Tag: patient financial advisor

Is the digitalization of patient access services losing momentum? Experian Health’s State of Patient Access 2023 survey suggests that both patients and providers feel there’s still work to do to open healthcare’s digital front door. Where are the gaps? And how can providers fulfill patients’ digital expectations? This article looks at the advantages of offering a digital patient access experience and three technologies that can help providers stay competitive and give patients what they need and want. What is healthcare’s digital front door? The term “digital front door” refers to the virtual gateway through which patients access healthcare services and information. It has become a synonym for patient access, encompassing the digital touchpoints patients interact with when they’re booking appointments, registering for care, verifying insurance eligibility, paying for services and checking their medical records. This can include a hospital’s website, mobile apps for registration and payment, patient portals, telemedicine platforms and online appointment scheduling systems. Digital services have become an integral part of daily life, and healthcare should be no different. Patients and providers alike are seeking streamlined ways to connect and engage. What are the benefits of opening healthcare’s digital front door?  According to the State of Patient Access survey, patients want one thing above all else: to see their doctor as soon as possible. More than three-quarters said online scheduling was a top priority. Being able to book appointments online sidesteps geographical and practical barriers to care, reduces wait times, and prevents more serious and costly health situations from arising. For providers, this is an effective route to patient loyalty as well as better health outcomes. Opening healthcare’s digital front door unlocks financial advantages, too. Registration forms can be pre-filled with verified patient data, eliminating the errors that can occur through manual processes. This saves time, effort and expense for patients and providers later. CAQH estimates that the efficiencies gained through automated processes across the entire revenue cycle, including patient access, could allow the medical industry to release savings of as much as $22.3 billion each year. As healthcare labor challenges continue, a third of providers also noted that digital technology can help offset staff shortages, easing pressure on staff by automating repetitive tasks. Clarissa Riggins, Chief Product Officer at Experian Health, says, "For those in the healthcare industry who have been hesitant about implementing technology due to fears about replacing workers, the current staffing shortage may be the catalyst they need to change." And with a wealth of insights about service utilization and staff workflows now at their fingertips, data-driven digital services can facilitate continuous operational improvements. Why has the digital momentum slowed? Despite these benefits, patients report a slowdown in the digitalization of patient access. While the acceleration of the adoption of digital services seen during the pandemic could be expected to level off, survey responses from patients and providers hint at a more significant dip. Only 17% of patients think patient access has improved over the last two years, and 47% of providers say it’s gotten worse. Riggins says, "Patients have increasingly high expectations for easy and efficient tech-enabled solutions when it comes to accessing healthcare services...The bottom line is providers must prioritize updating their technology to avoid being left behind. Patients, especially younger generations, are demanding a better 'digital front door' experience or they could look elsewhere for care. In fact, Experian Health's survey found that 56% of patients who believed the access experience was worse said they would switch providers because of it." How can healthcare providers improve their digital front door? Fulfilling patients’ digital expectations comes down to three things: 1. Quick and convenient self-scheduling Survey results show that 76% of patients want to schedule appointments online or via a mobile device. With Experian Health’s patient scheduling software, providers can offer patients the option to book, cancel and reschedule appointments from any device, at any time. This omnichannel platform acts as the central scheduling hub across an entire health system. Self-service scheduling and integrated text and IVR outreach campaigns reduce the number of calls to agents. And for those calls that are needed, guided search makes scheduling quicker and easier. 2. Mobile-enabled patient registration Data from Experian Health and PYMNTS found that a third of patients chose to fill out registration forms for their most recent healthcare visit using digital methods, while 61% said they’d consider switching providers to one that could let them manage care through a patient portal. Aside from boosting patient engagement, automated registration also reduces the risk of denied claims, by preventing data entry errors that occur during patient registration. With Experian Health’s patient intake software, providers can simplify registration for a better patient experience, reduced administrative costs and fewer denied claims. 3. Anytime, anywhere payments More than seven in ten patients say they want to be able to pay for healthcare using online or mobile methods. But before that, they also want to know in advance how much their bill is likely to be. The survey suggests that providers still struggle to deliver accurate, upfront cost estimates to patients. With tools like Patient Financial Advisor, Patient Estimates and self-service payment options, providers can help patients navigate the financial side of their healthcare journey, resulting in prompter payments and more positive reviews. Implementing new systems and tools can be daunting, but with the support of an expert vendor, providers can deliver the convenience and choice that patients demand in the most efficient and cost-effective way. As labor costs continue to rise, now is the time to invest in digital technology to ease pressure on staff, increase patient engagement and safeguard revenue going forward. Discover how Experian Health is helping to open healthcare’s digital front door with comprehensive patient access solutions.

How do patients rate their “patient access” experience? For most, the rating comes down to how quickly they can see their doctor – and many don't feel like their expectations are met. In December 2022, Experian Health surveyed more than 1000 adults who'd accessed care in the previous 12 months to gauge perceptions of patient access. Most think the experience remains unchanged or has gotten worse in the last two years, despite advancements and providers' heavy investments in technology.  Almost 8 in 10 of those patients say “seeing a doctor/practitioner quickly” is their biggest pain point. Other major factors include the level of friction involved in scheduling and registering for care and obtaining accurate pricing estimates before services are rendered. Patient access tools can help ensure that patients receive the care they need in a timely, efficient manner. Breaking down barriers for friction-free patient access What hinders patients' ability to see their doctor quickly? For some, the obstacles are logistical: patients may live far from facilities or lack reliable transportation to get to appointments. Others may have financial concerns, where a lack of insurance coverage or fear of mounting bills prevents them from seeking care. Language and cultural barriers can make it difficult to engage with healthcare services. But for many, it comes down to friction in the “patient access” process itself. This includes long wait times for appointments, disjointed scheduling systems, manual registration processes, and limited payment options. These processes are not only critical to patient satisfaction but also have real consequences for the patient's health and the provider's bottom line. One effective approach to improve access to care is to continue leveraging patient access tools, which has been proven successful in several use cases. Use case 1: Reduce wait times with online self-scheduling Among patients who think access has worsened over the last two years, 49% say their main challenge is finding appointments that fit their schedule, while 40% blame the scheduling process itself. Online self-scheduling solves both, making it easier to book and reducing wait times. With online self-scheduling, patients can log on to book appointments any time they like. There's no need to wait until the phone lines open and speak to customer support representatives. A self-scheduling tool like Patient Schedule can incorporate each provider's business rules and scheduling protocols, so patients get real-time access to the earliest available appointments. By allowing patients to easily cancel or reschedule appointments, same-day slots can be opened up to other patients, so they can see their doctor sooner. Use case 2: Increase operational efficiency with digital patient registration Staffing shortages are an ongoing stressor for providers, so making the best use of available staff time is crucial. Patient intake software can automate many of the manual activities associated with patient registration, such as helping patients fill out forms or manually entering information into electronic health records. In addition, more than 8 in 10 providers say their patients prefer an online registration experience. This corroborates earlier findings from a study by Experian Health and PYMNTS, which found that a third of patients prefer to fill out registration forms at home. Experian Health's Patient Intake Solutions allow patients to complete registration from their mobile. Data can be automatically pre-filled and checked against existing records to save time and avoid errors. Not only is this more appealing to patients than filling out forms in a stuffy waiting room, but it also helps drive down the risk of costly and time-consuming denials. Use case 3: Boost patient engagement with targeted patient outreach Another way to leverage patient access technology is through targeted, automated outreach. With automated text message (SMS) and interactive voice response (IVR) campaigns, patients can receive a personalized link to schedule their appointment directly. Alerts can be sent when earlier appointments become available, which both reduces wait lists and makes it more likely that patients will book. Patients can be sent bill reminders and payment options in the same way. Automated outreach solutions that incorporate reliable consumer data make sure patients get the details they need in a format and timeframe that helps them take action. Use case 4: Speed up collections with accurate estimates and payment plans As rising staffing and supply costs put a squeeze on healthcare profit margins, expediting collections is crucial. This begins with patient access: if patients can pay for care right at the start of their healthcare journey, this eases pressure on both parties to make sure bills are paid in a timely manner. Upgrading payment technology to include upfront pricing estimates, payment plan recommendations and convenient payment methods can all help patients better manage their financial responsibility. Unfortunately, it's still common for patients to go into procedures without knowing how much they'll owe. In Experian Health's survey, 65% of patients said they did not receive an estimate prior to care, and 40% said they were likely to cancel care without advance notice of costs. Leveraging tools such as Patient Financial Advisor and Patient Payment Estimates can automatically arm patients with the information they need to plan and manage their bills. Utilizing patient access tools to meet patients' expectations It is evident from the results of the State of Patient Access 2023 survey that patient access remains an issue. To ensure patients receive the care they need in a timely and efficient manner, providers must make a concerted effort to leverage digital technology. Although healthcare providers have made great strides in providing more efficient patient access solutions, clearly there is still much progress to be made.  The success of any patient-focused initiative relies heavily on being able to meet patients' expectations with timely, effective tools and resources. As healthcare evolves and continues to put a priority on improving outcomes, it's important to take proactive steps toward ensuring the best possible experience for patients when accessing their care. Find out more about how Experian Health's patient access tools can improve patient access and increase profitability for healthcare providers.

To improve the patient journey, providers need to think like consumers. Patients are accustomed to convenience and choice in industries such as retail and banking, and expect the same of their healthcare experience. How quickly can they see their doctor? How easy is it to book appointments? Are they going to be handed a stack of paper forms when they arrive? From scheduling appointments to making payments, every touchpoint in the patient journey is an opportunity to meet and exceed expectations. To improve the patient journey, providers will need to utilize digital tools. Providers that put themselves in the patients’ shoes and find ways to make patient access as frictionless as possible will secure a competitive advantage. Learn how digital technology can enhance healthcare providers' ability to deliver flexible, efficient, and supportive care throughout the patient journey. This article draws upon the insights of Experian Health's State of Patient Access 2023 report to explore the benefits of utilizing digital tools and solutions in healthcare. In 2023, Experian Health surveyed more than 1,000 U.S. patients & 200 healthcare providers to learn about the state of patient access. Get exclusive insights: Before the appointment: how easy is it for patients to schedule care? The patient journey should begin with a welcoming “digital front door”. Demand is clear: according to the State of Patient Access 2023 survey, 56% of patients want more digital options to manage their healthcare. Specifically, 76% say they would like to schedule appointments online or via a mobile device. Creating an inviting, convenient and user-friendly online presence will encourage patients to book more appointments. A multi-purpose online portal gives patients the flexibility to take care of appointment bookings anytime, anywhere. Automated patient scheduling also reduces pressure on call center staff, who are then able to offer extra support to individuals who need it. Real-time status updates and automated appointment reminders ensure patients see their doctor as soon as possible and reduce the risk of no-shows. By creating a seamless transition between a provider’s online presence and physical office, tools like Patient Schedule can create an efficient experience for both staff and patients. Arriving for care: is pre-registration simple and streamlined? Patients deserve a seamless and stress-free experience when arriving for their appointment. Unfortunately, traditional paper forms can be tedious and redundant. Incomplete forms can also lead to delays in treatment. Online self-check-in options and virtual waiting rooms allow providers to move registration out of the waiting area and into the patient’s home or mobile device. With a digital front door, patients can complete pre-registration tasks, get accurate price estimates and even pay their bills before their appointment, via text or online portal. Automated tools can prefill identity information to keep errors and gaps at bay, and avoid claim denials and delays further on in the patient journey. A painless, paperless registration experience is easier and quicker for patients and saves time and resources for providers. Planning for bills: are patients getting upfront pricing estimates? Providers have many opportunities to improve the patient financial journey. Experian Health’s survey found that 40% of patients would cancel or postpone care without accurate estimates, yet 65% did not receive them. That price transparency isn’t the norm is surprising, given the legislative push in recent years. Medical bills can be extremely complex, so providing a detailed breakdown of expected costs is a great way to improve the patient experience. Patient Estimates is a web-based tool that allows patients to generate accurate estimates using their current insurance and benefits information, before or at the point of service. Patients can also be offered personalized financial assistance options including payment plans and charity care. For patients that prefer to take care of business via their mobile device, Patient Financial Advisor offers a similar service via secure text message. Patients get a clear cost breakdown and a link to make secure payments. When financial management is easier for patients, providers are more likely to get paid. Paying for care: do patients have a choice of payment methods? In addition to clear and upfront pricing, providers can enhance the financial experience by offering multiple convenient payment options. Digital-first consumers are looking for the same self-service, secure, one-click payment options that they use for other purchases. Providers that enable digital patient payment tools earlier in the process are not only delivering a more satisfying patient experience, but they’re also more likely to be paid sooner. With Experian Health’s Patient Payment Solutions, providers can collect payments 24/7 via mobile, web and patient portals. Leveraging digital technology to improve the patient journey Alex Harwitz, VP, Digital Front Door, at Experian Health, says that patient loyalty is increasingly tied to digital offerings: “Whether we’re talking about scheduling, registration or payments, the message from the State of Patient Access 2023 survey is clear: patients are looking for transparency, convenience and a significant amount of control. They’re more likely to choose providers that offer these benefits and switch away from those that don’t. For example, nearly a quarter have considered looking for a different provider because of a poor payment experience.” The realization that a better patient access experience results in better business outcomes is almost universal among providers. And with advancing patient access technology, providers now have more ways to deliver a consumer-friendly experience that allows patients to focus on their health, and not on the admin of care. Download the State of Patient Access 2023 – the Digital Front Door, to find out more about patient and provider perspectives on how to improve the patient journey.

The COVID-19 pandemic and economic volatility cast a spotlight on America's healthcare system, revealing many complications with patient access. Most patients and providers agree: patient access along with financial strain, are major contributors to patient burnout and delayed or lapsed healthcare. Healthcare providers can help ease the burden for patients by taking steps to implement digital solutions that make access to care easier. What's causing patient burnout? Today, there are many contributing factors causing patient burnout and most have to do with patient access, according to the latest Experian Health data. In fact, 21% of patients feel that patient access today is much worse than in previous years. And 80% of patients feel that the biggest challenge they face is seeing a doctor quickly. Frustrating experiences with registration and inaccurate estimating – all parts of patient access – are burning patients out, too. Nearly half of patients (49%) have trouble finding appointments that fit their schedule and 40% say the process to schedule an appointment is one of their top issues. And when they're finally able to be seen by a provider, patients are often met with understaffed offices, overworked physicians, long waits and rushed appointments. As a final blow, patients are also finding themselves faced with higher-than-expected medical bills thanks to inaccurate pre-treatment estimates. In fact, only 29% of patients say they received a cost estimate before care, and of those who didn't receive an estimate, 41% said the final costs for care were more than expected. Today's patients are seriously fed up, and providers agree. Nearly half (47%) say that patient access is worse than in the previous two years. Close to 90% of providers (87%) also feel that staffing shortages are contributing heavily to poor patient experiences along with outdated technology (21%). The State of Patient Access 2023 report is based on a new survey, fielded in December 2022, that gathered responses from 202 healthcare professionals responsible for patient access and 1,001 patients who engaged in care for themselves or a dependent in 2022. It is the third survey in a series fielded by Experian Health since 2020. Building a better patient experience A positive patient experience begins with simplifying patient access. In fact, according to a recent Experian Health report, more than half of patients want more digital options to manage their care (56%) and have even considered changing to a provider that offers better access. To retain existing patients and attract new patients, healthcare providers need to have digital patient access solutions in place. From the ability to register for appointments online to mobile payments, a digital front door can help providers create more satisfactory patient experiences. Not only can digital tools improve the patient experience, but it's also the starting point of the revenue cycle and accounts for registration, scheduling, gathering insurance information and collecting co-pays or deductibles. And it's where 30% to 50% of denied claims initiate, thanks to inaccurate patient information, lack of real-time insurance verification and manual processes, among other factors. Alex Harwitz, Experian Health's VP of Product, Digital Front Door, says, “When we think about how digital front door solutions can solve for patient burnout, the answer is simple. What's good for the patient is good for the provider. Our latest Experian Health study has shown us that patients want more access. They're looking for functions that are easy to use and don't take up a lot of time. When providers provide streamlined digital solutions, it leads to better patient access experiences that directly result in better business outcomes for the practice.” Introducing automated patient access solutions can help healthcare practices give patients more control over their healthcare, reduce claim denials and alleviate some of the issues caused by short staffing. Recent data from Experian Health and PYMNTS also found that a third of patients opted to fill out registration forms for their most recent healthcare visit using digital methods, while 61% of patients said they'd consider changing healthcare providers to one that offers a patient portal. Automated patient access solutions can offer high-quality service without limiting care options, providing an ideal win-win situation for both patient and provider alike. Automate patient access with digital solutions According to recent Experian Health data, over 46% of providers are planning to invest in digital front door capabilities in the next six months. This shows a growing recognition of the importance of digital patient access solutions among healthcare providers. Automated digital patient access solutions can help healthcare providers improve patient access, reduce waiting times, and increase operational efficiency, among other benefits. Some of the automated digital patient access solutions that providers can consider investing in include: 1. Patient registration and scheduling Using integrated registration and scheduling solutions, such as Experian Health's Registration Accelerator, Patient Scheduling software, and Patient Outreach, can help providers create a better patient experience before they even see a provider. Automating intake online can simplify registration processes, while reducing administrative costs and boosting revenue. When patients have easy access to schedule appointments online 24/7, there are fewer gaps in care and providers have reduced staff call times and more time to collect billing. Plus, providers can automate patient outreach messages and offer the ability to self-schedule via IVR or text – giving patients even more access. 2. Patient payment tools 26% of patients say that paying for healthcare is harder than ever, and 77% of healthcare consumers say it's important to understand the cost of their care before getting treatment. But it's still the norm for patients to go into procedures without knowing what they'll ultimately owe. A tool like Experian Health's Patient Financial Advisor can send patients accurate cost estimates and easy payment options ahead of time. Estimates using the Patient Financial Advisor are based on real-time patient benefit information, the provider's payer contracted rates and provider pricing. By giving individuals a clear understanding of their costs and payment prior to a medical procedure, providers can help their patients feel more financially confident. A built-in payment portal also offers methods to make a secure payment, resulting in fewer billing delays. 3. Patient estimates According to recent Experian Health and PYMTNS data, 4 in 10 patients said they spent more on healthcare than they could afford, but when they know the costs upfront, they feel empowered to make better decisions about their healthcare. Although there are measures in place to help ensure self-pay and uninsured patients receive a good-faith estimate up front, such as the Price Transparency Final Rule and the No Surprises Act, inaccurate estimates can still be an issue. Using a digital solution such as Experian Health's Patient Estimates, can help providers meet regulatory requirements, create a positive patient experience and bring in faster payments. Plus, estimates are more accurate as they account for payment plans, prompt-pay discounts, state-mandated discounts as well as other types of financial assistance policies for self-pay patients. Reduce patient burnout with digital front door solutions To reduce patients' financial strain and ease their frustration with access to care, providers must make it a priority to adopt digital solutions that better serve patient needs. These digital front door capabilities not only help increase access to care but also provide a personalized experience for each individual. Digital patient portals, online appointment scheduling, patient estimates – all of these can help deliver better outcomes and drive efficiency for both patients and providers. By implementing these digital patient access solutions, healthcare providers can create a more efficient and convenient patient experience, reduce administrative burdens, and streamline their revenue cycle management processes. Learn how Experian Health can help healthcare organizations implement digital front door capabilities that can improve patient access and minimize patient burnout.

With inflation still high, the economic outlook remains uncertain for healthcare consumers. Many households feel squeezed by rising housing, food and fuel bills, while their incomes remain broadly static. Inflation’s impact on healthcare can be seen in delayed treatments, as a 2022 Gallup poll found that 38% of patients postponed medical care because of concerns about costs – the highest amount since the poll began in 2001. The situation is exacerbated by the fact that Medicaid continuous enrollment came to an end on March 31, 2023. To complicate things further, reimbursement rates and employer health plans tend to be negotiated in advance, which means inflation can take longer to filter through the healthcare economy. Both McKinsey and Deloitte predict that hospital profit margins will reduce in the coming year or so. Resulting price increases will be reflected in employer coverage plans, and ultimately pass to workers in the form of higher deductibles and out-of-pocket costs. In short, inflation’s impact on healthcare may continue to create ripples in the healthcare industry. For healthcare providers, reimbursement may become more challenging as patients find it harder to pay their portion of the cost. What can providers do to mitigate inflation's impact on healthcare? Providers are already working to maximize operational efficiency with automation and digital tools that reduce workforce pressures, streamline back-office processes, and leverage data to drive improvements. Reducing costs is just one side of the coin. The other is to maximize opportunities for reimbursement by supporting patients throughout their financial journey and making it as easy as possible for them to pay. Here are 4 ways that healthcare providers can mitigate inflation’s impact on healthcare while reducing friction for patients and maintaining cash flow: 1. Provide transparent pricing and upfront patient estimates Because inflation has forced patients to prioritize their spending, many are opting to postpone healthcare. But delaying treatment or stretching out medicines to save money could lead to poorer health outcomes, and potentially more expensive treatment being needed later. By proactively offering patients accurate pricing estimates before they come in for care, providers can help patients get a fuller picture of what their final bills are likely to be. Estimates can be sent directly to the patient’s mobile device, along with user-friendly links to payment plans and payment methods. This makes it much easier for patients to plan, so they’re less likely to default on payments or delay care. 2. Help patients find unknown insurance coverage With the end of continuous Medicaid enrollment, millions of patients could have gaps in coverage. While this is largely an issue for states to manage, providers can take steps to help patients find additional coverage, and support those at greatest risk to find financial assistance and plan for upcoming bills. Coverage Discovery can be used at any point in the revenue cycle to search for missing or forgotten billable coverage. It uses advanced search and proprietary data sources to check for both government and commercial insurance coverage. When coverage is found, patients get the reassurance of knowing that their bills will be covered, while providers can avoid writing off these accounts to bad debt. And because Coverage Discovery uses a contingency fee pricing model, providers only pay for the tool when they are reimbursed. 3. Offer simple and convenient methods to plan and manage bills Prescription medications, inpatient visits and other services are expected to increase in price over the coming year. Americans may be more concerned about how they’ll shoulder the costs – especially the 49% who say they’d be unable to pay an unexpected bill of $1000 or more. Providers can make the process easier for patients with data-driven digital tools. Patient Financial Clearance identifies patients that are likely to be able to pay upfront and those who may need a payment plan or financial assistance. This information allows providers to engage in compassionate financial counseling to make sure patients are guided to the most appropriate pathway. Another option is to leverage self-service tools to give patients more control over how and when they pay. Patient Financial Advisor offers pre-service estimates and payment options that patients can access anywhere, anytime. They can take stock of their financial situation, plan for bills, and then make payments at the click of a button. If it’s easier to pay, patients will be less likely to delay. 4. Make it easier for patients to schedule care While many patients may consider delaying care because of cost, many say they’ve postponed treatment for other reasons. Concerns about COVID-19, work commitments, and difficulty booking appointments can also lead to delayed care. For those that are foregoing care for reasons other than cost, providers should look at improving the patient access experience with more self-service options. Online self-scheduling allows patients to book, reschedule and cancel appointments at their own convenience. Digital patient registration similarly reduces friction, by enabling patients to fill out forms from their mobile devices. Patients will be less likely to forego care when access is as easy as ordering groceries online. Proactively reducing inflation's impact on healthcare Inflation’s impact on healthcare continues to be felt – and could get worse as the year goes on. Rising medical bills may cause patients to keep deferring care. Providers can proactively reduce the effects by incorporating digital solutions and patient engagement strategies that make it easier for patients to afford and receive care. Find out more about how Experian Health can help healthcare organizations bolster their revenue cycles and mitigate inflation’s impact on healthcare.

On April 1, 2023, millions of Medicaid recipients are set to lose coverage as the U.S. government’s COVID-19 public health emergency (PHE) expires. The Kaiser Family Foundation estimates that 5.3 to 14.2 million people will lose Medicaid coverage as the continuous enrollment provision of the PHE ends. Of this group, 6.8 million may be eligible to re-apply for Medicaid, but in the immediate term, it falls to patients and providers to sort through coverage questions, navigate charity and Medicaid eligibility, and keep bills out of collections. Mindy Pankoke, Senior Product Manager at Experian Health, shares her insights on how Patient Financial Clearance and other digital solutions can help providers and patients cut through the confusion to achieve the best healthcare and financial outcomes during this time. Q1: The public health emergency is ending on April 1, which means that many will lose Medicaid coverage. How will this impact providers and patients? “Patients who qualified for Medicaid under the Public Health Emergency requirements during COVID will be dropped from Medicaid on April 1, leaving them without coverage,” explains Pankoke. “Healthcare organizations have been trying to reach out proactively to pre-enroll some of these patients, but others may not know what their options are or may show up to receive care without realizing they no longer have coverage.” Patients will face a range of financial challenges. “Self-pay patients may defer treatment, which could keep them from receiving the care they need and may ultimately lead to more costly hospital visits,” Pankoke says. “Also, patients may be confused about what’s happened to their coverage and what their options might be going forward. If they end up being responsible for paying out of pocket for care, some may have to choose between paying their medical bills and paying for food or utilities.” Providers will see a surge in patients needing help after losing Medicaid coverage With millions of patients in flux, providers will need to dedicate time and attention to helping patients sort through their concerns, including: Confirming whether Medicaid coverage is still in force Verifying coverage with new insurance Determining eligibility to re-enroll in Medicaid Qualifying patients for full or partial charity care Explaining patient financial responsibility and working out payment plans Managing billing and collections with a higher volume of accounts in AR Optimizing outcomes so that patients get the best care possible and providers end up with the least amount of bad debt Time is a critical element. Lengthy processes and administrative delays are likely to increase patient stress levels. Meanwhile, many providers face industry-wide staffing shortages. Time-consuming manual processes, multiplied by a sudden surge of affected patients, could quickly become overwhelming for staff. “For providers, this could be a hard situation to navigate,” says Pankoke. “At the same time, it gives providers an opportunity to come through for patients in a moment of need. Being able to identify patients who need assistance and offering them help can be powerful.” Q2: That raises an important question: How can providers create a compassionate experience for patients? “I think awareness is one place to start: making sure your staff knows this change is coming and that they understand the impact,” Pankoke says. “Your staff are the ones who’ll be working with patients personally when they come in and find out they no longer have Medicaid coverage.” But compassion doesn’t end there. “Many providers already have charity programs in place to provide relief for patients who can’t afford care,” says Pankoke. “The challenge lies in identifying the patients who need that charity assistance and connecting them to the help that’s available, while also learning which patients may still qualify for Medicaid and need help to re-enroll. Patient Financial Clearance uses credit and non-credit data to identify patients who may still be eligible for Medicaid, as well as self-pay patients who may qualify for charity assistance.” Using data-driven digital tools to quickly and proactively size up patient financial needs and offer personalized help can make the patient experience more humane. “Making these steps easier is another piece of being compassionate.” Q3: Screening for charity can be complicated, especially when new regulations are introduced – how do providers streamline this process? “My best advice is to embrace your charity programs and use a partner like Experian Health to help you automate the financial assistance screening process,” says Pankoke. “Patient Financial Clearance removes the manual screening for the likelihood to qualify for your charity programs and Medicaid.  It can automate the document-gathering in a patient-friendly way, and speed up the process to extend charity assistance, or work to enroll those likely to qualify for Medicaid early on before patients go through a costly uncollectable experience.” Automating these processes doesn’t have to be onerous. “Clients can provide their charity policy  requirements to Experian Health and let our expert consultants help to create the most effective and efficient workflows for Medicaid and charity screening both  up-front and as back-end scrubs.” Pankoke also urges providers to consider patient self-screening options as well: “Providers should consider other options aside from paper applications.  We’ve seen clients shrink the application process from 60 days of paperwork down to 3.5 days by enabling patient self-screening options via text.  This creates a better experience for the patient and hospital staff.” Q4: What else can providers do to help patients manage the cost of care? Providers can focus their resources on improving the patient's financial journey—for all patients, not just those who are struggling with their Medicaid status. Pankoke’s suggestions: Reach patients on their preferred channels - “Providers can empower patients with less paper-heavy ways to apply for financial assistance. Text and online applications embedded on your website or patient portal put the power into the patient’s hands using the channels they prefer.” Providers can also offer patients the ability to make payments right from their mobile devices using Patient Financial Advisor, making it easier to pay outstanding bills anytime and anywhere. Use data to gain insight into patient finances and offer personalized options - “In addition to screening for possible charity and Medicaid eligibility, Experian data enables providers to offer realistic payment plan options that consider how much the patient is likely to afford, enabling patients to bite off what they can chew with higher likelihoods of making payments successfully.” Customize collections - Sending patients who are struggling to collections may not be cost-effective or compassionate. “Providers don’t want to hound people for payment if the patient is having trouble covering their basic expenses and could qualify for Medicaid or charity care,” says Pankoke. Using Collections Optimization Manager, providers can tailor collections processes to their own specific needs. “A partner who is agnostic to your in-house and early-out agencies can help you manage, monitor, and optimize agency performance for maximum revenue.” Providers who are concerned about upcoming shifts to Medicaid coverage may want to consider leveraging solutions like Patient Financial Clearance, Collections Optimization Manager and Patient Financial Advisor to help them meet this challenge—along with the many challenges of managing patient financial needs in a rapidly-changing world.

Medicaid continuous enrollment will come to an end on March 31, 2023, as the temporary provisions are decoupled from the COVID-19 public health emergency. The federal government introduced the protections to ensure individuals did not lose coverage during the pandemic, leading to record enrollment levels. But as states prepare to resume routine renewals, up to 15 million people could end up without adequate insurance. Coverage gaps could disrupt access to health services and increase the risk of uncompensated care for providers. With Medicaid continuous enrollment coming to an end, how can providers prepare? Mitigating the effects of the unwinding of the Medicaid continuous enrollment provision Under the Consolidated Appropriations Act passed in December 2022, states will have 14 months to complete renewal processes for Medicaid and the Children’s Health Insurance Program (CHIP). While 6.8 million people are likely to remain eligible, churn and administrative delays could leave some without coverage. Analysis by the Kaiser Family Foundation suggests that in recent years, around 65% of people who disenroll from Medicaid or CHIP experience a gap in coverage for all or part of the following 12 months. Some transition to other forms of coverage, but around 41% eventually re-enroll. Implementation of the forthcoming “unwinding” process largely falls to states. While the new legislation and associated guidance bring welcome certainty, concerns remain around how to avoid unnecessary disenrollment and expedite redetermination. That way, patients (and providers) aren’t left holding bills that could have been covered when the Medicaid continuous enrollment period ends. 4 things providers can do if a patient loses Medicaid coverage As patients steel themselves for the return of renewal paperwork, providers are considering how they can help patients maintain coverage and get the financial assistance they need. Digital self-service tools to apply for financial assistance can help patients access the appropriate support, with tailored payment plan options based on their individual financial situation ­­­– all through automation. Here are 4 key actions for providers to consider: 1. Find missing coverage with Coverage Discovery Healthcare providers should put automated processes in place to find any active coverage that may have been overlooked. Coverage Discovery searches for any billable government or commercial insurance to eliminate unnecessary write-offs and give patients peace of mind. Using advanced search heuristics, millions of data points and powerful confidence scoring, this tool checks for coverage across the entire patient journey. If the patient’s status changes, their bill won’t be sent to the wrong place. In 2021, Coverage Discovery identified previously unknown billable coverage in more than 27.5% of self-pay accounts, preventing billions of dollars from being written off. 2. Quickly identify patients who may be eligible for Medicaid and financial assistance A lack of clarity around enrollment and eligibility could cause chaos for claims and collections teams. How can they handle reimbursements and billing efficiently if financial responsibility is unclear? Claim denial rates are already a top concern for providers, on top of wasted time from seeking Medicaid reimbursement for disenrolled patients. Equally, patient collections will take a hit if accounts are designated as self-pay when the patient is entitled to financial assistance and charity care. It may be difficult to tell who’s who without a robust process to check patients’ ability and propensity to pay. With Patient Financial Clearance, providers can quickly determine if patients are likely to qualify for financial support, then assign them to the right financial pathway, using pre- and post-service checks. Self-pay patients can be screened for Medicaid eligibility before treatment or at the point of service, and then routed to the Medicaid Enrollment team or auto-enrolled as charity care if appropriate. Post-visit, the tool evaluates payment risk to determine the most suitable collection policy for those with an amount to pay and can set up customized payment plans based on the patient’s ability to pay. Patient Financial Clearance also runs back-end checks to catch patients who have already been sent a bill but may qualify for Medicaid or provider charity programs. This helps providers secure reimbursement and means patients are less likely to be chased for bills they can’t pay. 3. Screen and segment patients according to their propensity to pay Optimizing collections processes is always a smart move for providers, and will be particularly important when federal support ends. Collections Optimization Manager uses advanced analytics to segment patient accounts based on propensity to pay and send them to the appropriate collections team. With access to Experian’s consumer credit data, the Collections Optimization Manager segmentation models are powered by a more unique and more catered approach that includes robust and proprietary algorithms.  It screens out Medicaid and charity eligibility, so collections staff focus their time on the right accounts. Between 2019-20 and 2020-21, UCSDH increased collections from around $6 million to over $21 million with Collections Optimization Manager. Altru Health System also used this solution to ensure that patients who were eligible for Medicaid were not allocated to collections and their insurance was billed promptly. Over a 10-month period, more than 4,000 accounts were flagged as eligible for financial assistance, representing nearly $2.7 million. This automated process also alleviates the burden on staff, who will likely be handling greater numbers of queries from anxious patients when continuous enrollment ends. 4. Make it simpler for patients to manage and pay bills The reality is that many patients affected by the unwinding of continuous enrollment will be on low incomes. When more than half of patients say they’d struggle to pay an unexpected medical bill of  $500, providers need to take steps to make it easier for patients to gauge their upcoming bills. Digital, self-service tools such as Patient Financial Clearance can help self-screen for charity and financial assistance. Patient Financial Advisor and PatientSimple can help patients navigate the payment process with pre-service estimates, access to payment plans and convenient payment methods they can access on a computer or mobile device. Together, these tools can help providers manage the fluctuating Medicaid continuous enrollment landscape efficiently and offer extra support to patients who may be facing disenrollment. Find out more about how Patient Financial Clearance and other digital solutions can help healthcare organizations deliver compassionate financial experiences to their patients.

Digital tools are gradually helping to modernize healthcare, but there are still many gaps to fill when it comes to meeting critical needs. Outdated billing, payment and pricing models continue to be a hindrance for healthcare providers and patients. In an article for Chief Healthcare Executive, Tom Cox, President of Experian Health, made the case for using digital tools and online payment software to help patients better understand, manage, and live up to their financial responsibilities. “At a hefty $140 billion price tag, medical debt in the United States is a growing crisis,” Cox wrote. “There are many contributing factors, but it doesn’t help that costs are often unclear upfront and confusing at best once the bill arrives, with a lack of seamless digital payment options throughout the journey.” Better digital solutions exist, including tools that provide clear, accurate pre-treatment estimates and mobile billing and payment options, but not all healthcare providers are up to speed. Meanwhile, a study by Experian Health and PYMNTS found that 60% of millennials are “very” or “extremely” interested in digital services; 61% of patients who are interested in using patient portals would change healthcare providers for more digital convenience. Managing healthcare expenses is a growing challenge for patients Too often, patients enter treatment without a clear understanding of what they’ll be required to pay. External factors contribute here: Many patients have changed jobs and insurance coverage or have moved to high-deductible health plans that carry greater out-of-pocket expenses. Receiving a personalized estimate that shows projected costs, insurance coverage, potential discounts, and payment options helps patients anticipate costs and plan for payment. Yet, Easing Digital Frictions in the Patient Journey, a collaborative survey of 2,333 consumers from Experian Health and PYMNTS, found that only a third of patients received cost estimates prior to their visits and another 14% only received estimates after requesting them. Knowing out-of-pocket costs in advance matters to patients. The survey also found that 82% of patients living paycheck to paycheck with issues paying their bills consider it “very” or “extremely” important to preview out-of-pocket costs before treatment. Among patients who received surprise bills, 40% spent more on healthcare than they could afford, compared with 18% of patients who did not receive surprise bills. A lack of modern payment options is an additional challenge. “Younger generations raised on digital banking expect immediacy and convenience in how they handle finances,” Cox said. A range of choices, including digital card payments, digital wallets, or personalized payment plans, gives patients tools for managing their healthcare costs. Online payment software removes friction and enhances the patient experience If providers are ready to offer a better digital patient experience, where do they begin? Giving patients accurate cost estimates before treatment, at the point-of-service, and via a patient self-service portal offers greater clarity and control. Experian Health’s Patient Estimates solution creates personalized cost estimates using the provider’s chargemaster, claims history, payer contract terms, and the patient’s insurance. Estimates may also include information on discounts, payment plans, and financial assistance where appropriate. Patient Financial Advisor enables patients to review estimates, make payments, and even set up payment plans using their mobile devices. “Reaching patients where they are—on their mobile devices—brings the patient payment experience in line with the way people already shop, manage money, and transact in other areas of their lives,” says Riley Matthews, Senior Product Manager at Experian Health. “Consumers who routinely see an upfront, detailed breakdown of costs when they order lunch delivery or hail a ride, then pay seamlessly on a mobile app, want a frictionless digital experience when they’re dealing with something as consequential as healthcare.” Confusion, unexpected costs, and a lack of payment options can all slow the collection process. Patients are more likely to delay payment if they don’t understand their charges—or if they aren’t able to pay anytime, anywhere using the payment method of their choice. But the cost of living may also play a role – as household budgets tighten, patients may need more time and better tools to handle expenses. “The good news is that providers have access to digital solutions that improve the patient payment experience. Implementing new technologies that provide patients with accurate cost estimates and familiar online payment options removes friction and makes it easier for patients to understand and pay their bills, which ultimately boosts the bottom line,” says Berenice Navarrete, Product Director at Experian Health. Patient experiences can speak to individual needs By helping patients succeed at managing their healthcare costs, patient-centered payments may also help speed up collections. Digital tools help, not only by providing clear up-front estimates and easy-to-use mobile billing and payments, but also by using data to get a broader view of patients’ financial situations. By better understanding individual insurance coverage and factors like a patient’s propensity to pay, providers can create patient payment experiences that speak to individual needs. “Digital solutions like Coverage Discovery and Patient Financial Clearance give insight into what a patient’s insurance will cover and whether they might benefit from a payment plan,” says Matthews. Effectively communicating with patients throughout the patient journey—all the way through to payment—is an additional consideration. Automated bill reminders, self-pay options, and text or voice messages keep patients aware of outstanding bills, especially when they may need extra time to process and plan. Improving the patient experience is part of patient care Ultimately, billing and payment are part of patient care. When providers bring greater clarity and ease to the patient payment experience, they eliminate barriers to both treatment and payment. And while implementing digital technology requires an investment, improving the patient experience, accelerating collections, and extending care with less pain in the process is valuable to patients and providers alike. Learn more about Patient Estimates, Patient Financial Advisor, and Experian’s full suite of online payment software solutions.

As household finances tighten, providers face a growing challenge to address patients’ financial needs while caring for their health. A new survey from LendingClub and PYMNTS found that 64% of Americans live paycheck-to-paycheck. That leaves little or no room for healthcare expenses and could mean there’s less in savings to tap as well. Healthcare organizations will need to take extra steps to provide patients with financial support during tough times. Survey results match up with Kaiser Family Foundation data on healthcare affordability. KFF found that 41% of Americans currently carry some form of medical or dental debt: 24% have bills that are past due or that they’re unable to pay 21% are paying providers directly over time 17% owe a bank, collection agency, or other lenders 17% have credit card bills 10% owe a friend or family member “The idea that patients are willing and able to access the healthcare they need regardless of cost is not in line with economic realities,” says Alex Harwitz, Experian Health's VP of Product, Digital Front Door. “But patients and providers may be encouraged to know that there are many digital solutions that can improve access to financial information and provide personalized pathways to meeting healthcare costs, so patients don’t have to go without needed care—or end up with medical debt they can’t manage and the massive stress that goes with it. By helping patients deal with the financial aspect of getting care and offering patient-centric payments, providers can also reduce the need for collections and bad debt.” How does a paycheck-to-paycheck reality affect healthcare and how can providers better support their patients? Here are a few things to consider: 1. There may not be enough money to cover unexpected medical expenses. Roughly half of the adults in the KFF study – including three in ten who do not currently have healthcare debt – are at risk of falling into debt. These respondents say they would be unable to pay a $500 unexpected medical bill without borrowing money. Identifying patients who might need additional information or help is one way providers can offer support. Coverage Discovery finds a patient’s available insurance coverage, including billable commercial insurance that may have been unknown or forgotten, and potential Medicare or Medicaid coverage, so both patients and providers get a clearer picture of what insurance will pay. Patient Financial Clearance is an automated solution that determines which patients are most likely to be able to pay prior to service and which patients might benefit from a payment plan or financial assistance. This solution helps healthcare organizations provide empathetic and supportive financial counseling by allowing staff to connect patients to the assistance programs they qualify for, and can even auto-enroll them. Because Patient Financial Clearance provides this information in real-time, providers can begin a conversation about costs and offer help early in the process when patients can benefit most. 2. Healthcare costs are difficult for patients to gauge. While the average consumer may be able to ballpark the cost of a new car or refrigerator, many can’t accurately predict the cost of a medical or dental procedure. Patients may not know what a complex procedure entails, what the charges for each line item might be, and what insurance will or will not cover. Facing the unknown can trigger anxiety, especially when finances are tight. Increasingly, providers are stepping up with pre-treatment estimates that give patients information about what their expected costs will be—even more so as new regulations require providers to share pricing information with patients and provide detailed cost estimates in advance of service. Patient Estimates is a web-based price transparency tool that generates accurate cost estimates patients can review prior to treatment, to help them understand their anticipated costs and begin planning for payment. 3. Patients who don’t think they can afford healthcare costs may avoid getting treatment. Providing accurate cost estimates is a critical first step, but with so many patients living paycheck to paycheck, estimates alone aren’t always enough. A 2022 survey from Experian Health and PYMNTS found that 60% of patients living paycheck to paycheck with issues paying their bills have canceled a healthcare appointment after receiving a high estimate, as have three in four millennials. “Providing patients with accurate cost estimates in advance of treatment is important to helping them understand and manage healthcare costs,” says Harwitz. “But adding digital tools that can help providers and patients explore their options is an equally important next step. Following through with additional support regarding insurance coverage, payment plans, and financial assistance can help ensure that patients don’t forgo needed care due to financial concerns.” PatientSimple is a self-service portal that allows patients to generate cost estimates, pay their balances using a card on file, set up payment plans, view and update insurance information, and apply for charity care. Behind the scenes, PatientSimple uses advanced analytics and Experian data to identify options for each patient, providing personalized support that can ease the patient's financial journey. Self-service digital tools are the key to providing better support for patients. Self-service tools empower patients to manage their healthcare expenses. Patients living paycheck to paycheck appreciate digital tools that help them work through estimates and bills. Digital tools like PatientSimple and Patient Financial Advisor, which provides mobile access to pre-service estimates and payment options, give patients access to financial information where they’re most likely to use it: on a computer or mobile device. “Solutions like PatientSimple and Patient Financial Advisor use data analytics to create personalized options that take a patient’s insurance coverage and financial situation into account,” says Harwitz. “Patients are not only getting a user-friendly interface, but also powerful support to navigate complex healthcare finances.” Financial health is inseparable from patient health. “The financial challenges facing patients living paycheck to paycheck and the providers working to serve them are increasing,” says Harwitz. “Fortunately, digital tools can provide real support for both patients and providers: pre-treatment estimates, digital access to insurance coverage and billing information, and personalized payment recommendations powered by data analytics. Automated processes mean these additional capabilities are available in real-time and don’t place a massive burden on human resources.” Helping patients mind their financial health is good for providers’ bottom lines: It’s key to maintaining revenue and avoiding costly collections and bad debt. Moreover, supporting patients’ financial well-being is an integral part of providing effective healthcare in the current economy. By recognizing financial realities and improving the patient payment experience, providers can help ensure that financial health enables patient health. Learn more about how Experian Health can help healthcare organizations better support their patients and improve the patient experience.