Registration QA, which has improved data quality and patient registration accuracy.   Since MLKCH integrated Coverage Discovery and Registration QA into Cerner, it has saved precious time when it comes to validating patient and payment information.   “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," said Lori Westman, patient access manager at MLKCH. “This has saved us two to three minutes of our registration time.”   “We average about 300 patients every 24 hours,” she continued. “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.”   Managing the season   Only 42 percent of Americans got a flu vaccine last year — painfully shy of the CDC’s 70 percent target. Misconceptions and fears about the vaccination and its effectiveness can keep people from getting it, which only increases the spread of the flu.   Flu season is always going to be a busy time for healthcare providers. But finding ways to manage staff and resources and work more efficiently is going to help hospitals and other facilities better manage the busy season.   Learn more about Experian Health’s Patient Access solutions.

The world of healthcare, as everyone knows, can be complex. And in such a complicated system, solutions that simplify, automate, and reduce busywork can make a real difference in both patient satisfaction and workplace efficiency. Although healthcare is, by its nature, a high-touch field, there are several opportunities to allow automated software solutions to handle the basic processing tasks associated with patient management. When routine interactions with patients are automated, medical and administrative staff members can devote more of their time to the cases that need the most attention. Automated workflow solutions also simplify and reduce busywork to make a noticeable difference in patient satisfaction and workplace efficiency. Obviously, that outcome is desirable for all parties involved. It reduces costs, improves morale, and results in satisfied patients. In an ideal workflow environment, employees can personally attend to problem cases and resolve certain issues manually while an automated system handles the run-of-the-mill cases that cause administrative backlogs. Experian Health has worked hard to develop just such a system. We call it eCare NEXT®. Introducing eCare NEXT The eCare NEXT platform, using an approach called Touchless Processing™, is able to offload a number of key patient processes, including scheduling, preregistration, registration, and admissions. Touchless Processing is an exception-based system, meaning that it automatically flags patients who require manual follow-up with staffers. The system updates data in real time, and users can interact with it through either a work queue system or by responding to triggered alerts. Healthcare organizations using the system can automate up to 80 percent of human intervention in the patient management process — allowing healthcare staff to focus on larger, more important initiatives to improve the patient experience. And Touchless Processing doesn't just free up staff time; patients see immediate benefits as well. One of the biggest frustrations in a patient's experience is the inability to get a reliable estimate for how much a service will cost. The eCare NEXT system sorts through all the complex factors that affect healthcare pricing — which are often too complex for hospital billing departments to accurately estimate on their own — and quickly determines accurate cost estimates for both the patient and insurance. Efficiency results in lowered costs — and happier patients The eCare NEXT system cuts costs in other ways, too: by reducing staff training needs, by ensuring compliance, by enforcing transparency, and so on. The benefits of an automated patient management system can manifest themselves in all sorts of ways. Blessing Health System, based in Quincy, Illinois, implemented eCare NEXT and found that it reliably increased efficiency and accuracy in patient management: "Experian Health provided our staff with a reliable, real-time registration error-alerting process. Our overall registration accuracy rate has improved significantly since implementing eCare NEXT. We now have the tools we need to be successful in one user-friendly application." Blessing's employees found that eCare NEXT improved dashboard capabilities and made it easier to view critical data, including missed estimates and copays. It was a clear upgrade over Blessing's previous system, in which employees manually calculated patient estimates. After adopting eCare NEXT, Blessing's point of sale collections increased by over 80 percent, its clean claim rate increased from 63 percent to 90 percent, and denials went down by 27 percent. And because the process had become so much more accurate and efficient, the average number of days an account spent in accounts receivable decreased by 28 percent. There’s no need to labor under an outdated administrative system that's certain to cause backlogs, errors, and intense frustration for patients and staffers. By offloading patient management work to the eCare NEXT system, healthcare providers can do what they do best: help people. For more information, contact Experian Health or check out our Touchless Processing whitepaper.

As most doctors will say, healthcare is about helping patients, not making money. However, these two goals aren't as separate as some would assume. In order to help their patients, healthcare providers need to buy equipment, pay salaries, and spend money to maintain an effective, efficient customer experience. Revenue is what makes healthcare work, so preserving revenue should be a main priority for healthcare administrators. That's how Stacy Calvaruso, assistant vice president of patient services and revenue cycle at Louisiana Children's Medical Center (LCMC) Health, approaches her job. "Revenue preservation is a term that we use in our organization to talk about how we're going to ensure that we're maintaining all the money that we can possibly collect for the services that we provide for our community," Calvaruso says. "Everyone is being asked to do more with less, and patient access or the revenue cycle is no different than the clinical areas. We have to ensure that we're able to collect all the money and all the income that we generate as an organization so that we can put more money back into the community to provide more services to more patients." For help with revenue preservation, Calvaruso's team uses Experian Health's revenue cycle management tools. The full suite of Experian Health's revenue management products help LCMC Health facilitate patient access, manage contracts, process and submit claims, and streamline collections. Here's a closer look at how Experian Health approaches each stage of the revenue preservation process. Patient Access With 86 percent of leading medical practices seeing an increase in payer prior authorization, having accurate and comprehensive patient data is crucial to getting patients the treatment they need with fewer denials from insurers. Experian Health can help by verifying patient information at the point of service. From there, automated software coordinates patient data across all connected facilities so customers, doctors, and insurers are better informed about possible treatment options and how much they're likely to cost, eliminating any surprises in the payment or collections process. According to Calvaruso, a transparent process helps to prevent repeated work, which is a major cause of revenue loss. "Instead of calling a patient after the fact about a denial or incorrect insurance information, we're able to call them on the front end to let them know that we've verified their benefits, we know what the estimate of their out-of-pocket payment is going to be, we've talked to their doctor, and we're ready for them to come and have these services," she says. Experian Health's Patient Access tools make it quick and easy to find the right information and avoid miscommunications and delays that affect revenue preservation. Hospital staff will be grateful for the lightened workflow and improved outcomes for both customers and administrators. Contract Management One of the most common clogs in revenue collection comes from unclear contract management. Without the right data to analyze contract compliance, hospitals will struggle to get accurate payments from insurers and customers. Calvaruso says that one of the cornerstones of her revenue preservation philosophy is reducing the avoidable denials; Experian Health's contract management tools can analyze and audit contracts to ensure payer compliance and clarify anything that could lead to such a denial. Experian Health's contract management tools also provide patients with more accurate estimates of treatment costs. One recent survey of 54 hospitals found that getting a price estimate is a frustrating process for patients; another poll found that 46 percent of younger patients aren't paying their full bill at the point of service because they didn't have an accurate cost estimate. Having accurate contract management data can make a big difference at both the point of service and in later payment collections. Experian Health's contract management tools can not only increase the revenue a hospital collects, but they can also improve the financial experience and build better relationships with customers and insurers. Claims Everybody makes mistakes, but given the amount of stress that healthcare providers are under, it's more likely that they'll make mistakes on routine paperwork like claims forms, which can lead to the kind of rework that hospitals loathe and that eats away at revenue. On top of that, without a streamlined system in place, it's often unclear where the initial problem occurred, which means administrators can't correct the problem for next time. "We make sure we've done all the work in the beginning to prevent the rework," Calvaruso says. "One way we can do that is by using that lean process that assists us with identifying where we can improve." Experian Health's solutions helped Calvaruso develop that type of process. ClaimSource helps organizations prioritize the claims that need immediate attention, which saves time and reduces the number of tardy claim submissions. To avoid errors in the claims themselves, Experian Health's Claims Scrubber® makes sure clean claims are submitted the first time, eliminating the dreaded rework. Collections Submitting new claims after denials is aggravating, but bad debt write-offs are even more harmful to revenue preservation — it's money that the organization will never see, no matter how much more work is put in. The only way to ensure accurate collections is to minimize the risk of denial in the first place. As Calvaruso says, a key component of preserving revenue is moving back-office work to the front end. For collections, this means accurately verifying patient identity and analyzing litigation risks. Of course, not every situation can be accounted for, and there will always be issues with collections, Experian Health's collections solutions make it easier for organizations to prioritize their past-due accounts and pursue them effectively. No healthcare organization will ever receive 100 percent of the revenue it's due, but taking the right steps to preserve revenue can mitigate much of the loss and keep things running smoothly. With healthy revenue management, healthcare providers can better help the people who need them most.

Experian Health will be at HFMA ANI again this year–booth 1025–at the Venetian-Palazzo Sands Expo in Las Vegas, Nevada. Kristen Simmons, Senior Vice President, Strategy, Innovation, Consumer Experience, and Marketing, with Experian Health, chatted with Joe Lavelle of IntrepidNOW to provide her insights on this year’s HFMA ANI conference, consumerism in healthcare and much more! Excerpt below: Experian Health booth activities  "[In our booth this year at HFMA ANI, we want to focus] around peer to peer learning and exchanges, so we are doing less selling and more engaging and more understanding. Understanding folks problems and helping to collectively arrive at solutions. We are doing a lot this year in terms of hands on demos of our solutions. We'll be showing some of our patient engagement products which include, self-service portals and mobile options for getting price estimates for applying for charity care, and setting up payment plans. Likewise, on the revenue cycle management side to automate orders with patient access functionality, contract management claims and collections, all those types of things that we do to improve efficiency and increase reimbursement for our clients. We'll also be showing off some of our identity management capabilities to match, manage, and protect patient identities so we can safe guard medical information and reduce risks for our clients. And on the care management side, our early support and sharing of post acute patient care information to help providers succeed as we all move forward into a value based paradigm." How Experian Health is addressing the need for consumerism in healthcare  "When it comes to consumerism, it's interesting when you're a company that has a lot of data and a lot of capabilities to say, 'Hey what can we do for people?' One of the things we really wanted to look at for our consumer approach, was to say, 'What is it that needs to be done?' We had some great hypotheses coming in and a lot of those were borne out but we actually undertook a big national study to take a look at what consumers biggest pain points were. It has a qualitative and a quantitative component. But, we basically looked at the entire healthcare journey so we weren't just asking them about the administrative and financial aspects of care, but also the clinical aspects. As we walked through the journey and were able to get a lot of quantitative data about all these different aspects of their healthcare journey, what actually turned out to be the most painful for the most people, were all the things around the financial equation. And, so clearly there can be pain in a clinical side, especially if you're unhealthy, you've got something chronic, you've got something terminal. There's all kinds of awful situations there but, really affecting almost everyone is a lot of the pain around the financial aspect of healthcare. So, we were able to look closely at some of those pain points and decide on some of the biggest ones that we wanted to tackle." How Experian Health is helping providers address financial pain points for patients and providers "Some of the big pain points for people is just the fact that you don't know what you're going to owe and as the patient portion of responsibility increases, understanding what you're going to be paying becomes more and more important to a consumer. So, understanding what I owe earlier, being transparent, and then helping me pay, those are some of the areas. And there are others but those are some of the absolute biggest pain points. And as you pointed out with some of our propensity to pay analytics, and some of the other capabilities that we have, we're able to help providers understand the financial situation patients are in much earlier in the process so they can get them to the right kind of funding sources. They can give them peace of mind so that they know what they're paying upfront, which may impact when they choose to go in for a major procedure or how they might want to save up for it or how they might want to access different funding sources." Listen to the full podcast