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Healthcare is undergoing a digital revolution driven by artificial intelligence (AI) and machine learning (ML) technology. While some organizations have been slow to adapt, others incorporated new solutions that have helped their organization identify patterns, reduce claim denials, and more. This infographic breaks down common phrases related to artificial intelligence and machine learning so that healthcare organizations can understand what they mean and how they're utilized. Introducing: AI Advantage™ Experian Health is the top-performing claims management vendor, according to the 2023 Best in KLAS: Software and Professional Services report. Experian Health’s ClaimSource® solution, an automated, scalable claims management system designed to prevent claim denials, ranked number one in the Claims Management and Clearinghouse category. With denials and staffing shortages on the rise, an efficient claims management strategy is essential. Experian Health is here to help with AI Advantage™ – a new solution that utilizes true artificial intelligence that proactively helps reduce denials and, when necessary, identifies the best denials to resubmit.

In 2009, processing claims was listed as the second greatest contributor to “wasted” healthcare dollars in the US, at an estimated $210 billion. A decade later, that amount was estimated at $265 billion. Today, healthcare providers are still grappling with denied healthcare claims, with both challenges and solutions accelerated by the pandemic. To put the scale of operational and delivery changes into perspective, Experian Health recorded well over 100,000 payer policy changes for coding and reimbursement between March 2020 and March 2022. The implications for claims processing are immense, which is why healthcare providers need to reevaluate their denial management strategies and invest in new technology that can help increase reimbursements. In June 2022, Experian Health surveyed 200 revenue cycle decision-makers to understand how they feel about the current situation. What are the priorities of those on the front line of denials management? And how can technology contribute to improvements? This article breaks down the key findings. Takeaway 1: Denials are increasing and reducing them is priority #1 30% of respondents say denials are increasing by 10-15% Nearly 3 out of 4 respondents say that reducing denials is their top priority For most respondents, claims management is more important now than it was before the pandemic, because of payer policy changes, reimbursement delays and increasing denials. Respondents attribute this to insufficient data analytics, lack of automation in the claims/denials process and lack of thorough staff training. When it comes to improving denial rates, staffing seems to be the greatest challenge. More than half of respondents say staff shortages are slowing down claims submissions and hampering efficiency. Shrinking offices mean there is less staff to handle the growing volume and complexity of claims. It’s no surprise, then, that around 4 in 10 respondents are also concerned about keeping up with rapidly changing payer policies and keeping track of pre-authorization requirements. Providers recognize that technology can help reduce denials while easing the burden on staff. A tool like ClaimSource manages the entire claims cycle using customizable work queues that make it easy to prioritize accounts, saving staff time and avoiding the errors that lead to denials. This also incorporates payer edits to ensure that claims are clean before being submitted to the payer. And if claims do end up needing further attention, Denials Workflow Manager eliminates time-consuming manual processes and allows providers to attend to high-risk claims quickly, so there’s less chance of delayed reimbursement. Takeaway 2: Automating denials management in healthcare is critical 52% of respondents upgraded or replaced previous claims process technology in the last 12 months 51% are using robotic processes, including automation, but only 11% are using artificial intelligence Prior to the pandemic, automation was sometimes perceived as a threat to jobs. But with changing employment patterns and evidence of the broader benefits of automation, attitudes are shifting. Automation can make life easier for staff by removing manual tasks to allow them to focus on other priorities. It speeds up the healthcare claims processing workflow, reduces the risk of errors, and enables better communication between providers, patients and payers. Providers recognize that automation drives more efficient claims management. The survey revealed that 45% of respondents turned to automation to keep track of payer policy changes, 44% had automated patient portal claims reviews, and 39% had digitized patient registration in the last year. Automation supports all stages of the claims management process, from auto-filling patient data during registration, to generating real-time claim status reports for back-office staff. Payer authorizations were a common challenge for providers, and a perfect fit for automation. Experian Health’s Prior Authorizations solution eliminates the need for staff to visit multiple payer websites, automates inquiries, and offers real-time updates on pending and denied submissions so staff knows when to intervene. Takeaway 3: Providers are searching for denial management solutions that will achieve the greatest ROI 91% of those likely to invest in claims technology say they will replace existing solutions if presented with a compelling ROI The majority of providers may be on the lookout for better claims management solutions, but they vary in how they measure ROI. Predictably, one of the most common metrics is how much staff time can be saved, with 61% concerned with hours spent appealing or resubmitting claims, and 52% looking at time spent reworking claims versus reimbursement totals. Rates of clean claims and denials were also popular metrics, at 47% and 41%, respectively. Using Denials Workflow Manager and ClaimSource alongside additional claims management solutions like Claim Scrubber and Enhanced Claim Status can deliver an even stronger performance against the above metrics. Each solves a specific challenge within the claims management workflow, but when used together, the ROI is multiplied. Overall, there’s optimism that digital technology and automation can help healthcare providers improve claims and denial management and reduce the amount of “wasted” dollars. This survey shows that providers are keen to grasp the opportunities offered by automation to optimize the reimbursement process and get paid sooner. Download the report to get the full results on the State of Claims 2022, and discover how Experian Health can help organizations with their denial management strategies.

The U.S. is currently struggling with a critical healthcare labor shortage that is impacting every part of the revenue cycle. In fact, the American Hospital Association has deemed this challenge a “national emergency” that is only expected to worsen. Staffing shortages leave healthcare providers vulnerable to reimbursement delays, low morale and negative patient experiences.  As a result, many healthcare providers are leveraging automation to tackle this staffing crisis. Revenue cycle management (RCM) software and analytics can help providers navigate labor shortages by relieving staff of repetitive, process-driven manual tasks and improving operational efficiency. As healthcare labor shortages continue, how can providers maximize the return on their investment in automation? The snowball effect of healthcare labor shortages The first quarter of 2022 ended with a peak of 11.9 million open vacancies in the United States. Just about every industry is feeling the impact of the Great Resignation, driven largely by the fact that more people are reaching retirement age than are entering the labor market. In healthcare, the challenge of attracting and retaining top talent is felt even more acutely - in May 2022, the healthcare vacancy rate was 8.8%, second only to hospitality services. While the pandemic created greater pressures on healthcare staff, chronic understaffing and burnout were already a problem. Now, healthcare workers are contending with the snowball effect of increasing stress, sickness absences, lack of time to train new staff and loss of morale. Potential recruits may be tempted away to industries touting fewer COVID regulations, competitive pay, and more flexible and remote positions. Healthcare providers need smart and creative staffing strategies to close the gaps. Automation should be at the heart of HR contingency planning Providers may look to traditional market forces to solve the staffing challenge. Reducing services, increasing wages, improving working conditions and partnering with local education facilities to attract new staff are all on the table. But tight margins and inflationary pressures limit the options available, and policy changes can take time to be implemented. Automation can help mitigate healthcare labor shortages in three main ways. It can reduce the workload and increase staff capacity, improve operational performance and free up resources that can be reinvested in the workforce, and create better experiences for staff (and patients). Using automation to increase staff capacity Repetitive tasks that follow the same process every time are perfect for automated programs. Shifting the load from staff to software means that fewer team members are needed for those activities, and available staff can focus on more complex issues. Patient access is a good place to start. Many hospitals have already started to scale back care due to severe staffing shortages. Online scheduling and automated registration can ease the burden as patient volumes increase. These self-service tools cut down call center queues and eliminate labor-intensive data entry. With automated pre-registration, the correct information for each patient can be pre-filled and follow them throughout their healthcare journey, so staff no longer lose entire days spent resolving data input errors. Automation can improve operational efficiency, even with labor shortages Automation is more than replacing human effort with software programs: it also strengthens operational performance. Automated revenue cycle tools can complete tasks such as data entry, coverage checks, pre-authorizations and eligibility verifications much faster – and with fewer errors – than staff. If data-driven tasks can be completed with greater accuracy and efficiency, then the entire revenue cycle will move more quickly, leading to faster reimbursement. This is especially obvious when using automation to streamline collections. It doesn’t make sense for staff to pursue all past-due accounts, but with automation and advanced analytics, they can identify the patients most likely to pay and focus their efforts accordingly. Collections Optimization Manager uses multiple data sources to automatically screen and segment accounts, so staff doesn’t waste time chasing the wrong ones. Accounts are then distributed to appropriate collections channels using specific routing and recall rules. With a better understanding of each patient’s financial situation, staff can engage with patients in a more compassionate way and resolve issues without repeated calls and emails. Alongside this, automated patient outreach can provide personalized and convenient communications about patient collections. PatientDial frees up staff from time-consuming calls by providing automated inbound, outbound and blended calls with live agents or automated interactive voice response (IVR) services. “Queue callback” automatically calls patients back when a suitable agent becomes available, maximizing staff time while improving the patient experience. PatientDial also monitors agent performance so managers can make strategic decisions to improve workflow. Using automation to create better user experiences Existing staff may worry that increasing the use of automation could lead to their jobs becoming redundant. This isn’t really the case: while automation and artificial intelligence (AI) allow RCM teams to “do more with less” and reduce the need to recruit additional staff, they should be seen as complementary to rather than replacing staff. By removing time-consuming and tedious tasks, automation creates a better experience for staff. User-friendly interfaces give patient access, claims and billing teams all the information they need to help patients quickly and accurately. And as prior authorizations and payer policy changes change ever more frequently, staff will be relieved to hand over the task of checking each payer’s website to a software program that can complete the job quickly and accurately. Shifting to online and mobile options gives patients a more convenient and satisfying user experience, too. For example, automated self-service tools can be used to give patients upfront estimates about their expected cost of care, and link to convenient payment methods. It’s a quick win for providers who will find it easier to comply with new price transparency rules and makes it easier for patients to clear their bills faster. And the result? A happier workforce, a better patient experience and a healthier revenue cycle. Find out more about how Experian Health’s automated revenue cycle management solutions can help healthcare organizations build resilience and thrive in the face of healthcare labor shortages.

Being able to settle bills anytime, anywhere, is one of the reasons why 110 million Americans switched to “digital-first” payment methods last year. Today’s consumers can pay household bills with their mobile devices while cooking dinner or waiting in the school pick-up line. They can pay for their morning coffee by tapping their phone at the point of sale. Imagine their frustration when paying for healthcare still involves paper bills, multiple phone calls, and limited payment options. But the healthcare industry can make the same “anytime, anywhere” payment promise. Berenice Navarrete, Director of Product Management for Patient Payments at Experian Health, says: “We’ve seen healthcare make great strides in using automation and digital tools for scheduling, registration, and telehealth, fueled in no small part by the pandemic. As consumer payments are constantly evolving, there are huge opportunities for improvements in the patient payment experience too.” “We’ve seen healthcare make great strides in using automation and digital tools for scheduling, registration, and telehealth, fueled in no small part by the pandemic. As consumer payments are constantly evolving, there are huge opportunities for improvements in the patient payment experience too.” -Berenice Navarrete, Director of Product Management for Patient Payments Experian Health’s recent Payments Predictions white paper identifies seven emerging healthcare payment predictions and trends heading into 2022. This blog offers a preview of the top three insights that will be of interest to providers intending to leverage – or considering – digital tools that simplify payments and speed up healthcare collections. Prediction: Patients want fast, secure and smooth payments to match their experience in other industries. According to Experian Health’s State of Patient Access 2.0 survey, providers are feeling more confident about collecting payments from patients now, compared to a year ago. However, the collections landscape is always changing; providers should continue to find ways to match consumer expectations with tailored communications, flexible payment options and automated payment methods. Listen in as Matt Baltzer, Senior Director of Product Management at Experian Health, explains why providers feel more confident about patient collections. He also discusses how automated healthcare solutions can help providers shore up these gains and optimize healthcare collections – especially as consumer behavior returns to pre-pandemic patterns. As cash usage declines, patients are looking for a wider variety of payment options – a trend that’s likely to gather steam as digital payment platforms like Apple Pay and Google Pay continue to gain traction. Providers must keep pace with these advances in consumer payment technology. Utilizing Patient Financial Advisor is one way to give patients the flexible experience they want. This solution sends personalized text messages with links to convenient and contactless ways to pay.  Patients may have different preferences about payment methods, but they all want to feel confident that their payment is secure. With PaymentSafe, healthcare providers can collect any form of payment securely and quickly, regardless of the payment option a patient chooses. Prediction: Patient loyalty will be tied to a convenient and compassionate payment experience. A poor payment experience will leave a bad taste in the patient’s mouth, regardless of how good the rest of their healthcare journey has been. With 70% of consumers saying healthcare is the industry that makes it hardest to pay, any provider that offers a smooth, supportive and transparent payment experience is going to stand out from the competition and foster greater patient loyalty. Comprehensive consumer data can give providers early and accurate insights into a patient’s specific financial situation. This information can help providers direct the patient to the most appropriate financing options. Automation can then be leveraged to send timely reminders of open balances, improve patient engagement and minimize the risk of missed payments. Tools such as Patient Financial Advisor and Patient Payment Estimates can help providers give patients transparency, control and reassurance from the very start of their financial journey, so bills are settled quickly and easily. Prediction: Automation will be used for an increasing number of payment-related tasks. Artificial intelligence and automation aren’t just for cars and the metaverse. Technological advancements are opening up a wide range of benefits to healthcare providers, from faster patient payments to fraud prevention. Automation also enables operational efficiencies in reporting and reconciliation, while protecting and processing unprecedented amounts of patient data. For example, Collections Optimization Manager uses extensive datasets and advanced analytics to segment patient accounts according to each individual’s specific financial situation. Patient satisfaction will improve because patients receive the right support at the right time. Additionally, providers will be able to use monitoring and benchmarking data to spot previously unseen opportunities and further improve collections. Keeping that “anytime, anywhere” promise COVID-19 was a catalyst for the evolution of healthcare payments. Digital payment solutions that give patients easy, convenient, and safe ways to pay not only help meet changing consumer expectations but will also allow providers to boost loyalty and revenue for years to come. Download the white paper to discover a full list of healthcare payment predictions and find out how to create a modern payment experience that meets patient expectations.

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.

Getting a claim right the first time is much less expensive than reworking it. Experian Health's 2022 State of Claims survey illustrates most claims denials result from simple human errors. Automation and claim scrubbing software help lower the burden of denied claims. But payer contract management software offers one of the most critical strategies for optimizing revenue cycle. These tools help providers maximize reimbursements throughout the lifecycle of their payer contracts.   Experian Health client OrthoTennessee, which has an 86% successful appeals rate, recovers hundreds of thousands of dollars annually by conducting contract audits and recovering underpayments with these tools. This result could extrapolate across healthcare if providers consider implementing payer contract management software.  Understanding the financial impact of denial rates Denial rates can significantly affect a healthcare provider's revenue. One study showed these administrative complexities cause $265 billion in healthcare misspending annually. Preventing claims denials should be a high-priority issue for healthcare providers. It's an untenable situation for cash-strapped healthcare providers, and by most accounts, the problem is getting worse.  Payer contract management software reduces denial rates. A well-managed contract ensures providers are reimbursed accurately and promptly, reducing denials due to billing errors or non-compliance. Individual payer contracts stipulate how and how much a healthcare provider gets paid. In addition to critical payment terms, payer contracts contain:  How many days a provider has to submit a claim  How many days the payer will take to reimburse a correctly submitted claim  The services and scope of coverage by payer  Reimbursement rates for every covered service  How to dispute a claim denial  The term of the payer contract  When to renegotiate or the notice period for a contract termination Most of these reimbursement contracts allow payer amendments. Tricia Ibrahim, Director of Product Management, Contract Manager Suite, says, “Depending on how the contract is written, providers may receive very little notice of these changes. Without a way to systematically and efficiently monitor these agreements throughout the contract term, there is simply no way for a provider to ensure they're paid properly.” Better payer contract management can reduce denials and improve revenue collection by reducing the most common reasons for medical claim denials.  Proactive strategies for denial reduction Proactive denial reduction correlates with a better bottom line. This effort entails a multi-faceted approach with two key elements at its core: Analyzing payer contracts for pitfalls To mitigate denials effectively, healthcare providers must scrutinize payer contracts meticulously. By delving into the fine print, organizations can identify potential pitfalls and the sources of denials. Whether complex reimbursement terms, ambiguous language, or stringent coding requirements, a comprehensive contract analysis can unveil these challenges. Crafting contract strategies for denial mitigation With a deep understanding of contract nuances, providers can develop tailored strategies for denial mitigation. These strategies encompass streamlined claims submission and staff training. Additionally, organizations can engage in informed negotiations with payers to amend unfavorable reimbursement terms.  Through this fusion of contract analysis and proactive strategy development, providers can navigate the complex landscape of healthcare payer contracting with precision, ultimately reducing denials and bolstering financial stability.  Crafting comprehensive contract management strategies for denial mitigation Developing proactive strategies within payer contract management is a critical component of denial reduction.   For example, when creating payer contracts in healthcare, providers must proactively negotiate advantageous terms for their organization. These negotiations should focus on fair reimbursement rates, reasonable timeframes for claims submission, and other favorable conditions that minimize the potential for denials.  Strategies should also encompass addressing ambiguities in healthcare payer contracting. These misunderstandings lead to disputes and denials. Clarifying any vague or unclear language within the agreement ensures all parties have a shared understanding of the terms and expectations.  Finally, to mitigate denials effectively, healthcare payer contracts should align seamlessly with billing and coding practices. These contracts must reflect current industry standards and guidelines to prevent discrepancies resulting in claim rejections. Harnessing the power of payer contract management software in healthcare  Payer contract management software offers healthcare providers a powerful way to automate payer document analysis. A single provider can have 20 or more payer contracts to manage. From HMOs to PPOs, fee-for-service federal programs, third-party administrators, to ACOs and CINs—the payer list can be long. While a thorough analysis of healthcare payer contracting is essential to identify potential areas of improvement, it can be challenging to scrutinize all of these contract terms and conditions to mitigate future denial risks. But with the right software, this revenue cycle function can be a game-changer.  Payer contract management software can handle contract renewal and regulatory updates automatically, ensuring healthcare providers remain compliant. The software eliminates the hours spent manually reviewing data. Some of the benefits include:  Centralizing contracts in one location  Alerting significant milestones, such as contract renewals or changes  Automating processes and workflows  Linking contracts with provider procedures and complianc OrthoTennessee Manager of Payer Strategy, Frances Thomas, uses Experian Health's payer contract management software. She states, “The system gives us the information we need to be successful. They can't really argue with you on that.”  The role of automation in error reduction  Healthcare runs on revenue. Automation is pivotal for reducing healthcare claims errors that tie up revenue in the denials process. Automation software streamlines workflows, reducing manual intervention and the likelihood of human errors. These tools can apply across the revenue cycle, including during the payer contract management process. For example, Experian Health's payer contract management software includes Contract Manager and Contract Analysis features that can automatically:  Compare the expected payment with the actual reimbursement from payors  Maintain and manage contract terms  Pinpoint underpayments  Audit claims   Analyze claims data and the financial impact of potential changes to provider fee schedules  Highlight bulk claims for appeal en masse   OrthoTennessee highlights the importance of the ability to handle claims in bulk. Thomas says, “We had over 600 claims for one day in the wrong network. I was able to take that bulk of claims and handle those—otherwise, I was going to have to sit there and go claim by claim. It's a huge time saver to work smarter, not harder.”  Real-time verification and validation with automation Automated systems revolutionize healthcare operations by offering real-time verification and validation capabilities. Automation technology streamlines the billing process and minimizes errors that can lead to claim denials. It enhances efficiency and precision, allowing healthcare staff to allocate more time to patient care. As providers embrace automation, they can expect increased accuracy and financial stability. RevCycleIntelligence estimates the healthcare industry could save nearly 41%, or nearly $25 billion, of the $60 billion they spend annually by fully automating administrative transactions. But payers also stand to benefit; McKinsey says administrative automation could shave 30% off insurance claims processing costs.  Seamless integration of automation with payer contracts  Integrating automation tools with payer contracts in healthcare enhances efficiency. Integration ensures contract terms are consistently applied throughout the claims lifecycle, reducing denials. Interoperability between these platforms also improves the payer-provider relationship by increasing communication and streamlining processes.   Cross-platform integration creates two-way accountability that's a win/win for both provider and payer. It's a transformative step in healthcare revenue cycle management that could:  Streamline claims submission, verification, and adjudication  Continuously monitor claims for contract adherence and correct problems before they lead to denials  Reduce human errors  Apply advanced analytics to identify trends and patterns   Improve contract negotiations with data-driven decision-making  Lower administrative costs  Navigating challenges and embracing payer contract management software Healthcare providers face numerous challenges in revenue cycle management, especially when handling intricate payer contracts and the need for standardized handling of these documents. These challenges create scenarios where providers underbill or are underpaid for services, in addition to tying up revenue in denials management. Becker's Hospital Review reports providers lose up to 3% of their revenue from underpayments. Plus, the insurance industry isn't immune to making mistakes; the AMA says the claims processing error rate of public and private payers is more than 19%. By harnessing the power of technology, healthcare providers can streamline complex payer contracts and standardize how providers handle these agreements. For example:  To expedite negotiations, modeling tools within payer contract management software offer claim scenarios that help providers negotiate better rates from payers.  These systems provide real-time feedback through smart log messages, enhancing staff training and refining registration best practices.   Most healthcare organizations lack the time and resources to closely monitor payer contracts. When these agreements are on auto-renewal, it's easy to forget their importance. Payer contract management software helps these organizations wring the maximum amount out of these revenue streams. Embracing Experian Health's payer Contract Management software Experian Health's healthcare payer contract management software offers a comprehensive contract management solution that can substantially lower denial rates. By adopting this software, providers can maximize revenue potential and streamline their revenue cycle. Importantly, healthcare providers can implement payer contract management tools without adding staff or conducting major process improvements. This software is the one tool organizations need to ensure they don't leave revenue on the table. Learn more or contact us to speak to our experts.

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