Patient Experience

  “The entire healthcare industry was turned upside down by the pandemic. Procedures were pushed back, insurance companies gave policy holders a lot of mixed information. It has been a mess.”   This is what one healthcare executive told us when we surveyed patients and providers on the state of patient access, in June 2021. Changing prior authorizations requirements were particularly messy, and as more patients return to care, there’s a risk they’ll become even more chaotic.   During 2020, many in-person healthcare services were canceled, delayed, or avoided for fear of infection. Now, patients feel more comfortable about returning for care. When we first surveyed consumers in November 2020, 58% said they’d wait until COVID-19 subsides before rescheduling. In June 2021, only 19% said they’d wait. Canceled procedures have dropped by half, and while the opportunity to recoup lost revenue is a relief for providers, processing prior authorizations for the sudden influx of patients is a worry.   Two thirds of providers say they find it difficult to keep track of changing pre-authorization requirements. Two in three also expect to face issues in securing authorizations for scheduled elective procedures, up from just over half last year. Embedding accurate and efficient workflows will be paramount as patient volumes rise, which means it’s time to rethink the archaic manual processes that often result in delays, errors, and non-compliance. Could automation offer a mess-free way to manage the growing challenge of prior authorizations?   Manually managed prior authorizations cost time, money, and quality of care   Even before the pandemic, prior authorizations were a thorny issue for healthcare organizations who wanted to offer the best possible care to patients, without risking denied claims. According to the Medical Group Management Association (MGMA), 80%-90% of medical groups say prior authorization requirements have grown year over year.   In an ideal world, prior authorizations protect patients from undergoing therapies that are overpriced, ineffective or unnecessary. They assure providers that they’ll be reimbursed for the services they deliver, and confirm that treatments are high-quality, evidence-based, and safe.   In reality, while prior authorizations can help incentivize value-based care, the admin and financial burden for providers is growing exponentially. Frequent changes, increasing denials, and lengthy negotiations with payers mean many providers need to employ additional full-time staff to handle prior authorizations. As the cost of drugs soars, they’re forced to lay out huge sums and cross their fingers as they wait to recoup the costs.   There was a hint of respite at the peak of the pandemic, when payers lifted many requirements, or extended authorizations already held on file. But these changes took time to filter through, and some providers continued to lose up to two entire business days per week to prior authorizations work during the pandemic.   Now, as the pandemic starts to settle, those requirements are back (and growing), and providers are scrambling to re-join the dots using their old, manual processes. As patient numbers surge, traditional manual methods for such an admin-heavy process are straining under the pressure. With so many accounts to authorize, the need for an automated solution is even more apparent.   Leveraging automated solutions for speedy, accurate prior authorizations To ensure patients get the care they need and to keep a lid on further revenue loss, hospitals and medical groups should consider tapping into automated authorizations engines. With an integrated Authorizations management system, you can initiate more authorizations in less time, run automated status checks to avoid rescheduling care, keep abreast of changing payer rules, and avoid unnecessary reworking of claims.   Users are guided through the workflow, which auto-fills essential real-time payer information. Patient information is populated by the SmartAgent feature, so pre-certification can be progressed quickly behind the scenes. Users only need to step in when clinical questions pop up. Notice of Care (NOC) generates a worklist of all pending patient encounters, to ensure that no payer notification requirements for notice of admission, observation or discharge are missed. Staff can escape the time-suck of repeatedly checking payer websites or calling up payers to verify yet again whether a patient encounter qualifies.   Say goodbye to Excel spreadsheets and lengthy calls to payers For organizations worried about rising patient numbers choking their existing manual workflows, switching to an automated system could be a timely move. Chasing paperwork is never a good use of resources, and with the lingering possibility of pandemic flare-ups, automated authorization inquiries could help minimize time spent on tedious manual tasks and running checks with payers.   Find out more about how Experian Health’s Prior Authorization software could help your organization minimize the risk of missed reimbursements, and give your team the breathing space needed to focus on maximizing support for patients returning to care.

More than 40% of patients surveyed skipped medical care in the early months of the pandemic, according to a recent study by researchers at the Johns Hopkins Bloomberg School of Public Health. Of those who needed care, 58% missed scheduled preventive care. Similar trends are observed in cancer screening, with appointments for breast, colorectal, and cervical cancers – in some cases dropping by around 80%-90% in March and April 2020, compared to 2019. Diagnostic testing for several cancers also plummeted, as did HPV vaccinations.   These trends aren’t unexpected: COVID-19 forced medical facilities to cancel or scale back services, while fear of infection and financial worries kept many patients away. But with most services operating at near-normal capacity again, and the vaccine program tipping the balance in favor of rescheduling care, preventative services are still lagging. Many patients remain reluctant to attend screening and wellness visits, despite the health risks associated with delaying care for potentially serious conditions.   Re-establishing a preventive care routine is essential. For patients, getting back on track with earlier diagnosis means more timely treatment and a better chance of recovery. It promises a better financial outlook for patients, payers, and providers alike, who all suffer higher costs when medical conditions escalate. And providers want to get their day-to-day business back on track to smooth out what has been a heavily disrupted workflow and revenue cycle over the last year.   Providers must reassure patients that returning to care is safe and necessary. Compassionate and personalized support will be key to making sure patients get the right care at the right time. Automated patient outreach strategies built on comprehensive patient data can help reverse the trends in forgone care.   How can data and automation support personalized patient outreach?   Kelly E. Anderson, one of the authors of the John Hopkins study, suggests that “physicians can mitigate some of the long-term harmful effects of this forgone care by proactively reaching out to patients who missed care, to try and reschedule the care either in-person or through telehealth.”   Automated outreach combined with easy patient scheduling platforms can help providers identify and invite healthcare consumers to get much-needed preventive care appointments back on track. For example:   Automation makes scheduling easy for patients and efficient for providers Online scheduling platforms allow patients to reschedule missed appointments at a time and place that suits them. A targeted outreach list of those patients most likely to need screening (for example, based on age, lifestyle, or health risk factors) can be used to send automated booking prompts and reminders by text message or interactive voice response (IVR). It’s simple and convenient for patients and reduces pressure on call center staff. Plus, it generates a wealth of useful real-time data on response rates to pinpoint areas for improvement.   With the right data, providers can direct patients to appropriate services For patients that can’t or prefer not to attend their usual healthcare facilities, directing them to telehealth services or alternative venues might be a good option. Similarly, patients with a medical or family history that suggests a higher risk of cancer ought to be prioritized for screening. But you can only do this when you know who those patients are, and what exactly they need. Social determinants of health can be a powerful tool to help providers determine a holistic view of patients’ clinical and non-clinical needs.   ConsumerView collates consumer data from over 300 million individuals, across multiple demographic, psychographic and behavioral attributes, so providers know more about the lifestyles and interests to be able to effectively resonate and engage. Data helps create a better patient financial experience Since many patients are worried about the loss of health insurance, outreach efforts might also involve pointing patients towards appropriate financial support. When socio-economic data reveals that a patient is struggling financially, providers can quickly check for missing coverage, offer tailored payment plans, and help obtain charity care if required.   Automated outreach can also deliver the upfront information about healthcare pricing that so many patients demand, and help staff collect faster patient payments by providing easy payment links through text and IVR campaigns. Consumer data can inform compassionate patient communications With the majority of patients opting out of scheduled appointments because of concerns about COVID-19 exposure, any invitation to reschedule care should offer plenty of reassurance about hygiene protocols. Some patients may need a gentle nudge to reschedule appointments, so if you can help them feel comfortable visiting facilities and tell them what to expect, they’ll be more likely to return.   Offering additional reassurance and support to communities who are traditionally underserved by healthcare services, or who have been harder hit by COVID-19, will be even more important. Best contact information, social determinants of health insight and ethnicity insight can support efforts to promote screening to groups who may face additional barriers to care.   With the right data, you can go beyond compassionate messages and choose an appropriate communications channel that’s the right fit for the consumer, too.   One thing that hasn’t been hindered by COVID-19 is the trend toward healthcare consumerism. Patients have a choice about which provider they use. Proactively supporting patients to catch up on missed care is a surefire way for providers to stand out as the easy choice.  

The pandemic dominated healthcare in 2020, but it won’t be recognized as a reason to delay complying with CMS’ price transparency mandate, which went into effect on Jan. 1, 2021. A recent study conducted by HealthAffairs indicated that 65 of the 100 largest hospitals in America had not complied as of February 2021. And new reports from CMS suggest $300 daily fines will follow if CMS warning letters have no impact, in addition to the possible public exposure of facilities failing to be compliant. There are a number of reasons why price transparency has generated so much attention – both before and during the COVID pandemic. Consumer advocates point to other transactional experiences, such as auto and home purchases, where understanding the price is complicated, but achieved. There’s been a lot of research on price transparency’s impact on patients, as well; helping consumers understand healthcare billing reduces the stress of their financial experiences. Transparent pricing makes sense in many cases for providers, too. They may benefit from patients being able to plan for the costs of care, which can result in fewer missed payments and write-offs. For these reasons and others, price transparency has been a hot topic for the last few years. The Centers for Medicare and Medicaid Services (CMS) final rule on price transparency became effective on January 1, 2021, requiring hospitals to give patients clear information about their medical costs, including a list of charges for the hospital’s 300 most shoppable services, so patients can make informed decisions. Payers are expected to provide similar pricing information beginning January 1, 2022. The spotlight on healthcare pricing seems unlikely to dim any time soon. What does this mean for providers and payers? Price transparency is here to stay There were legal challenges made against the price transparency final rule, questioning federal authority and invoking constitutional rights violations, but the DC Circuit Court dismissed the claims in December 2020. Arguments against the current mandate are not limited to disputing legal authority, suggesting that government should not interfere with private sector pricing – and that complex pricing information could create the opposite effect of confusing consumers. In fact, many providers and payers voice support for price transparency, but not as put forward by the final rule. Despite this, consumer demand for pricing clarity before delivery of services continues to grow and current government regulation is the most far-reaching attempt so far to remedy this. A few state legislatures are moving forward with their own regulations, which could prompt more local collaborations between providers and payers to clarify out-of-pocket cost estimates. Achieving the level of transparency that CMS and consumer groups hope for will be challenging, but attempts to find common ground are growing. What will price transparency look like under the Biden Administration? Since President Biden entered the White House, the trend towards transparent pricing has continued. Provider compliance has been slow – many pointing to 12 months of battling COVID as the primary reason – prompting legislative pressure to step up audits and penalties. CMS has already started issuing noncompliance warning letters and, while it may modify the ruling under a new administration, there’s no sign of any plans to reverse the policy. Consumer action groups have voiced concerns that the regulation falls short, citing the difficulty a consumer may have trying to find pricing at provider web sites. Other consumers are limited to payer-negotiated rates and have little choice but to stick with their current providers. Making information available is likely an early step toward what price transparency will ultimately look like, but making that information easy to find, understand and act on is what consumers value – and what many providers and payers say they want to provide in a more customized, less one-size-fits-all application. A marketing strategy for price transparency As patients bear more responsibility for healthcare costs, they’ve come to expect a consumer experience that affords them greater control and choice. A Pioneer Institute study found that 70% of healthcare consumers want to see pricing information before undergoing a medical procedure. Actively communicating a commitment to price transparency can be a powerful marketing strategy to attract and retain loyal consumers. Not surprisingly, this messaging resonates more with user-friendly tools to guide patients through their financial journey and make sense of charges. Many providers believe they’re complying with the final rule but may actually be vulnerable to penalties because their pricing files are in user-unfriendly formats. A web-based pricing tool can help solve for this by offering patients accurate estimates and recommended payment plans before or at the point of service. Similarly, a text-to-mobile tool, such as Patient Financial Advisor, can send automated text messages to patients with personalized estimates and bills. Keeping an eye on healthcare price transparency More tools are now available to help patients make sense of their billing and it’s becoming easier for providers and payers to create a patient financial experience that’s supportive from the start. Not only will this help patients understand their cost of care (and with that understanding likely comes better collections performance), it’ll help reduce the risk of uncompensated care ¬– and avoid penalties as the final rule takes root. The Biden Administration’s focus on consumer-friendly healthcare services will likely keep price transparency at the forefront. What that looks like over the next few years depends on regulatory and market forces, but providers and payers alike will benefit from offering solutions that make sense for their organizations and patient populations. Find out how Experian Health’s price transparency tools could help your organization with the transition.

Will handshakes become a thing of the past? Will face masks become a regular feature of flu season? Will home-working remain popular, even after workplaces re-open? COVID-19 forced some abrupt behavior changes that challenged existing cultural norms, but as the pandemic subsides, how many of these adaptations will survive?   For healthcare executives, the return to on-site medical visits raises similar questions. Healthcare consumers were already expressing an appetite for more convenience and control, and the pandemic accelerated the use of digital solutions for everything from patient access to telehealth. Being able to book appointments, complete pre-registration forms and make payments online is the new baseline.   As patient volumes start to increase, hospitals and physician groups shouldn’t take their foot off the gas with digitalization, particularly in patient intake, which doesn’t have to involve in-person contact. There’s an opportunity now to learn from what’s worked well over the last year and cement the pandemic’s digital legacy.   What does the new normal look like in patient intake? Getting back to basics with convenience and compassion Once crisis mode has passed, providers can refocus their efforts on the building blocks of an optimal health service: high quality care and a convenient and compassionate patient experience. After the uncertainty and loss of control over the last year, patients want autonomy and choice. Initiating a smooth patient journey through online pre-registration, patient portals, virtual waiting rooms and digital scheduling can contribute to this.   Many will be happy to say goodbye to piles of paper forms and long waits in the waiting room. But any digital strategy must also support those with limited access to devices and broadband or limited digital literacy. Liz Serie, Director of Product Management at Experian Health, says:   “The goal is to give patients the same exceptional experience and care, regardless of when or how they complete patient intake. Using the same tools that we know our patients are already comfortable with will help to ensure an inclusive approach.”   Digital technology can support a multichannel approach, for example, using automated dialers to make phone calls where mobile apps aren’t an option, or using patient data to segment individuals according to contact preferences. Re-engaging hesitant patients The CDC reported in September 2020 that around 40% of adults delayed care due to the pandemic. While more recent data suggests fewer patients are deferring care, some experts worry that patient volumes won’t return to normal until 2022. How can providers ease the return to care?   Online health portals were helpful in keeping people out of facilities during the pandemic – can they now serve a different purpose in reminding patients to come in for check-ups?   Patients will need clear information about what protocols to follow during patient intake and what to expect from virtual waiting rooms, as well as reassurance that the experience will be safe. Streamlining patient access with accurate data Unlocking the digital front door made logistical sense during the pandemic. It’s even more critical as patient volumes drive back up. Providers will want to review their protocols to be sure that speedy implementation has not left that door open to costly data errors. Is the right information being collected at the right time?   Consumers are looking for flexible and accurate appointment slots for self-scheduling, and they want their financial ducks in a row as soon as possible with quick authorizations and coverage checks. Getting data right first time makes for a smoother patient experience, more efficient staff workflows and fewer claim denials down the line. Preparing for an uncertain future Looking ahead, patient intake protocols will need to be flexible enough to adapt to changing patient needs, particularly if there are further waves of the pandemic. Digital solutions can help providers prepare for the unexpected and shift from a reactive response in a crisis to a proactive step towards the future.   For many providers, future-proofing the patient intake experience is also an important remedy to the financial losses suffered during the pandemic. Digital solutions built on accurate data, consumer needs, accessible information can protect against further revenue loss by giving patients reliable ways to access and pay for care, no matter what the future holds.   Medicine is built on in-person care, but we don’t need to be face-to-face to fill out forms. Patient intake is one area where “the old way” doesn’t have to return. Find out more about how your organization can build on the pandemic’s digital legacy and create a leading patient intake experience.

  More than 7 million households moved to a new county during the pandemic. Huge numbers of Americans deciding to escape busy urban centers is one unexpected side-effect of COVID-19 that’s hitting healthcare providers hard. According to a Pew Research Center study, more one in five relocated during the pandemic or know someone who did. More recent research suggests that just over half of Americans plan to move in 2021!   While fears around the risk of infection and the knock-on effect of rising unemployment prompted some to seek out quieter and more affordable areas early on in the pandemic, motivations for moving in 2021 are driven by new perspectives on what’s important in life. After a year of uncertainty, many are relocating in search of a better quality of life, remote working opportunities, or adventures someplace new.   High turnover calls for better local healthcare marketing  Whatever the reason, relocating brings significant upheaval: new jobs, new schools, a new community – and potentially a new healthcare provider. There’s a huge opportunity for providers who can make it easy for new residents to take “find a healthcare provider” off their relocation to-do lists.   As the “for sale” signs go up, the geography of healthcare use is changing. Some providers are seeing a dip in their consumer population, while others are gaining new consumers. Providers must think differently about attracting new patients to minimize the risk and impact of this high turnover. How do they find them and communicate in the most engaging way? Here, we look at how healthcare marketing strategies can help providers maintain a pipeline of new patients and inspire lasting loyalty in their existing consumer base.   Smart marketing when there’s a surge in new residents  Traditionally, providers looking to draw in new patients might rely on “new mover lists” and mailshots. But these lists don’t reveal much about who these new movers are and what they care about, which leads to generic, one-size-fits-all marketing messages. With the right data, providers can access more meaningful insights about these newcomers’ lifestyles, interests, incomes, and preferences, for a more sophisticated marketing strategy.   For example, one in ten people aged 18 to 29 are affected by pandemic-related house moves. As a healthcare provider in an area with a growing young population, it would make little sense to send mailshots that promote retirement health checks. A more relevant option might be an email or text with information about a new easy payment app or telehealth service. The more providers understand about potential new patients, the more they can customize their patient engagement strategy.   Mindy Pankoke, Senior Product Manager at Experian Health, says:   “The heavy movement patterns we expect this year mean providers must double down on acquisition strategies to maintain a healthy pipeline of new patients as consumers move into their service areas. If multiple health systems are trying to attract the same new patients, you need a clear message to differentiate your services. What’s going to resonate most? How do new patients want you to communicate with them? With the right data insights, you can reach them first with a tailored engagement experience and get the competitive edge.”   ConsumerView aids this by combining hundreds of millions of data points to reveal how patients spend their time, how they spend their money, and how they think. This includes demographic attributes, communication preferences, credit and financial information, plus insights on how individuals may be affected by the social determinants of health.  Using consumer insights to keep existing consumers happy   For regions that experience a net loss in patient numbers, retention marketing will be more important than ever. Patients have more choice now, and as providers compete to attract new members, existing patients may spot competitors’ healthcare ads and be tempted to switch too.   Consumer data powers retention in much the same way as acquisition, by allowing providers to segment patients to offer personalized communications and point them towards relevant services. For example, new research shows that patient loyalty in pediatrics tends to hinge on quality, while choice of adult care is driven by convenience. Segmenting people with young children from those without means you can focus your messaging on what matters most to them. With a supportive patient experience already available to them, those consumers will have no reason to look elsewhere.   Providers shouldn’t rule out marketing to existing patients who have moved. Though they may be in a new area, they can still access services via telehealth. Since convenience is a key motivator, reminding them of remote and virtual offerings could be a great way to retain their business. Focusing on a specific niche not widely available elsewhere is another strategy to retain clients even as they relocate.   ConsumerView is one way to leverage consumer insights to improve the customer experience through targeted outreach, regardless of location. This specialty list of consumer data from a trusted original source compiler draws together everything providers need to attract and retain patients and offer a personalized patient experience as communities adjust to life beyond COVID-19.   Contact us to find out how consumer data could help your organization market to new and existing residents more effectively in 2021.

Collections were tough even before COVID-19 hit. Provider’s bottom lines were already strained, and the high-deductible trend continued, putting patients on the hook for a bigger chunk of their medical bills.   A highly volatile – but improving – employment environment hasn’t helped, and some patients’ ability to pay hasn’t kept pace with their growing financial responsibilities. Many have new health plans, lapsed coverage or are more focused on other debts, making collections even less predictable. Providers may also feel that payer policy changes haven’t made recouping lost pandemic revenue any easier, with some losing two whole business days per week to completing prior authorizations. It’s no wonder that nearly one in five providers have overhauled their patient collections strategy in the last year.   Now, after a year of the pandemic’s impact on revenue, three dominant trends continue in this space: rising patient balances, an accelerated move toward innovative payment experiences that are moving toward digital engagement as a preferred option to paper or “payment at the counter,” and a realization that compassion is a key factor in solving this challenge.   Avoiding new pitfalls in patient collections   Go-to strategies for improving patient collections before the pandemic might have only included offering more patient payment options, doing more to check for missing coverage, or focusing efforts on patients who are most likely to pay. These are sensible options but, if implemented poorly, they’re more of a band-aid than a cure. Some shortcomings include:   Models relying on historical payment data don’t show the full picture Providers know that focusing their collections efforts on patients who are most likely to pay is the most efficient approach. But determining a patient’s ability to pay on historical payment data alone is likely to be unreliable.   Experian Health’s research suggests that when a collections model relies on historical data alone, around 50% of accounts end up being worked on the basis of no data at all. New accounts are assigned to a “highly likely to pay” segment, whether or not that reflects the reality of their situation. This model costs four times more than utilizing Experian Health’s Collections Optimization Manager, which can predict the ability of patients to pay, even without historical payment, by using multiple data sources.   Collections based on limited data will require more resources to work more accounts, but which ultimately will collect the same as collections based on multiple data sources.   Beware of artificial claims about artificial intelligence To streamline workflows and avoid losing staff hours to inefficient processes, many providers are turning to automated patient collection solutions. Artificial intelligence in healthcare is an exciting prospect, but not all solutions are what they seem.   Matt Baltzer, Product Director at Experian Health, says:   “Many collections tools claim to use artificial intelligence when they’re really using basic automations based on incomplete data. Since the quality of the output is only as good as the data that’s put in, the insights generated by these tools will be severely limited.”   To solve the collections workflow challenge, providers need an end-to-end strategy that integrates multiple high quality data sources, intelligent analytics and a responsive platform that learns and adapts in order to prioritize patients and communicate with them in a way that makes collections easier. Cash payments and price transparency can be part of, but not all of, the solution One way to smooth out a bumpy revenue cycle is to offer discounts to patients who pay in cash. It saves on admin costs and guarantees at least some of the bill will be paid. While this makes sense for minor ailments, admin and treatment costs for chronic conditions and major medical events remain persistently high. A resilient collections strategy needs to work across the board, addressing the many treatments, procedures and care plans that providers deliver and manage every day.   Requirements for improved collections, post-COVID-19 The cohesive, integrated model that providers need has the following key elements:   Multi-data sources for comprehensive analysis Optimal collections modeling uses different sources of data to build a more reliable prediction about a patient’s ability to pay. Combining credit data, behavioral modeling and socio-economic insights can help providers better understand their patients’ financial situation and group them accordingly – quickly and accurately.   Convenience and clarity for patients and staff Automated workflows with easy-to-use interfaces will make collections easier for staff, and eliminate time-wasting manual tasks. At the same time, a smoother, more targeted collections process means staff can engage with patients on the basis of accurate information, with fewer (and less stressful) calls and emails.   Advanced data analytics and automation for fewer errors and denials In-depth data analytics allow providers to screen and segment patients quickly to help prioritize accounts by payment probability, to achieve a higher rate of collections. A tool such as Collections Optimization Manager will evaluate collection performance in real-time, to help providers forecast patient payments and avoid bad debt. Expert consultancy support to stay on top of industry trends With the payments landscape in constant flux, having an expert on hand to help navigate the changes and advise on industry trends is a major asset. Experian Health’s team stands ready to help providers monitor and improve collections with industry insights and best practice strategies.   Find out how Collections Optimization Manger can help your organization avoid patient collections pitfalls and reduce lost revenue in the wake of the pandemic.

As Spotify and Amazon can attest, digital technology plus personalization is a winning formula. Consumers want anytime-anywhere access to the services and products they enjoy, without having to sift through irrelevant information. They want tailored recommendations that will make their life easier. More than eight in ten consumers say they’re more likely to choose businesses that treat them like a person instead of just a number. The pay-off for business—and health plans—is huge: by paving the way for better services, better relationships and a better consumer experience, personalization boosts profits, too. There’s one challenge: delivering personalization requires data. Health plans that want to offer a member-centric experience need the right insights to build a complete picture of what individual members need and want. Yet many health plans are forced to work from stale or incomplete data, notably when CMS hands over a new list of members or a new employer signs on to the plan. A system like that makes it nearly impossible to provide meaningful personalization, and consequently, the member experience suffers. With originally sourced data and consumer insights, health plans can fill in the missing links in member profiles and maximize opportunities to improve the consumer experience. Here, we look at how three specific data-driven strategies could help your health plan attract and retain satisfied members and demonstrate digital excellence by using personalization to drive improvements in communications and care. Personalize member communications for maximum engagement By looking beyond simple demographic data and clinical information, health plans can discover what really matters to members. Consumer data provides detailed insights about the kind of content that will resonate most with the member’s lifestyle, interests and health circumstances. Health plans can tailor their marketing messages accordingly, by highlighting articles about the treatment of relevant medical conditions or sending reminders ahead of annual check-ups.Health plans can also discover when and how to communicate with members so they’re most likely to respond. When member profiles reveal who prefers an email or a text and when, health plans can elicit higher levels of engagement, improve the consumer experience and see better results from targeted outreach campaigns. Make improvement decisions based on the most relevant data Consumer insights can also be used to develop improvement plans that zero in on exactly what members need for the best possible health outcomes. Combining insights on patient behavior patterns with an understanding of the challenges facing individual members means health plans can segment members, so the right support goes to the right place.For example, efforts to drive up medication adherence are going to be far more successful if based off accurate and current member profiles. Specific members can be sent automated, personalized reminders to fill out prescriptions in good time before they run out. Compare that to a “spray and pray” awareness campaign using generic messages that are likely to be ignored. Data-led improvement strategies are operationally efficient and create a better experience for members. Help members overcome social barriers to health Finally, when member profiles include a snapshot of how social and economic factors influence their ability to access healthcare, health plans can take action to offer support. Closing the gaps in care that arise when a patient fails to turn up to their appointment or ends up being readmitted to hospital, can often involve quite simple solutions. If data suggests the member has small children, but there’s no other adult in the household, it makes sense to cross-promote childcare services. Similarly, if the member isn’t known to own a car, a health plan could offer information on free transportation.Understanding these social determinants of health can help health plans offer proactive support so members enjoy better health outcomes in the long run. Experian Health’s rich datasets give health plans access to member-level insights on more than 330 million consumers, with data analysis and automation tools to help make business decisions based on the most relevant, current data. Contact us to find out how we can help provide the personalized experience members are looking for.

    Many thought the end of COVID-19 was in sight with the availability of a vaccine, and while that is somewhat true, an entirely new set of issues has arrived: how to properly administer and manage the vaccine. Now that a COVID-19 vaccine is approved and underway, providers need to execute a medical billing and coding strategy to sustain vaccination efforts. We interviewed J. Scott Milne, senior director of product management at Experian Health, about what’s changed and what providers can do to prepare. How can providers ensure that vaccine administration codes are billed correctly? The ICD-10 and CPT codes for the COVID-19 vaccine haven’t existed until now, which means providers have a new set of codes to learn and unfortunately, those codes seem to change or update almost daily. As more vaccines are introduced, more codes are also introduced, and not just for the vaccine as a whole, but for each specific dose of the vaccine. For example, dose one of the Pfizer vaccine will have a code that differs entirely from dose two of the Moderna vaccine. Keeping up with these changes isn’t only difficult for provider staff, who are likely already stretched thin, but they certainly don’t want to run the risk of submitting a claim with incorrect information. The errors are what result in denials or undercharges. A solution like Claim Scrubber ensures code sets are current on a daily basis – a necessity for times like these – but applies an extensive set of general and payer-specific edits before preparing the claim for processing. That means claims for vaccine administration are error-free before submission to the payer or clearinghouse. Providers can eliminate undercharges, boost first-time pass through rates and do away with costly, time-consuming rework. But proper coding is only the first piece of the billing puzzle. The second piece is to verify the accuracy of payment received from third-party payers. How can providers ensure that third party payers will reimburse at the contracted rates? Providers can certainly get reimbursed for administering the vaccine, but there are a lot of moving parts to keep up with. For example, both Medicaid and Medicare will reimburse providers for administering COVID-19 vaccines, but the percentage of what is covered will differ by carrier and the reimbursement rates can vary both by state and type of arrangement. Reimbursement rates will also vary amongst private payers. Then there is the variation in reimbursement based on vaccine type and dosage -- vaccines that require a single dose may be reimbursed at a rate different than those that require two doses. Even without the vaccine rollout underway it can be a headache for hospitals and health systems to manage multiple payer contracts and reimbursement methodologies. A solution like Contract Manager will pinpoint variance in reimbursement quickly and easily, accurately pricing claims and comparing actual allowed amounts to expected amounts. It is a tool built to adapt to changes within the industry, so providers can capitalize on emerging reimbursement schemes and changes in payer payment policies. It can also help identify sources and patterns of errors so recurring issues can be promptly resolved. The end result: the provider organization can the payer revenue that is due for vaccine administration. Interested in learning more about how providers can optimize vaccine-related reimbursements?     Other blog posts in this series: Segmenting your patient population for the COVID-19 vaccine Engaging patient segments with convenient, secure scheduling solutions Authenticating portal access with automation Optimizing reimbursements by capturing missing coverage

You may also like: Supercharge your COVID-19 vaccine management plan with digital solutions “Experian Health’s ability to move quickly and adapt their self-service platform to schedule vaccines for patients has been an invaluable improvement not only for our operations, but to the patient experience. The power to schedule the vaccine’s second dose after the first is administered helps us deliver on our commitment to providing reliable, quality care.” - Julie Frahm, director of consumer digital products at Sharp HealthCare The unpredictable nature of patient volume is a large part of what makes scheduling for the COVID-19 vaccine so difficult. Before now, providers haven’t had to manage mass appointment slots and registrations tied specifically to vaccinations. And even with those features streamlined, providers are still unsure of the best way to reach out to patients who are eligible for the vaccine to prompt them to schedule their appointment. Already a user of Experian Health’s Patient Schedule solution, Sharp HealthCare turned to online self-scheduling to improve patient access to the COVID-19 vaccine. With the solution in place, patients of Sharp HealthCare who are eligible for the vaccine can schedule their first dose online via computer or mobile phone. After answering a short set of questions, the scheduling solution will guide patients to a calendar of available day and time slots for receiving the first vaccination. After the first shot is administered, Sharp HealthCare staff can schedule patients for their second dose onsite, prior to leaving the office. Patients of Sharp HealthCare are consistently utilizing online self-scheduling to book appointments for their vaccinations. More than 1,000 vaccinations were scheduled in the first three weeks of online self-scheduling being available to patients. The ability for provider staff to help book the second dose of the vaccine for patients has also helped Sharp HealthCare deliver on their commitment to quality care, further ensuring the efficacy of the vaccine for each and every patient. Patients are also enjoying the expanded use of a self-service digital service, especially for a process that has been widely known to, at least thus far, be a detriment to the patient experience. Discover how Patient Schedule can improve vaccine management.