All posts by Tom Cox

Healthcare insurance coverage is a necessity in the U.S. but it’s a complex system to navigate for both providers and patients. At Experian Health, we aim to simplify the administrative and operational sides of healthcare so improving the registration and insurance identification process for providers within the patient access workflow is an important problem we want to help solve. With a myriad of insurers, plans and benefits coverage, along with complexities like multiple levels of coverage some individuals may have, providers have a tough task trying to coalesce all the right information when a patient registers for care in real time – so the searching and querying is often pushed out beyond the registration desk, creating manual rework, denied claims and delays in reimbursements. This downstream impact has been a huge pain point with claims denials contributing to hospitals and medical practices losing more than $200 billion dollars in lost revenue per year. A rejection not only impacts the provider but the patient too. If inaccurate information is submitted to a payer and the claim gets denied, providers don’t get reimbursed and patients could receive bills that they may not be able to pay. We believe technology is the answer to solve many administrative challenges, which led us to acquire Wave HDC, a healthcare company that can deliver a real-time response. Identifying insurance coverage and benefits is a piece to the overall claims puzzle and this workflow has been ripe for improvement with better software. We believe we can now deliver the best solution in the market with this integration. What is Wave HDC’s expertise? Their AI-powered healthcare data curation solutions utilize an “if-then” logic, returning multiple data points required for accurate patient billing from a single inquiry, in real-time (30-45 second processing time), during the registration process. This innovation is a major step forward. No longer is a single response efficient as it pertains to uncovering a patient’s eligibility, coordination of benefits, insurance coverage and beyond. Our acquisition of Wave HHDC transforms the outdated clearinghouse model and will deliver immense benefits to our healthcare providers in the form of more accurate claim submissions and higher reimbursement rates, while also reducing manual work on their administrative teams. In fact, Wave HDC has prevented denials for its clients of over $1 billion dollars since 2020. Reducing claims denials will have a major impact on providers as the industry faces many headwinds including inflation, complex regulations, and constantly changing payer rules that may hurt their financial stability. The issue is only getting worse; a 2022 Experian Health survey revealed that 42 percent of respondents see claims denials increasing and that uptick is between 10-15 percent according to a third of respondents. Additionally, 3 out of 4 survey respondents say reducing denials is the highest priority. We are very excited to tackle this pain point with an advanced solution and welcome the Wave HDC team and these additional capabilities to Experian Health. For more information about Experian Health, visit experian.com/health.

Healthcare providers are struggling to address the high volume of insurance claims denials. It’s one of the top contributors to wasted dollars to the tune of more than $250 billion per year, according to industry reports. A denied claim means healthcare providers, like hospitals, are not getting reimbursed for care, leaving much-needed funds on the table. The cause of a denied claim is often due to incorrect data. The result? An endless cycle of submissions and resubmissions, which not only affects providers’ financial stability, but also puts pressure on the issue of staffing shortages with rounds of rework. You could even argue patients experience pains with this administrative burden, as inefficiencies could result in higher out-of-pocket costs. It’s no surprise that reducing claim denials is at the top of many healthcare leaders’ wish lists. In fact, a recent Experian Health survey among healthcare executives found that 72 percent said reducing denials was their highest priority. Experian Health aims to simplify the administrative aspects of healthcare and we recognize the claims process is currently one of the most challenging for providers. From the perils experienced with manual data entry to payer codes changing frequently to the decentralization of data and lack of staffing, the industry must adopt new ways to tackle the claims denial conundrum. We believe the solution involves tapping into the benefits of using artificial intelligence and are proud to announce the launch of AI Advantage™, an artificial intelligence engine in our #1 KLAS ranked ClaimSource® suite. With two new claim reimbursement products for the pre- and post-submission process, AI Advantage - Predictive Denials™ and AI Advantage - Denial Triage™, these products offer real-time intelligence and predictive modeling to prevent avoidable denials and prioritize re-submissions, leading to greater efficiencies and faster recouped revenue. This is an example of how Experian Health is using AI, analyzing and processing data and information in ways others can’t to solve problems. The next frontier in healthcare is upon us and the industry must embrace the technologies that make administrative processes faster and more efficient to allow providers to be more financially solvent and, most importantly, be in a better position to focus on patient care. For more information about AI Advantage, click here.  

Simplifying healthcare for all - that seems like a tall task to accomplish considering the last two years. What we once considered simple activities in our daily lives, such as going to the store to buy groceries or getting children to school, was upended by a global pandemic. Factor in the massive changes in healthcare operations, and it is clear the system needs to continue to evolve. It also cements my belief that Experian Health’s mission is even more relevant and achievable today than it was pre-COVID 19. In fact, this aspiration of simplifying healthcare for all is top of mind for me and Experian as we go into HIMSS22, the premier healthcare conference being held in Orlando this week. The healthcare industry has undergone massive changes since the fateful announcements in early 2020. While adapting to the pandemic was a huge undertaking for many organizations at the onset, those who opted to embrace change saw the payoff as they simplified administrative tasks and created efficiencies for both providers and patients. We saw organizations eagerly adopt technology and tools to take paperwork digital, streamlining the patient intake process and improving the accuracy of the data received. Instead of phone calls, patients and providers scheduled appointments and communicated online through secure portals saving time and manpower. The use of telehealth appointments allowed providers to see more patients and do so safely. Who would not want the simplicity of carving out just a few minutes from the comfort of one’s home for a non-urgent appointment? We are proud to have been a part of this evolution helping healthcare organizations pivot in the face of such a daunting predicament. For example, through our digital front door solutions, patients were able to schedule and pre-register for appointments online avoiding extra time spent in waiting rooms. We verified hundreds of thousands of identities quickly as Americans lined up for COVID-19 testing and vaccines. Our mobile payments system served to make the financial aspects of care easier to fulfill. Providers turned to us to help recoup costs from the government and insurers for COVID-19 care with our insurance discovery solution. Experian will not stop here, and we will continue to innovate high-tech, data-driven approaches to simplify healthcare for all; I hope the industry doesn’t stop either in tackling tough operational challenges using the power of technology and data. With this in mind, I look forward to hearing about the lessons learned by the industry as well as future innovations from the participants at HIMSS22. It’s the “can’t-miss healthcare conference of the year,” and we are pleased to be a sponsor and exhibitor once again. For those attending, visit us at Booth #3059. Taking the conference playbook of a hybrid approach with both digital and in-person participation, the healthcare industry should follow suit. Let’s certainly keep valuable in-person mechanisms in place, but not forget about the last two years and the incredible progress made that moved the industry forward. At Experian, we strive to help clients operate more quickly, smoothly and efficiently across the healthcare journey. With a new mindset in the industry and the tools available to act on change from providers like Experian, simplifying healthcare for all is not just a mission but an outcome we must achieve. Tom Cox is President of Experian Health.

It’s been an interesting - and inspiring - six months. My short time as part of the Experian family (following the acquisition of MyHealthDirect last year) has exposed me to the extensive capabilities and innovative mindsets this company offers, and that has clearly been on display during the pandemic. It’s been amazing to see what Experian has accomplished in such a short time to turn around tools and resources that can help healthcare organizations better operate in the “new normal.” With our expertise in providing front and back-end technology and data sets that are vital for operating patient engagement, revenue cycle, care and identity management solutions, we felt we were well-suited to address some of the new systematic needs healthcare organizations would face in light of the pandemic. Experian’s mantra is to apply “data for good” and we pressed the gas pedal to leverage what products and data we had that could address COVID-related operational issues. Additionally, we looked to innovate in ways that addressed the needs of our clients. Our efforts produced new, free resources such as the following: Experian COVID-19 Outlook and Response Evaluator (CORE) – this “heat map” is intended to guide healthcare organizations and government agencies as they plan for coronavirus recovery. The map leverages de-identified data such as pre-existing conditions and social determinants of health to form a comprehensive picture that predicts possible pandemic impact on communities. Staffing, supplies, community outreach and facilities planning all benefit from any kind of “advance warning.” Payer Alerts Portal - a free comprehensive list of payer modifications including COVID-19 and telehealth payer policy alerts for United States hospitals, medical groups, pharmacies and specialty healthcare service organizations pulled from reviews of over 52,000 Web pages operated by more than 475 payers. These alerts deliver a comprehensive overview of the latest policy and procedure changes, as well as a link to the source of the payer policy, so providers can quickly make required adjustments, save time and streamline operations. In addition, Experian has helped clients quickly secure remote patient access to portals and scheduling as the pandemic necessitated a quick pivot to “contactless” healthcare. We also worked with our clients to enable their work-at-home transitions, maintaining access and functionality for collections and reimbursement – both for pandemic-related services and as they slowly brought elective procedures back online. And, our revenue cycle management products have served as a critical part of many clients’ focus on recovering revenue lost to the national shutdown. In times of crisis, heroes are more visible. These incredible challenges can bring out the best in people. Working with our healthcare clients every day has left us in awe of those who work tirelessly to take care of COVID-19 patients (and ALL that comes with that role) despite many obstacles. They inspire us and we are forever grateful. To access these resources, visit our COVID-19 Resource Center at https://www.experian.com/healthcare/client-services/covid-19/resource-center.