IoMT Is Improving Patient Access: We Must Avoid Creating New Barriers

The Internet of Medical Things (IoMT) is changing the face of healthcare and has the potential to significantly improve patient access as well as system efficiencies. The adoption of telemedicine, for example, spurred on by the Covid-19 pandemic, has spread rapidly.  Forrester revised its forecasts to predict that virtual care visits in the United States will soar to more than one billion this year—including 900 million visits related to Covid-19 specifically. Likewise, in the United Kingdom, 40% of doctor’s appointments now consist of phone or video calls.

Even before the pandemic, the adoption of IoMT was already growing rapidly, with the market valued at US$44.5 billion in 2018 and predicted to reach US$254 billion in 2026. There are more than 500,000 medical devices on the market, helping to diagnose, monitor, and treat patients – and more and more of these can, and are, becoming connected – not to mention innovations yet to enter the market. The connected medical devices segment specifically is expected to exceed $52 billion by 2022.

The COVID-19 Effect

The COVID-19 pandemic has changed the healthcare landscape more than any other single event in recent memory. The urgent and widespread need for care, coupled with the challenge of physical distancing, has accelerated the creation and adoption of new digital technologies as well as new processes to support their adoption and implementation across healthcare. The MedTech industry is emerging as a key apparatus to combat the virus and provide urgent support.

A simple example demonstrating the potential benefits of IoMT can be seen even within a hospital setting, where monitoring COVID-19 patients is costly in terms of time and PPE (personal protective equipment) consumption, since simply walking into a patient’s room becomes a complex process. IoMT technologies enable medical devices to send data to medical practitioners who can monitor a patient’s condition without having to take readings at the bedside. The same technologies can enable patients who do not require hospitalization to be safely monitored while remaining at home or in a community setting. 

From the patients’ perspective, many are embracing virtual healthcare as an alternative to long waits or having to go to a clinic or hospital altogether. And given the growing number and scope of connected medical devices and services, such as remote patient monitoring, therapy, or even diagnosis, there will be even more options in the future.  

Catalyzed by the pandemic, the IoMT genie is fully out of the bottle, and it is unlikely to go back. 

Increasing Access

This is good news for healthcare and good news for patients and families. Patient access is improving as telehealth, supported by connected devices to enable the collection of health-related data remotely, is helping to lift barriers. This increase in accessibility has the potential to improve the convenience, timeliness, and even safety of access to healthcare services for more people in more places. 

IoMT is lifting geographic barriers that have impeded access to healthcare since its very inception. Individuals with transportation or mobility challenges will no longer need to travel to receive routine care if they can be safely monitored while at home. Historically underserved rural or remote communities can gain access to medical specialists without needing to fly or drive great distances, while services can be delivered more cost-effectively. 

Furthermore, with fewer clinic or hospital-based appointments required for routine monitoring of patients who are otherwise doing well, doctors would be able to concentrate their in-person time and clinic resources on those most in need of care. 

The capacity for specialized medicine enabled by IoMT could also have a dramatic impact. The vast quantities of health data becoming available (with the requisite permissions in place), can enable sophisticated AI-driven health applications that can, for example, predict complications before they occur, better understand the health needs of specific populations, or enable stronger patient engagement and self-care. These models can also equip healthcare practitioners with better sources of information, ultimately leading to better patient outcomes.

Navigating Barriers

That said, while technology capabilities expand, innovation must take into consideration the needs of all the stakeholders within healthcare – from patients and caregivers to healthcare practitioners to administrators and payors/funders. Internet access, infrastructure, and comfort with technology, for example, can pose significant barriers for patients and health practitioners alike. 

One approach is to minimize the technological burden facing end-users. Devices should be user friendly and “ready to go” right out of the box, taking into consideration the circumstances and abilities of the potential range of users (patients and practitioners alike). Relying on the patient’s home Wi-Fi to provide connectivity is not ideal from either a usability or security perspective – not to mention availability and affordability. It is better for medical devices to have a cellular connection that can be immediately and securely connected to the network from any location, while also being remotely manageable to avoid burdening the user with network and setup requirements, or apps to download. 

Another barrier is the concern that both patients and healthcare providers have about security and data privacy risks. According to the 2016 edition of Philips’ Future Health Index, privacy/data security is second only to cost in the list of top barriers to the adoption of connected technology in healthcare across the countries surveyed.  

The Cybersecurity and Infrastructure Security Agency, FBI, and U.S. Department of Health and Human Services have warned of cybercrime threats against hospitals and healthcare providers. The WannaCry ransomware attacks affected tens of thousands of NHS medical tools in England and Scotland. The enthusiasm in rolling out new digital health solutions must not overlook security principles or create systems that rely on ad hoc patches.

One way of meeting the stringent security requirements of healthcare is to ensure that connected medical devices have security literally built into their hardware, following the most recent guidelines set out by the GSMA for IoT security, including the GSMA IoT SAFE specifications. In accordance with this globally relevant approach, connected devices have a specially designed SIM that serves as a mini “crypto safe” inside the device to ensure that only authorized communication can occur.

Similarly, new medical devices and software that are difficult to implement or cannot communicate with other systems such as electronic health/medical records risk being “orphaned” in the system or simply not used.  The latter is a matter of both developing the necessary integrations and ensuring the appropriate access and permissions are managed. More easily said than done, fully integrated systems take time, and some of the pieces may be added incrementally – the key is that the potential to do so is there from the beginning so future resources can be invested in enhancements rather than replacements. 

Early Collaboration is Key

Accessibility and usability must be designed right into IoMT solutions from the outset, and the best way of ensuring that is for developers and healthcare stakeholders to have plenty of interaction long before the product enters the market. Stakeholders are many and healthcare systems are complex, so innovators can look to startup accelerators and other thought leaders to help navigate the territory. The time and effort spent by innovators and healthcare stakeholders in collaborating is a sound investment in the future, ensuring that technology is designed and then applied in meaningful and equitable ways to address the most pressing issues. 

The telehealth genie, powered by IoMT, is indeed out of the bottle and is set to revolutionize healthcare. By ensuring that IoMT technologies are developed and implemented with security, accessibility, and ease of use for all stakeholders as priorities, we can make sure that the full benefits of this new dawn can be enjoyed by all. 

Heidi Sveistrup, Ph.D. Bio

As the current CEO of the Bruyère Research Institute and VP, Research and Academic Affairs at Bruyère Continuing Care, Heidi Sveistrup, Ph.D. is focusing on increasing the research and innovation supporting pivotal transitions in care; meaningful, enjoyable and doable ways to support people to live where they choose; and creating opportunities to discover and create new approaches to identify, diagnose, treat and support brain health with individuals with memory loss. Fostering new and supporting existing collaborations among researchers, policymakers, practitioners, civil society and industry continues to be a priority.

Elza Seregelyi Bio

Elza Seregelyi is the Director for the TELUS L-SPARK MedTech Accelerator program, which offers participants pre-commercial access to a secure telehealth platform. L-SPARK is currently working with its first cohort of MedTech companies. Elza has an engineering and entrepreneurship background with extensive experience driving collaborative initiatives.

The future of patient access: digital front door

Experian Health products referenced in this blog post:

Patient Engagement Solutions
Patient Scheduling
Precise ID
Patient Payment Estimates
Patient Payment Solutions

To access more insights and trends, download the entire white paper: 

The State of Patient Access: 2021

How has the pandemic affected consumer attitudes toward patient access? What kind of digital experience do consumers expect from their healthcare provider in 2021? Are patients and providers on the same page when it comes to self-service in the healthcare journey? Providers must answer these questions if they are to improve their digital front door, boost patient loyalty and withstand the financial impact of COVID-19.

While we know that a satisfying patient access experience translates to a stronger revenue cycle, change can feel risky without knowing what consumers really want. Experian Health surveyed hundreds of healthcare consumers and providers to find out what each expects from patient access in 2021, and uncovered opportunities for providers to lay the groundwork for future financial success.

Survey findings: 4 revenue-boosting opportunities for patient access in 2021

1. More control and convenience for consumers

Nearly eight in ten consumer survey respondents want to be able to schedule their own appointments, at any time of day or night, from their home or mobile device. They can already order groceries and view their bank accounts this way – and they want the same level of control and convenience when managing the non-clinical aspects of their healthcare.

Digital patient engagement solutions allow providers to offer consumers the flexibility and accessibility they crave. Patients can schedule appointments online, complete registration from home and pay bills from a mobile device. Convenience also delivers health benefits: no-shows are less likely, and patients find it easier to adhere to care plans. And while COVID-19 remains a concern, self-service options minimize face-to-face contact, keeping staff and patients safe.

Automating patient access even contributes to better collection rates, for example, by reducing errors that can lead to denied claims.

2. But don’t deliver convenience at the expense of safety and security

Patients want convenience, but they also want their data to be kept safe. More than half of consumers surveyed, particularly the younger age groups, say they worry about security when accessing their personal details online.

Security can be challenging for providers: they need multi-layered solutions that can adapt to security threats that evolve with ever-increasing complexity, without creating cumbersome log-in processes for patients. But with the right technology, providers can  safeguard patient data with confidence.

Experian Health’s patient portal security tools use leading-edge identity proofing, risk-based authentication and knowledge-based questions to reliably verify patient identities. Patients can book appointments, register for care or view their health information. Calls to IT support are likely to drop too, saving staff and patients valuable time.

3. Contactless care requirements are driving long term, systemic change

While many of these changes were already simmering in the background, the pandemic has turned up the heat and accelerated the need for contactless care. Will this be a long-term trend? Both patients and providers believe self-service technology is here to stay and seven in ten providers surveyed say they don’t expect patients to feel comfortable in waiting rooms until at least summer 2021. While face-to-face care will always be important, it seems likely that a digital front door will become the default to make the non-clinical portion of the healthcare journey easier and quicker for everyone.

“As providers expand the use of patient portals, there is a huge opportunity to demonstrate the true value of virtual care – and transform healthcare for the long-term.”
– Tom Cox, general manager, head of product, Experian Health

4. The financial conversation between consumers and providers must be based on trust, transparency and empathy

When the final bill bears no resemblance to initial estimates, patients feel frustrated and misled. With deductibles and out-of-pocket expenses on the rise, patients are demanding simple and clear pricing information so they can plan accordingly. Providers that offer consumers transparency, understanding, control and convenience when managing their financial responsibilities are going to have the competitive edge.

Providers can achieve this with clear, upfront and accurate pricing estimates to help patients understand their financial obligations before their visit. Next, support to check coverage and advice on tailored payment plans will provide patients with as many tools as possible as they plan to meet those obligations. Experian Health’s Patient Payment Solutions can check for patient coverage, identify a payment plan(s) that suits a patient’s individual situation, and then make it easy to pay via a mobile device.

Future provider revenue hinges on investment in digital healthcare. A welcoming, convenient and secure digital front door translates to patient loyalty, which in turn can mitigate losses in challenging times. Wherever are in digital patient access journey, there’s an opportunity to improve the experience for patients and build a revenue cycle that not only survives the tumult of the pandemic, but also thrives in the years ahead.

Learn more.

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Nuance Launches AI-Powered Patient Engagement Virtual Assistant Platform

Nuance Launches AI-Powered Patient Engagement Virtual Assistant Platform

What You Should Know:

– Nuance Communications, Inc. launched an AI-powered
patient engagement virtual assistant platform to transform omnichannel digital
experiences for patients.

Healthcare provider organizations can now deploy
a single, common cloud-based platform to support their entire patient journey
across engagement channels using Nuance’s market-leading Intelligent Engagement
AI technology

– The launch comes as patients increasingly expect the
same level of engaging experiences from healthcare organizations that they have
with consumer brands.

Communications, Inc.,
today launched an AI-powered patient
engagement virtual assistant platform
to transform voice and digital
experiences across the patient journey. The platform combines Nuance’s decades
of healthcare expertise and its award-winning AI technology trusted by consumer
brands like H&M, Rakuten and Best Buy. It works by integrating and
extending Nuance’s EHR, CRM and Patient Access Center systems to enable
healthcare provider organizations to modernize their “digital front door” and
improve clinical care experiences.

Holistic Approach to Healthcare’s New Digital Front Door

Patients are demanding the same conveniences from healthcare
organizations that they enjoy from major consumer brands. A recent survey reveals that consumers are ready for
digital changes such as telemedicine options (44%), digital forms and
communication (41%), and touchless check-in (37%). What’s more, 68% value a
customized patient experience. In fact, a poor digital health experience caused
more than a quarter of patients to change medical providers in 2020 — up 40
percent from 2019.

“Our new omnichannel Patient Engagement Virtual
Assistant Platform takes a holistic approach to powering healthcare’s new
digital front door, overcoming the shortcomings and inconsistencies of partial
point solutions,” said Peter Durlach, Senior Vice President, Strategy
and New Business Development, Nuance. “By marrying the capabilities of our
healthcare experience and the proven omnichannel customer engagement technology
trusted by Fortune 100 companies worldwide, we can help address the
urgent need of providers and patients alike to transform access to, and
delivery of, care in the modern age of digital medicine.”

Success at a glance: finding unidentified coverage

It is estimated that 30-50% of denied claims occur on the front end during the patient access process, namely during registration, authorization and eligibility. Unfortunately, manual patient intake processes contribute to these denials, and ultimately, the bottom line, staff productivity and the patient experience take the hit.

Banner Health chose to automate its patient access processes with eCare NEXT from Experian Health. The solution, which integrates directly with Banner Health’s acute and ambulatory electronic health records (EHRs), automates the organization’s preregistration workflow, including medical necessity and financial clearance. This improves registration accuracy, provides more accurate patient estimates and reduces the number of denials on the front end.

Banner Health has benefited by incorporating a mix of Experian Health products that integrate directly and collaborate with other technologies and workflows already in place:

  • Decrease in eligibility errors. With eCare NEXT, initial denials due to eligibility errors have been reduced by $30M in the first quarter alone since going live with Experian Health.
  • Significant cost savings. With more accurate estimates, Banner Health has seen significant cost savings on the front end from more efficient coverage discovery. The system is consistently finding 30+% unique or new coverage in the patient access workflow.
  • Improved staff engagement and satisfaction. Automation has greatly reduced manual inputs, enabling staff to focus more on the patient rather than systems and logins required for patient intake.

Our partnership with Experian Health helps Banner Health’s revenue cycle team deliver on its mission of “getting it right, at the right time, every time.” 
— Becky Peters, Executive Director of Patient Access Services, Banner Health

Want to learn more about Banner Health’s success in finding unidentified coverage earlier in the revenue cycle? Sign up for the January 21 webinar below, where attendees will gain insight into the organization’s proven workflow and processes.

Register here.

The post Success at a glance: finding unidentified coverage appeared first on Healthcare Blog.

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Teladoc Health and Livongo Merge

2020’s Top 20 Digital Health M&A Deals Totaled $50B

The combination of Teladoc Health and Livongo creates a
global leader in consumer-centered virtual care. The combined company is
positioned to execute quantified opportunities to drive revenue synergies of
$100 million by the end of the second year following the close, reaching $500
million on a run-rate basis by 2025.

Price: $18.5B in value based on each share of Livongo
will be exchanged for 0.5920x shares of Teladoc Health plus cash consideration
of $11.33 for each Livongo share.

Siemens Healthineers Acquires Varian Medical

2020’s Top 20 Digital Health M&A Deals Totaled $50B

On August 2nd, Siemens Healthineers acquired
Varian Medical for $16.4B, with the deal expected to close in 2021. Varian is a
global specialist in the field of cancer care, providing solutions especially
in radiation oncology and related software, including technologies such as
artificial intelligence, machine learning and data analysis. In fiscal year 2019,
the company generated $3.2 billion in revenues with an adjusted operating
margin of about 17%. The company currently has about 10,000 employees

Price: $16.4 billion in an all-cash transaction.

Gainwell to Acquire HMS for $3.4B in Cash

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Veritas Capital (“Veritas”)-backed Gainwell Technologies (“Gainwell”),
a leading provider of solutions that are vital to the administration and
operations of health and human services programs, today announced that they
have entered into a definitive agreement whereby Gainwell will acquire HMS, a technology, analytics and engagement
solutions provider helping organizations reduce costs and improve health

Price: $3.4 billion in cash.

Philips Acquires Remote Cardiac Monitoring BioTelemetry for $2.8B

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Philips acquires BioTelemetry, a U.S. provider of remote
cardiac diagnostics and monitoring for $72.00 per share for an implied
enterprise value of $2.8 billion (approx. EUR 2.3 billion). With $439M in
revenue in 2019, BioTelemetry annually monitors over 1 million cardiac patients
remotely; its portfolio includes wearable heart monitors, AI-based data
analytics, and services.

Price: $2.8B ($72 per share), to be paid in cash upon

Hims & Hers Merges with Oaktree Acquisition Corp to Go Public on NYSE

Telehealth company Hims & Hers and Oaktree Acquisition Corp., a special purpose acquisition company (SPAC) merge to go public on the New York Stock Exchange (NYSE) under the symbol “HIMS.” The merger will enable further investment in growth and new product categories that will accelerate Hims & Hers’ plan to become the digital front door to the healthcare system

Price: The business combination values the combined
company at an enterprise value of approximately $1.6 billion and is expected to
deliver up to $280 million of cash to the combined company through the
contribution of up to $205 million of cash.

SPAC Merges with 2 Telehealth Companies to Form Public
Digital Health Company in $1.35B Deal

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Blank check acquisition company GigCapital2 agreed to merge with Cloudbreak Health, LLC, a unified telemedicine and video medical interpretation solutions provider, and UpHealth Holdings, Inc., one of the largest national and international digital healthcare providers to form a combined digital health company. 

Price: The merger deal is worth $1.35 billion, including

WellSky Acquires CarePort Health from Allscripts for

2020’s Top 20 Digital Health M&A Deals Totaled $50B

WellSky, global health, and community care technology company, announced today that it has entered into a definitive agreement with Allscripts to acquire CarePort Health (“CarePort”), a Boston, MA-based care coordination software company that connects acute and post-acute providers and payers.

Price: $1.35 billion represents a multiple of greater
than 13 times CarePort’s revenue over the trailing 12 months, and approximately
21 times CarePort’s non-GAAP Adjusted EBITDA over the trailing 12 months.

Waystar Acquires Medicare RCM Company eSolutions

2020’s Top 20 Digital Health M&A Deals Totaled $50B

On September 13th, revenue cycle management
provider Waystar acquires eSolutions, a provider of Medicare and Multi-Payer revenue
cycle management, workflow automation, and data analytics tools. The
acquisition creates the first unified healthcare payments platform with both
commercial and government payer connectivity, resulting in greater value for

Price: $1.3 billion valuation

Radiology Partners Acquires MEDNAX Radiology Solutions

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Radiology Partners (RP), a radiology practice in the U.S., announced a definitive agreement to acquire MEDNAX Radiology Solutions, a division of MEDNAX, Inc. for an enterprise value of approximately $885 million. The acquisition is expected to add more than 800 radiologists to RP’s existing practice of 1,600 radiologists. MEDNAX Radiology Solutions consists of more than 300 onsite radiologists, who primarily serve patients in Connecticut, Florida, Nevada, Tennessee, and Texas, and more than 500 teleradiologists, who serve patients in all 50 states.

Price: $885M

PointClickCare Acquires Collective Medical

2020’s Top 20 Digital Health M&A Deals Totaled $50B

PointClickCare Technologies, a leader in senior care technology with a network of more than 21,000 skilled nursing facilities, senior living communities, and home health agencies, today announced its intent to acquire Collective Medical, a Salt Lake City, a UT-based leading network-enabled platform for real-time cross-continuum care coordination for $650M. Together, PointClickCare and Collective Medical will provide diverse care teams across the continuum of acute, ambulatory, and post-acute care with point-of-care access to deep, real-time patient insights at any stage of a patient’s healthcare journey, enabling better decision making and improved clinical outcomes at a lower cost.

Price: $650M

Teladoc Health Acquires Virtual Care Platform InTouch

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Teladoc Health acquires InTouch Health, the leading provider of enterprise telehealth solutions for hospitals and health systems for $600M. The acquisition establishes Teladoc Health as the only virtual care provider covering the full range of acuity – from critical to chronic to everyday care – through a single solution across all sites of care including home, pharmacy, retail, physician office, ambulance, and more.

Price: $600M consisting of approximately $150 million
in cash and $450 million of Teladoc Health common stock.

AMN Healthcare Acquires VRI Provider Stratus Video

2020’s Top 20 Digital Health M&A Deals Totaled $50B

AMN Healthcare Services, Inc. acquires Stratus Video, a leading provider of video remote language interpretation services for the healthcare industry. The acquisition will help AMN Healthcare expand in the virtual workforce, patient care arena, and quality medical interpretation services delivered through a secure communications platform.

Price: $475M

CarepathRx Acquires Pharmacy Operations of Chartwell from

2020’s Top 20 Digital Health M&A Deals Totaled $50B

CarepathRx, a leader in pharmacy and medication management
solutions for vulnerable and chronically ill patients, announced today a
partnership with UPMC’s Chartwell subsidiary that will expand patient access to
innovative specialty pharmacy and home infusion services. Under the $400M
landmark agreement, CarepathRx will acquire the
management services organization responsible for the operational and strategic
management of Chartwell while UPMC becomes a strategic investor in CarepathRx. 

Price: $400M

Cerner to Acquire Health Division of Kantar for $375M in

Cerner announces it will acquire Kantar Health, a leading
data, analytics, and real-world evidence and commercial research consultancy
serving the life science and health care industry.

This acquisition is expected to allow Cerner’s Learning
Health Network client consortium and health systems with more opportunities to
directly engage with life sciences for funded research studies. The acquisition
is expected to close during the first half of 2021.

Price: $375M

Cerner Sells Off Parts of Healthcare IT Business in
Germany and Spain

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Cerner sells off parts of healthcare IT business in Germany and Spain to Germany company CompuGroup Medical, reflecting the company-wide transformation focused on improved operating efficiencies, enhanced client focus, a refined growth strategy, and a sharpened approach to portfolio management.

Price: EUR 225 million ($247.5M USD)

CompuGroup Medical Acquires eMDs for $240M

2020’s Top 20 Digital Health M&A Deals Totaled $50B

CompuGroup Medical (CGM) acquires eMDs, Inc. (eMDs), a
leading provider of healthcare IT with a focus on doctors’ practices in the US,
reaching an attractive size in the biggest healthcare market worldwide. With
this acquisition, the US subsidiary of CGM significantly broadens its position
and will become the top 4 providers in the market for Ambulatory Information
Systems in the US.

Price: $240M (equal to approx. EUR 203 million)

Change Healthcare Buys Back Pharmacy Network

2020’s Top 20 Digital Health M&A Deals Totaled $50B

 pharmacy unit eRx Network
 a leading provider of comprehensive, innovative, and secure
data-driven solutions for pharmacies. eRx generated approximately $67M in
annual revenue for the twelve-month period ended February 29, 2020. The
transaction supports Change Healthcare’s commitment to focus on and invest in
core aspects of the business to fuel long-term growth and advance innovation.

Price: $212.9M plus cash on the balance sheet.

Walmart Acquires Medication Management Platform CareZone

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Walmart acquires CareZone, a San Francisco, CA-based smartphone
service for managing chronic health conditions for reportedly $200M. By
working with a network of pharmacy partners, CareZone’s concierge services
assist consumers in getting their prescription medications organized and
delivered to their doorstep, making pharmacies more accessible to individuals
and families who may be homebound or reside in rural locations.

Price: $200M

Verisk Acquires MSP Compliance Provider Franco Signor

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Verisk, a data
analytics provider, announced today that it has acquired Franco Signor, a Medicare Secondary Payer
(MSP) service provider to America’s largest insurance carriers and employers.
As part of the acquisition, Franco Signor will become part of Verisk’s Claims
Partners business, a leading provider of MSP compliance and other analytic
claim services. Claims Partners and Franco Signor will be combining forces to
provide the single best resource for Medicare compliance. 

Price: $160M

Rubicon Technology Partners Acquires Central Logic

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Private equity firm Rubicon Technology Partners acquires
Central Logic, a provider of patient orchestration and tools to accelerate
access to care for healthcare organizations. Rubicon will be aggressively driving Central Logic’s
growth with additional cash investments into the business, with a focus
on product innovation, sales expansion, delivery and customer support, and
the pursuit of acquisition opportunities.

Price: $110M – $125 million, according to sources

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

As we close out the year, we asked several healthcare executives to share their predictions and trends for 2021.

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Kimberly Powell, Vice President & General Manager, NVIDIA Healthcare

Federated Learning: The clinical community will increase their use of federated learning approaches to build robust AI models across various institutions, geographies, patient demographics, and medical scanners. The sensitivity and selectivity of these models are outperforming AI models built at a single institution, even when there is copious data to train with. As an added bonus, researchers can collaborate on AI model creation without sharing confidential patient information. Federated learning is also beneficial for building AI models for areas where data is scarce, such as for pediatrics and rare diseases.

AI-Driven Drug Discovery: The COVID-19 pandemic has put a spotlight on drug discovery, which encompasses microscopic viewing of molecules and proteins, sorting through millions of chemical structures, in-silico methods for screening, protein-ligand interactions, genomic analysis, and assimilating data from structured and unstructured sources. Drug development typically takes over 10 years, however, in the wake of COVID, pharmaceutical companies, biotechs, and researchers realize that acceleration of traditional methods is paramount. Newly created AI-powered discovery labs with GPU-accelerated instruments and AI models will expedite time to insight — creating a computing time machine.

Smart Hospitals: The need for smart hospitals has never been more urgent. Similar to the experience at home, smart speakers and smart cameras help automate and inform activities. The technology, when used in hospitals, will help scale the work of nurses on the front lines, increase operational efficiency, and provide virtual patient monitoring to predict and prevent adverse patient events. 

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Omri Shor, CEO of Medisafe

Healthcare policy: Expect to see more moves on prescription drug prices, either through a collaborative effort among pharma groups or through importation efforts. Pre-existing conditions will still be covered for the 135 million Americans with pre-existing conditions.

The Biden administration has made this a central element of this platform, so coverage will remain for those covered under ACA. Look for expansion or revisions of the current ACA to be proposed, but stalled in Congress, so existing law will remain largely unchanged. Early feedback indicates the Supreme Court is unlikely to strike down the law entirely, providing relief to many during a pandemic.

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Brent D. Lang, Chairman & Chief Executive Officer, Vocera Communications

The safety and well-being of healthcare workers will be a top priority in 2021. While there are promising headlines about coronavirus vaccines, we can be sure that nurses, doctors, and other care team members will still be on the frontlines fighting COVID-19 for many more months. We must focus on protecting and connecting these essential workers now and beyond the pandemic.

Modernized PPE Standards
Clinicians should not risk contamination to communicate with colleagues. Yet, this simple act can be risky without the right tools. To minimize exposure to infectious diseases, more hospitals will rethink personal protective equipment (PPE) and modernize standards to include hands-free communication technology. In addition to protecting people, hands-free communication can save valuable time and resources. Every time a nurse must leave an isolation room to answer a call, ask a question, or get supplies, he or she must remove PPE and don a fresh set to re-enter. With voice-controlled devices worn under PPE, the nurse can communicate without disrupting care or leaving the patient’s bedside.

Improved Capacity

Voice-controlled solutions can also help new or reassigned care team members who are unfamiliar with personnel, processes, or the location of supplies. Instead of worrying about knowing names or numbers, they can use simple voice commands to connect to the right person, group, or information quickly and safely. In addition to simplifying clinical workflows, an intelligent communication system can streamline operational efficiencies, improve triage and throughput, and increase capacity, which is all essential to hospitals seeking ways to recover from 2020 losses and accelerate growth.

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Michael Byczkowski, Global Vice President, Head of Healthcare Industry at SAP,

New, targeted healthcare networks will collaborate and innovate to improve patient outcomes.

We will see many more touchpoints between different entities ranging from healthcare providers and life sciences companies to technology providers and other suppliers, fostering a sense of community within the healthcare industry. More organizations will collaborate based on existing data assets, perform analysis jointly, and begin adding innovative, data-driven software enhancements. With these networks positively influencing the efficacy of treatments while automatically managing adherence to local laws and regulations regarding data use and privacy, they are paving the way for software-defined healthcare.

Smart hospitals will create actionable insights for the entire organization out of existing data and information.

Medical records as well as operational data within a hospital will continue to be digitized and will be combined with experience data, third-party information, and data from non-traditional sources such as wearables and other Internet of Things devices. Hospitals that have embraced digital are leveraging their data to automate tasks and processes as well as enable decision support for their medical and administrative staff. In the near future, hospitals could add intelligence into their enterprise environments so they can use data to improve internal operations and reduce overhead.

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Curt Medeiros, President and Chief Operating Officer of Ontrak

As health care costs continue to rise dramatically given the pandemic and its projected aftermath, I see a growing and critical sophistication in healthcare analytics taking root more broadly than ever before. Effective value-based care and network management depend on the ability of health plans and providers to understand what works, why, and where best to allocate resources to improve outcomes and lower costs. Tied to the need for better analytics, I see a tipping point approaching for finally achieving better data security and interoperability. Without the ability to securely share data, our industry is trying to solve the world’s health challenges with one hand tied behind our backs.

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

G. Cameron Deemer, President, DrFirst

Like many business issues, the question of whether to use single-vendor solutions or a best-of-breed approach swings back and forth in the healthcare space over time. Looking forward, the pace of technology change is likely to swing the pendulum to a new model: systems that are supplemental to the existing core platform. As healthcare IT matures, it’s often not a question of ‘can my vendor provide this?’ but ‘can my vendor provide this in the way I need it to maximize my business processes and revenues?

This will be more clear with an example: An EHR may provide a medication history function, for instance, but does it include every source of medication history available? Does it provide a medication history that is easily understood and acted upon by the provider? Does it provide a medication history that works properly with all downstream functions in the EHR? When a provider first experiences medication history during a patient encounter, it seems like magic.

After a short time, the magic fades to irritation as the incompleteness of the solution becomes more obvious. Much of the newer healthcare technologies suffer this same incompleteness. Supplementing the underlying system’s capabilities with a strongly integrated third-party system is increasingly going to be the strategy of choice for providers.

Angie Franks, CEO of Central Logic

In 2021, we will see more health systems moving towards the goal of truly operating as one system of care. The pandemic has demonstrated in the starkest terms how crucial it is for health systems to have real-time visibility into available beds, providers, transport, and scarce resources such as ventilators and drugs, so patients with COVID-19 can receive the critical care they need without delay. The importance of fully aligning as a single integrated system that seamlessly shares data and resources with a centralized, real-time view of operations is a lesson that will resonate with many health systems.

Expect in 2021 for health systems to enhance their ability to orchestrate and navigate patient transitions across their facilities and through the continuum of care, including post-acute care. Ultimately, this efficient care access across all phases of care will help healthcare organizations regain revenue lost during the historic drop in elective care in 2020 due to COVID-19.

In addition to elevating revenue capture, improving system-wide orchestration and navigation will increase health systems’ bed availability and access for incoming patients, create more time for clinicians to operate at the top of their license, and reduce system leakage. This focus on creating an ‘operating as one’ mindset will not only help health systems recover from 2020 losses, it will foster sustainable and long-term growth in 2021 and well into the future.

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

John Danaher, MD, President, Global Clinical Solutions, Elsevier

COVID-19 has brought renewed attention to healthcare inequities in the U.S., with the disproportionate impact on people of color and minority populations. It’s no secret that there are indicative factors, such as socioeconomic level, education and literacy levels, and physical environments, that influence a patient’s health status. Understanding these social determinants of health (SDOH) better and unlocking this data on a wider scale is critical to the future of medicine as it allows us to connect vulnerable populations with interventions and services that can help improve treatment decisions and health outcomes. In 2021, I expect the health informatics industry to take a larger interest in developing technologies that provide these kinds of in-depth population health insights.

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Jay Desai, CEO and co-founder of PatientPing

2021 will see an acceleration of care coordination across the continuum fueled by the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access rule’s e-notifications Condition of Participation (CoP), which goes into effect on May 1, 2021. The CoP requires all hospitals, psych hospitals, and critical access hospitals that have a certified electronic medical record system to provide notification of admit, discharge, and transfer, at both the emergency room and the inpatient setting, to the patient’s care team. Due to silos, both inside and outside of a provider’s organization, providers miss opportunities to best treat their patients simply due to lack of information on patients and their care events.

This especially impacts the most vulnerable patients, those that suffer from chronic conditions, comorbidities or mental illness, or patients with health disparities due to economic disadvantage or racial inequity. COVID-19 exacerbated the impact on these vulnerable populations. To solve for this, healthcare providers and organizations will continue to assess their care coordination strategies and expand their patient data interoperability initiatives in 2021, including becoming compliant with the e-notifications Condition of Participation.

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Kuldeep Singh Rajput, CEO and founder of Biofourmis

Driven by CMS’ Acute Hospital at Home program announced in November 2020, we will begin to see more health systems delivering hospital-level care in the comfort of the patient’s home–supported by technologies such as clinical-grade wearables, remote patient monitoring, and artificial intelligence-based predictive analytics and machine learning.

A randomized controlled trial by Brigham Health published in Annals of Internal Medicine earlier this year demonstrated that when compared with usual hospital care, Home Hospital programs can reduce rehospitalizations by 70% while decreasing costs by nearly 40%. Other advantages of home hospital programs include a reduction in hospital-based staffing needs, increased capacity for those patients who do need inpatient care, decreased exposure to COVID-19 and other viruses such as influenza for patients and healthcare professionals, and improved patient and family member experience.

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Jake Pyles, CEO, CipherHealth

The disappearance of the hospital monopoly will give rise to a new loyalty push

Healthcare consumerism was on the rise ahead of the pandemic, but the explosion of telehealth in 2020 has effectively eliminated the geographical constraints that moored patient populations to their local hospitals and providers. The fallout has come in the form of widespread network leakage and lost revenue. By October, in fact, revenue for hospitals in the U.S. was down 9.2% year-over-year. Able to select providers from the comfort of home and with an ever-increasing amount of personal health data at their convenience through the growing use of consumer-grade wearable devices, patients are more incentivized in 2021 to choose the provider that works for them.

After the pandemic fades, we’ll see some retrenchment from telehealth, but it will remain a mainstream care delivery model for large swaths of the population. In fact, post-pandemic, we believe telehealth will standardize and constitute a full 30% to 40% of interactions.

That means that to compete, as well as to begin to recover lost revenue, hospitals need to go beyond offering the same virtual health convenience as their competitors – Livango and Teladoc should have been a shot across the bow for every health system in 2020. Moreover, hospitals need to become marketing organizations. Like any for-profit brand, hospitals need to devote significant resources to building loyalty but have traditionally eschewed many of the cutting-edge marketing techniques used in other industries. Engagement and personalization at every step of the patient journey will be core to those efforts.

Marc Probst, former Intermountain Health System CIO, Advisor for SR Health by Solutionreach

Healthcare will fix what it’s lacking most–communication.

Because every patient and their health is unique, when it comes to patient care, decisions need to be customized to their specific situation and environment, yet done in a timely fashion. In my two decades at one of the most innovative health systems in the U.S., communication, both across teams and with patients continuously has been less than optimal. I believe we will finally address both the interpersonal and interface communication issues that organizations have faced since the digitization of healthcare.”

Rich Miller, Chief Strategy Officer, Qgenda

2021 – The year of reforming healthcare: We’ve been looking at ways to ease healthcare burdens for patients for so long that we haven’t realized the onus we’ve put on providers in doing so. Adding to that burden, in 2020 we had to throw out all of our playbooks and become masters of being reactive. Now, it’s time to think through the lessons learned and think through how to be proactive. I believe provider-based data will allow us to reformulate our priorities and processes. By analyzing providers’ biggest pain points in real-time, we can evaporate the workflow and financial troubles that have been bothering organizations while also relieving providers of their biggest problems.”

Robert Hanscom, JD, Vice President of Risk Management and Analytics at Coverys

Data Becomes the Fix, Not the Headache for Healthcare

The past 10 years have been challenging for an already overextended healthcare workforce. Rising litigation costs, higher severity claims, and more stringent reimbursement mandates put pressure on the bottom line. Continued crises in combination with less-than-optimal interoperability and design of health information systems, physician burnout, and loss of patient trust, have put front-line clinicians and staff under tremendous pressure.

Looking to the future, it is critical to engage beyond the day to day to rise above the persistent risks that challenge safe, high-quality care on the frontline. The good news is healthcare leaders can take advantage of tools that are available to generate, package, and learn from data – and use them to motivate action.

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Steve Betts, Chief of Operations and Products at Gray Matter Analytics

Analytics Divide Intensifies: Just like the digital divide is widening in society, the analytics divide will continue to intensify in healthcare. The role of data in healthcare has shifted rapidly, as the industry has wrestled with an unsustainable rate of increasing healthcare costs. The transition to value-based care means that it is now table stakes to effectively manage clinical quality measures, patient/member experience measures, provider performance measures, and much more. In 2021, as the volume of data increases and the intelligence of the models improves, the gap between the haves and have nots will significantly widen at an ever-increasing rate.

Substantial Investment in Predictive Solutions: The large health systems and payors will continue to invest tens of millions of dollars in 2021. This will go toward building predictive models to infuse intelligent “next best actions” into their workflows that will help them grow and manage the health of their patient/member populations more effectively than the small and mid-market players.

Jennifer Price, Executive Director of Data & Analytics at THREAD

The Rise of Home-based and Decentralized Clinical Trial Participation

In 2020, we saw a significant rise in home-based activities such as online shopping, virtual school classes and working from home. Out of necessity to continue important clinical research, home health services and decentralized technologies also moved into the home. In 2021, we expect to see this trend continue to accelerate, with participants receiving clinical trial treatments at home, home health care providers administering procedures and tests from the participant’s home, and telehealth virtual visits as a key approach for sites and participants to communicate. Hybrid decentralized studies that include a mix of on-site visits, home health appointments and telehealth virtual visits will become a standard option for a range of clinical trials across therapeutic areas. Technological advances and increased regulatory support will continue to enable the industry to move out of the clinic and into the home.

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Doug Duskin, President of the Technology Division at Equality Health

Value-based care has been a watchword of the healthcare industry for many years now, but advancement into more sophisticated VBC models has been slower than anticipated. As we enter 2021, providers – particularly those in fee-for-service models who have struggled financially due to COVID-19 – and payers will accelerate this shift away from fee-for-service medicine and turn to technology that can facilitate and ease the transition to more risk-bearing contracts. Value-based care, which has proven to be a more stable and sustainable model throughout the pandemic, will seem much more appealing to providers that were once reluctant to enter into risk-bearing contracts. They will no longer be wondering if they should consider value-based contracting, but how best to engage.

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Brian Robertson, CEO of VisiQuate

Continued digitization and integration of information assets: In 2021, this will lead to better performance outcomes and clearer, more measurable examples of “return on data, analytics, and automation.

Digitizing healthcare’s complex clinical, financial, and operational information assets: I believe that providers who are further in the digital transformation journey will make better use of their interconnected assets, and put the healthcare consumer in the center of that highly integrated universe. Healthcare consumer data will be studied, better analyzed, and better predicted to drive improved performance outcomes that benefit the patient both clinically and financially.

Some providers will have leapfrog moments: These transformations will be so significant that consumers will easily recognize that they are receiving higher value. Lower acuity telemedicine and other virtual care settings are great examples that lead to improved patient engagement, experience and satisfaction. Device connectedness and IoT will continue to mature, and better enable chronic disease management, wellness, and other healthy lifestyle habits for consumers.

Kermit S. Randa, CEO of Syntellis Performance Solutions

Healthcare CEOs and CFOs will partner closely with their CIOs on data governance and data distribution planning. With the massive impact of COVID-19 still very much in play in 2021, healthcare executives will need to make frequent data-driven – and often ad-hoc — decisions from more enterprise data streams than ever before. Syntellis research shows that healthcare executives are already laser-focused on cost reduction and optimization, with decreased attention to capital planning and strategic growth. In 2021, there will be a strong trend in healthcare organizations toward new initiatives, including clinical and quality analytics, operational budgeting, and reporting and analysis for decision support.

Dr. Calum Yacoubian, Associate Director of Healthcare Product & Strategy at Linguamatics

As payers and providers look to recover from the damage done by the pandemic, the ability to deliver value from data assets they already own will be key. The pandemic has displayed the siloed nature of healthcare data, and the difficulty in extracting vital information, particularly from unstructured data, that exists. Therefore, technologies and solutions that can normalize these data to deliver deeper and faster insights will be key to driving economic recovery. Adopting technologies such as natural language processing (NLP) will not only offer better population health management, ensuring the patients most in need are identified and triaged but will open new avenues to advance innovations in treatments and improve operational efficiencies.

Prior to the pandemic, there was already an increasing level of focus on the use of real-world data (RWD) to advance the discovery and development of new therapies and understand the efficacy of existing therapies. The disruption caused by COVID-19 has sharpened the focus on RWD as pharma looks to mitigate the effect of the virus on conventional trial recruitment and data collection. One such example of this is the use of secondary data collection from providers to build real-world cohorts which can serve as external comparator arms.

This convergence on seeking value from existing RWD potentially affords healthcare providers a powerful opportunity to engage in more clinical research and accelerate the work to develop life-saving therapies. By mobilizing the vast amount of data, they will offer pharmaceutical companies a mechanism to positively address some of the disruption caused by COVID-19. This movement is one strategy that is key to driving provider recovery in 2021.

Rose Higgins, Chief Executive Officer of HealthMyne

Precision imaging analytics technology, called radiomics, will increasingly be adopted and incorporated into drug development strategies and clinical trials management. These AI-powered analytics will enable drug developers to gain deeper insights from medical images than previously capable, driving accelerated therapy development, greater personalization of treatment, and the discovery of new biomarkers that will enhance clinical decision-making and treatment.

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Dharmesh Godha, President and CTO of Advaiya

Greater adoption and creative implementation of remote healthcare will be the biggest trend for the year 2021, along with the continuous adoption of cloud-enabled digital technologies for increased workloads. Remote healthcare is a very open field. The possibilities to innovate in this area are huge. This is the time where we can see the beginning of the convergence of personal health aware IoT devices (smartwatches/ temp sensors/ BP monitors/etc.) with the advanced capabilities of the healthcare technologies available with the monitoring and intervention capabilities for the providers.

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Simon Wu, Investment Director, Cathay Innovation

Healthcare Data Proves its Weight in Gold in 2021

Real-world evidence or routinely stored data from hospitals and claims, being leveraged by healthcare providers and biopharma companies along with those that can improve access to data will grow exponentially in the coming year. There are many trying to build in-house, but similar to autonomous technology, there will be a separate set of companies emerge in 2021 to provide regulated infrastructure and have their “AWS” moment.

Kyle Raffaniello, CEO of Sapphire Digital

2021 is a clear year for healthcare price transparency

Over the past year, healthcare price transparency has been a key topic for the Trump administration in an effort to lower healthcare costs for Americans. In recent months, COVID-19 has made the topic more important to patients than ever before. Starting in January, we can expect the incoming Biden administration to not only support the existing federal transparency regulations but also continue to push for more transparency and innovation within Medicare. I anticipate that healthcare price transparency will continue its momentum in 2021 as one of two Price Transparency rules takes effect and the Biden administration supports this movement.

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Dennis McLaughlin VP of Omni Operations + Product at ibi

Social Determinants of Health Goes Mainstream: Understanding more about the patient and their personal environment has a hot topic the past two years. Providers and payers’ ability to inject this knowledge and insight into the clinical process has been limited. 2021 is the year it gets real. It’s not just about calling an uber anymore. The organizations that broadly factor SDOH into the servicing model especially with virtualized medicine expanding broadly will be able to more effectively reach vulnerable patients and maximize the effectiveness of care.

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Joe Partlow, CTO at ReliaQuest

The biggest threat to personal privacy will be healthcare information: Researchers are rushing to pool resources and data sets to tackle the pandemic, but this new era of openness comes with concerns around privacy, ownership, and ethics. Now, you will be asked to share your medical status and contact information, not just with your doctors, but everywhere you go, from workplaces to gyms to restaurants. Your personal health information is being put in the hands of businesses that may not know how to safeguard it. In 2021, cybercriminals will capitalize on rapid U.S. telehealth adoption. Sharing this information will have major privacy implications that span beyond keeping medical data safe from cybercriminals to wider ethics issues and insurance implications.

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Jimmy Nguyen, Founding President at Bitcoin Association

Blockchain solutions in the healthcare space will bring about massive improvements in two primary ways in 2021.

Firstly, blockchain applications will for the first time facilitate patients owning, managing, and even monetizing their personal health data. Today’s healthcare information systems are incredibly fragmented, with patient data from different sources – be they physicians, pharmacies, labs, or otherwise – kept in different silos, eliminating the ability to generate a holistic view of patient information and restricting healthcare providers from producing the best health outcomes.

Healthcare organizations are growing increasingly aware of the ways in which blockchain technology can be used to eliminate data silos, enable real-time access to patient information, and return control to patients for the use of their personal data – all in a highly-secure digital environment. 2021 will be the year that patient data goes blockchain.

Secondly, blockchain solutions can ensure more honesty and transparency in the development of pharmaceutical products. Clinical research data is often subject to questions of integrity or ‘hygiene’ if data is not properly recorded, or worse, is deliberately fabricated. Blockchain technology enables easy, auditable tracking of datasets generated by clinical researchers, benefitting government agencies tasked with approving drugs while producing better health outcomes for healthcare providers and patients. In 2021, I expect to see a rise in the use and uptake of applications that use public blockchain systems to incentivize greater honesty in clinical research.

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Alex Lazarow, Investment Director, Cathay Innovation

The Future of US Healthcare is Transparent, Fair, Open and Consumer-Driven

In the last year, the pandemic put a spotlight on the major gaps in healthcare in the US, highlighting a broken system that is one of the most expensive and least distributed in the world. While we’ve already seen many boutique healthcare companies emerge to address issues around personalization, quality and convenience, the next few years will be focused on giving the power back to consumers, specifically with the rise of insurtechs, in fixing the transparency, affordability, and incentive issues that have plagued the private-based US healthcare system until now.

Lisa Romano, RN, Chief Nursing Officer, CipherHealth

Hospitals will need to counter the staff wellness fallout

The pandemic has placed unthinkable stress on frontline healthcare workers. Since it began, they’ve been working under conditions that are fundamentally more dangerous, with fewer resources, and in many cases under the heavy emotional burden of seeing several patients lose their battle with COVID-19. The fallout from that is already beginning – doctors and nurses are leaving the profession, or getting sick, or battling mental health struggles. Nursing programs are struggling to fill classes. As a new wave of the pandemic rolls across the country, that fallout will only increase. If they haven’t already, hospitals in 2021 will place new premiums upon staff wellness and staff health, tapping into the same type of outreach and purposeful rounding solutions they use to round on patients.

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Kris Fitzgerald, CTO, NTT DATA Services

Quality metrics for health plans – like data that measures performance – was turned on its head in 2020 due to delayed procedures. In the coming year, we will see a lot of plans interpret these delayed procedures flexibly so they honor their plans without impacting providers. However, for so long, the payer’s use of data and the provider’s use of data has been disconnected. Moving forward the need for providers to have a more specific understanding of what drives the value and if the cost is reasonable for care from the payer perspective is paramount. Data will ensure that this collaboration will be enhanced and the concept of bundle payments and aligning incentives will be improved. As the data captured becomes even richer, it will help people plan and manage their care better. The addition of artificial intelligence (AI) to this data will also play a huge role in both dialog and negotiation when it comes to cost structure. This movement will lead to a spike in value-based care adoption

M&A: Kyruus Acquires HealthSparq from Cambia Health Solutions

M&A: Kyruus Acquires HealthSparq from Cambia Health Solutions

What You Should Know:

– Kyruus is acquiring HealthSparq from Cambia Health
Solutions, a family of more than 20 companies working to make healthcare more
economically sustainable and efficient for people and their families.

– HealthSparq is a healthcare guidance and transparency
technology company serving the health plan market.

– With the acquisition, the combined entity now serves
more than 60 health systems and 100 health plan brands nationwide.

Kyruus, the leader in
provider search and scheduling solutions for health systems, today announced it
is acquiring
HealthSparq from Cambia Health Solutions, a family of
more than 20 companies working to make healthcare more economically sustainable
and efficient for people and their families. HealthSparq is a trailblazing
healthcare guidance and transparency technology company serving health plans.

As part of Cambia, HealthSparq has grown to serve more than
80 million health plan members nationwide through its digital solutions. Cambia
will have an ownership stake and a seat on the Kyruus Board of Directors. HealthSparq
will become part of Kyruus, accelerating a groundbreaking platform to connect
payer and provider organizations and enabling people to find and schedule with
the right providers seamlessly across access channels.

Acquisition Will Transform Care Navigation Through Novel
Payer-Provider Collaboration

Healthcare remains incredibly siloed, making it difficult
for people to find and schedule care that meets their unique clinical,
financial, and personal needs. Kyruus’ acquisition of HealthSparq expands the
company’s mission to make healthcare work better for everyone by connecting
people to the care they need, whether they search on a health system website or
health plan website. This will also accelerate payer-provider collaboration to
further streamline patient access and boost provider data accuracy.

Post-Acquisition Plans & Impact

Together, Kyruus and HealthSparq serve more than 60 health
systems and 100 health plan brands nationwide. The companies have already
started working together in select markets to enhance health plan directories
with provider-verified data and enable online scheduling from health plan websites.
Combining operations will accelerate the integration of their platforms,
enabling health plans to link personalized insurance benefit and cost
information with rich provider data, while allowing health systems to tap into
health plan websites as a new patient engagement source. Over time, the unified
platform will facilitate increasingly sophisticated patient routing and
matching across channels – all while giving people the convenience of online
scheduling wherever they look for care.

The HealthSparq team will transition to Kyruus and continue
to execute on HealthSparq’s full breadth of solutions for health plans. Mark
Menton, CEO of HealthSparq, will join the Kyruus executive team and serve as
General Manager of the health plan business unit.

COVID-19 vaccine distribution: 4 ways providers can win with online self-scheduling

It’s been almost an entire year since COVID-19 changed life as we know it. The good news? A vaccine has finally arrived and is currently making its way to distribution sites across the United States—a significant milestone as the nation has seen more than 16 million cases to date, and more that 300,000 deaths.

Because of the current supply, the Centers for Disease Control are recommending healthcare personnel and residents of long-term care facilities receive the vaccine first. Supply is expected to increase in the weeks and months to come, however, and the goal is for everyone to have access to a vaccine by the second quarter of 2021.

As healthcare organizations across the country prepare to meet the vaccine demand, it is expected the logistics and distribution management will add pressure to staff and services already under stress. The challenge: administer the vaccine as efficiently and safely as possible.

Online patient scheduling has already been a game changer during the pandemic, but its potential as a traffic management tool to address the influx of vaccine appointment requests is even greater—and not just for patients. In the early stages of deployment, online self-scheduling can be a game changer for healthcare workers and other essential employees looking to schedule and receive the vaccine.

Here are four ways providers can leverage online patient self-scheduling for the rollout of the COVID-19 vaccine:

Designate day and time slots specifically for administering vaccines

By incorporating providers’ scheduling rules into the scheduling process, there is the opportunity to designate specific day and time slots for administering the vaccine.

It not only makes it easy for patients to schedule, but it additionally allows both patients and providers to further minimize the risk of unnecessary contact with others in the office.

Create screening questionnaires during patient scheduling

As more patients go on-site for the vaccine, they must be routed to the most appropriate care source and location. This will prevent unnecessary traffic and bottlenecks in the office, while ensuring the safety of individuals.

As soon as a patient begins to book a vaccine appointment a few short questions about their symptoms and reason for booking can be presented. A screening questionnaire like this can triage people wanting to get a vaccine or get tested, and help identify potential COVID-19 positive individuals, and if that individual needs to quarantine prior to coming in for the vaccine. After screening, the system can direct patients through the correct channel of care.

Screening questionnaires can also be used to determine if a patient is eligible for the vaccine given the current status of vaccine deployment. Older patients may be given priority whereas younger patients may be told to schedule at a later date.

A system like this can also reduce pressure on call center staff and give providers control over the volume and timing of in-person appointments, thus helping to reduce patient and staff exposure to any contagion.

Make it as easy as possible for patients to schedule both doses

Most of the early COVID-19 vaccines will require shots to be effective, with the second dose being administered 21 to 28 days after the first. It’s critical that the second does is administered in a timely manner. There are a few ways to encourage patients to return.

First, providers can help patients book their follow-up appointment in the office before leaving.

Second, providers can leverage automated outreach as a method to contact and remind patients to book a follow-up. Experian Health’s Patient Outreach Solutions have been purpose built to meet this need, sending outreach campaigns to individuals enabling them to self-schedule needed care conveniently, right from a text or voice message.

Automated outreach would allow providers to reach out to specific subsets of patients that may require or benefit from the vaccine early on, like older individuals or those with chronic conditions. With it, providers have the ability to reach out to hundreds, even thousands of patients without manual call center workload – something that will come in handy as now the majority of Americans plan to get vaccinated for the coronavirus.

Improve the efficiency of drive-through vaccination programs

For those providers considering drive-through vaccinations (similar to drive-through COVID testing), online scheduling makes a huge difference—not only for booking an appointment, but for preventing bottlenecks as patients arrive. Detailed information such as the patient’s vehicle model, color and license plate number can all be recorded ahead of time during the screening process, allowing providers to quickly identify patients as they arrive.

Learn more about the benefits of digital scheduling and how Experian Health can help your organization navigate the rollout of the COVID-19 vaccine.

The post COVID-19 vaccine distribution: 4 ways providers can win with online self-scheduling appeared first on Healthcare Blog.

How to close gaps in care with automated patient outreach

Scheduling an appointment shouldn’t be complicated. Yet too often, patients are left to figure out their next move alone, with just a single phone number to call.

Frustrated and confused, patients may drop out of the scheduling process entirely or miss the appointments they’ve already booked. Missed appointments can lead to critical gaps in care, poor health outcomes and possible readmissions, and they are also unnecessarily costly for providers.

But what if you could make scheduling easy? Minimizing the burden on patients could close more gaps in care, improve the patient experience and reduce call center workload at the same time. Automated, targeted outreach campaigns can help you do exactly this.

Using a simple text message or voice message, you can prompt patients to book their next appointment right there and then. Here’s how:

5 ways automated patient outreach can help close gaps in care

1. Quicker and easier for patients to book care

An automated solution can send targeted text messages (SMS) or interactive voice calls (IVR) to patients to remind them to book an appointment. By providing a self-scheduling link in the message, patients can book their appointment immediately. Patients are often more likely to schedule when they’re given a reminder plus a booking link, compared to a reminder message alone. There’s less risk of appointments being forgotten, sealing any potential care gaps from the start.

2. More appointments booked

Automation also means you can contact and schedule more patients than if your call center was contacting each person individually. One large Medicaid managed care plan saw a 140% increase in their scheduling rates since using

Patient Schedule. They’re able to match patients to the right provider first time, protecting calendars from errant bookings and eliminating the dreaded three-way calls between member, provider and payer. 

3. More patients showing up to appointments

When automated patient outreach is paired with digital scheduling, patients are far more likely to show up to appointments. The Iowa Clinic found that when patients book online, they’re not only more likely to show up, but they feel more engaged and eager to follow their care plan. Their patient show rates are as high as 97% for appointments scheduled online. If those patients are also more engaged, that’s a good sign that care gaps can be minimized too. 

4. Better coordination of transport services

One obstacle to attending non-emergency appointments that is often overlooked is the lack of access to reliable transportation. With automated scheduling software, this can be easily fixed. Once a member has booked an appointment, data analytics can flag up a potential need for transportation, so the member can be sent an automated text reminder to book transport. And if they need to reschedule for some reason, the transportation booking will auto-update too. Patients (and staff) no longer need to wrangle two separate systems for booking appointments and transportation.

5. Better management of wait lists and reduced call times

Another way to close gaps in care is to give patients the option to book an earlier appointment, if a slot becomes available. Seeing their doctor sooner can mean quicker treatment and reduce the chance of a patient disengaging with their care plan because of a long wait.

With automated outreach, you can send an automatic message to offer an earlier appointment, and then cancel the old booking (and offer it to others) at the same time. This enables better wait list management and can reduce call time for staff by an average of 50%.

Automated patient outreach is a win-win. It’s far more convenient for patients, and drives down costs for providers and payers. Learn more about how automated appointment reminders and digital patient scheduling can help your organization improve the patient experience and close costly gaps in care.

The post How to close gaps in care with automated patient outreach appeared first on Healthcare Blog.

LeenTaaS Secures $130M for ML Platform to Help Hospitals Achieve Operational Excellence

LeenTaaS Secures $130M for ML Platform to Help Hospitals Achieve Operational Excellence

What You Should Know:

raises $130 million in Series D Funding to strengthen its machine learning platform
to continue helping hospitals achieve operational excellence during a time
where they are facing mounting financial pressures due to COVID-19. 

– LeanTaaS provides software solutions that combine lean
principles, predictive analytics, and machine learning to transform hospital
and infusion center operations to improve operational efficiencies, increase
access, and reduce costs.

– LeanTaaS’ solutions have now been deployed in more than
300 hospitals across the U.S., including five of the 10 largest health networks
and 12 of the top 20 hospitals in the U.S.

 LeanTaaS, Inc., a
Silicon Valley software innovator that increases patient access and transforms
operational performance for healthcare providers, today announced a $130
million Series D funding round led by
Insight Partners
with participation from Goldman Sachs. With this
investment, LeanTaaS has raised more than $250 million in aggregate, including
more than $150 million from Insight Partners. As part of the transaction,
Insight Partners’ Jeff Horing and Jon Rosenbaum and Goldman Sachs’ Antoine
Munfa will join LeanTaaS’ Board of Directors.

Lean + Predictive Analytics = Operational Excellence

LeenTaaS Secures $130M for ML Platform to Help Hospitals Achieve Operational Excellence

Healthcare reform, an aging population, and a higher
incidence of chronic disease has caused the demand for healthcare services to
escalate quickly. At the same time, pressure from payers to eliminate waste
requires that healthcare providers do more with less to meet this skyrocketing
demand with the resources in which they have already invested. And this
situation is only going to get worse.

As more healthcare data gets digitized, the opportunity exists to leverage that data to help providers meet these challenges and more efficiently match supply and demand. Founded in 2010, LeanTaaS believes hospitals should use objective data and predictive analytics – not intuition and “tribal rules”– to better match resource supply with demand and to amplify the business impact of investments they have already made in EHR, BI, and Lean/Six Sigma.

Better Healthcare Through Math

LeenTaaS Secures $130M for ML Platform to Help Hospitals Achieve Operational Excellence

LeanTaaS develops software that increases patient access to
medical care by optimizing how health systems use expensive, constrained
resources like infusion chairs, operating rooms, and inpatient beds. More than
100 health systems and 300 hospitals – including 5 of the 10 largest systems,
12 of US News and World Report’s top 20 hospitals. These hospitals use the iQueue
platform to optimize capacity utilization in infusion centers, operating rooms,
and inpatient beds. iQueue for
Infusion Centers
is used by 7,500+ chairs across 300+ infusion centers
including 70 percent of the National
Comprehensive Cancer Network
 and more than 50 percent of National Cancer Institute hospitals. iQueue for
Operating Rooms
is used by more than 1,750 ORs across 34 health systems to
perform more surgical cases during business hours, increase competitiveness in
the marketplace, and improve the patient experience.

Related: How
Hospitals Can Create Better Inpatient Bed Capacity Through Math

Expansion Plans

The funds will be used to invest in building out the existing suite of products (iQueue for Operating Rooms, iQueue for Infusion Centers, and iQueue for Inpatient Beds) as well as scaling the engineering, product, and go to market teams, and expanding the iQueue platform to include new products. 

“LeanTaaS is uniquely positioned to help hospitals and health systems across the country face the mounting operational and financial pressures exacerbated by the coronavirus. This funding will allow us to continue to grow and expand our impact while helping healthcare organizations deliver better care at a lower cost,” said Mohan Giridharadas, founder and CEO of LeanTaaS. “Our company momentum over the past several years – including greater than 50% revenue growth in 2020 and negative churn despite a difficult macro environment – reflects the increasing demand for scalable predictive analytics solutions that optimize how health systems increase operational utilization and efficiency. It also highlights how we’ve been able to develop and maintain deep partnerships with 100+ health systems and 300+ hospitals in order to keep them resilient and agile in the face of uncertain demand and supply conditions.”

Chief Marketing Officer Appointment

Concurrent with the funding, LeanTaaS announced that Niloy Sanyal, the former CMO at Omnicell and GE Digital, would be joining as its new Chief Marketing Officer. Also, Sanjeev Agrawal has been designated as LeanTaaS’ Chief Operating Officer in addition to his current role as the President. “We are excited to welcome Niloy to LeanTaaS. His breadth and depth of experience will help us accelerate our growth as the industry evolves to a more data-driven way of making decisions” said Agrawal.

What is Revenue Cycle Management?

There is no question that providers’ bottom line has been hit hard this year, and a new surge in COVID-19 is bound to threaten hospital finances once again.

As healthcare providers look to supercharge their payment velocity during these uncertain times, it’s worth taking a step back to examine the revenue cycle management process as a whole: what it is, how it works, and the clear actions providers can take to improve the process overall.

Below is an overview of healthcare revenue cycle management and how specifically providers can improve their bottom line now and after the pandemic subsides.

What is revenue cycle management?

Any business, regardless of industry, needs to develop successful processes and strategies for remaining financially healthy. For hospitals and health systems, that process is revenue cycle management. To run a successful healthcare organization, providers must employ and manage accurate and efficient billing processes. Without it, these organizations will likely have to close their doors and will, as a result, no longer be able to provide quality care for their patient population.

How revenue cycle management works in healthcare

To put it simply, in order to generate revenue for their organization, providers need to collect payments for services rendered. The process of doing this, however, isn’t always as straightforward and simple as it seems.

Think of healthcare revenue cycle management like a journey. It starts when a patient schedules an appointment and ends when all patient payments for medical service(s) received have been collected. As we move through the journey, providers have a lot to manage, starting first with front-end intake process, moving all the way through the back-office operations to ensure payment is ultimately secured.

Phases of the revenue cycle management life cycle

The revenue cycle management life cycle spans several phases:

  • Schedule visit and secure estimate. To kickstart the process, a patient will book an appointment with a provider or specialist and administrative staff will handle insurance eligibility verification and ultimately establish a patient account for that organization. This is also an opportunity for providers to offer price transparency and provide an estimate for services to be rendered.
  • Registration and check-in. An early and vital step for optimizing the entire revenue cycle management process, this is where providers capture details like medical history, insurance coverage and other patient demographics. Ensuring correct patient information on the front end reduces the errors that cause rework in the back office.
  • Ensure care is authorized by the payer. Still on the front end, this is where provider staff checks whether prior authorization is required for a particular procedure or service. Not securing authorization in advance of service can lead to costly denials, rework, operational inefficiencies, and a poor patient experience.
  • Receive treatment and discharge. Once the patient is discharged, the services provided will be translated into billable charges and a medical billing code will be assigned to the claim. It is crucial to the revenue cycle that these claims be accurately coded, as the re-work for incorrect codes and subsequent claim rejections can be costly and a drain for productivity.
  • Medical claims submitted. The claim must then be submitted to the payer. Submitting accurate and timely claims maximizes the revenue collected and prevents delays in reimbursement. Rejected claims directly affect an organization’s revenue cycle, making it all the more important to get the claim right before it makes its way to the payer. Even if a claim is denied, is important it be resubmitted as quick as possible.
  • Patient payments and collections. Once insurance reviews the claim and provides their reimbursement, patients are presented with their out-of-pocket costs for services rendered. On-time payments made in full are preferable for a healthy revenue cycle, but that isn’t always feasible for patients, especially now given the current environment with COVID-19. This is where quality collections practices can really help to optimize patient payments and reduce bad debt.

Challenges in revenue cycle management

Any process with this number of touch points is bound to come with challenges, but two major challenges seem to stand out: claims and collections.

Navigating healthcare claims is complex and costly. Providers and facilities often get stuck in a cycle of inaccurate claim submissions, denials, corrections and rebilling that delays reimbursement and negatively impacts financial performance.

A lot of denials can be traced back to errors within the claim submission: improper coding, issues with insurance eligibility, missing or inaccurate patient information, or duplicate claim submission. Errors like this on the front-end are a major cause of the headaches experienced by providers further down the line.

After claims are submitted, provider staff will monitor and keep track of claim status. Surprisingly, many still use a manual process not only for this, but for managing any claims that are ultimately denied. Without any kind of automation, this is a drain on productivity, time and resources and it becomes more difficult for providers to respond to denied, pending or returned claims in a timely manner for reimbursement.

Another prominent challenge in the revenue cycle is collections, notably collecting from patients before or at the point of service. Providers would prefer to collect from patients prior to them leaving the office, but it’s not always possible, and for a few reasons.

Patients are increasingly unable to pay their medical bills, more are presenting as self-pay (maybe now more than ever during the pandemic), and some may not be aware of subsequent coverage or that they qualify for charity assistance, all which directly impact providers’ abilities to collect. A lack of price transparency for services can make it even more difficult for patients to prepare financially.

Benefits of revenue cycle management

Despite its challenges, when done right, there are many benefits of revenue cycle management in healthcare.

Effective revenue cycle management not only improves the patient experience but improves staff satisfaction as well. Automating the process (billing, coding, claims management, etc.) reduces a lot of the associated administrative burden, which allows providers to focus on the delivery of quality care.

An optimized revenue cycle will also lower the rate of denials. As errors and redundancies are addressed and prevented on the front end, fewer claims will be denied.

Maybe one of the most obvious benefits of a healthy revenue cycle is maximized collections and revenue, and faster collection processes, especially when the process is automized. The entire collections process can be expedited, lowering administrative burden while also improving accuracy.

How to improve your revenue cycle management

We recommend providers take a holistic approach to improving revenue cycle management, focusing largely on automating the process and within the following four areas:

Automate access
Patient access is the starting point for the entire revenue cycle process. Ensuring correct patient information on the front end reduces the errors that cause rework in the back office. patient access.

With an automated, data-driven workflow, providers can reduce the errors that lead to claim denials while simultaneously improving access to care for patients through capabilities like online scheduling. Access is further improved by reducing the friction around patient billing by leveraging real-time eligibility verification to deliver accurate patient estimates at registration.

Increase collections
There is a definitely a delicate balance between ensuring that debts are collected and fostering a positive patient financial experience. It is imperative providers find a way to maximize patient collections while also increasing patient satisfaction. Patient access staff must be the patient’s advocate while also improving the organization’s ability to collect from the patient and payer.

By leveraging a data-driven approach, staff can verify patient identity and insurance coverage as well as provide an accurate estimate of payment responsibility ahead of service. Staff even can review data to assess ability to pay and evaluate various payment plan and/or financial assistance options.

The further upstream the revenue cycle can be managed the more effective the process will be to ensure the patients are informed prior to service, so they can make their portion of their payment responsibilities as early as possible to accelerate the cash collections for providers and to reduce the need to put significant effort into late stage collections.

Streamline claims
Providers can improve financial performance with automated, clean and data-driven medical claims management.

By integrating claims management software with customized edits into the workflow system, providers can thoroughly review every line of every encounter and verify that each claim is coded properly and contains the correct information before the claim is invoiced and submitted for reimbursement.

Encounters can be processed in real time with automatic alerts for incorrect codes or other potential issues before the claims submission. Responses include a detailed explanation of why a claim was flagged, so any necessary modifications can be made prior to submission.

Increase reimbursement
Healthcare organizations that don’t stay current on payer policy and procedure changes risk payment delays and lost revenue. It can also be difficult for providers to verify the accuracy of payment received from third-party payers.

With automated access to the right data, providers can be reimbursed more accurately and quickly, while also strengthening their relationships with payers.

Providers can avoid payment delays and lost revenue with automated payer policy and procedure change notifications. Solutions that continuously audit payer contract performance can assure that collections align with negotiated terms.

The key for successful revenue cycle management

Technology, specifically data and automation, is key to the success of the healthcare revenue cycle. Automation ensures problems don’t continue to effect productivity, and data can be matched precisely to predict, model and optimize financial results. Both can also be used to highlight a patient’s financial situation, as well as their propensity to pay, allowing providers to optimize collection strategies from the start and get patients on the right programs.

Explore Experian Health’s revenue cycle management solutions.

The post What is Revenue Cycle Management? appeared first on Healthcare Blog.

COVID-19: How Hospitals Can Create Better Inpatient Bed Capacity through Math

COVID-19: How Hospitals Can Create Better Inpatient Bed Capacity through Math
Dr. Pallabi Sanyal-Dey, Associate Professor of Medicine at UCSF & Director of Client Services at LeanTaaS

Since the beginning of the COVID-19 pandemic, key elements of hospital operations such as managing inpatient bed capacity, and access to ventilators and PPE have taken center stage. The general public got a crash course on what hospitals need in order to function successfully when disaster hits, and daily news and discussions were centered around ICU bed capacity as cases accelerated across the country.

The nightmarish predictions and reality led to the development of creative measures to help meet such catastrophic needs such as popup temporary screening and triage sites, non-medical and medical spaces being repurposed for COVID units, increased patient transfers to hospitals that had more space, and mathematical models to predict upcoming numbers of new COVID-19 cases. 

With the latest surge of COVID-19 cases (see figure 1), some states have or will begin opening up field hospitals (Wisconsin, Texas) while others are considering transfers to other locations (both in and out-of-state), and even the concept of ‘rationing care’ has surfaced. 

1Figure 1. The Covid Tracking Project

This public health crisis intensified what happens when hospitals and healthcare providers run out of the right space and resources. As alarming as it has been to watch this play out, the reality is that these capacity and resource challenges are not unique to the pandemic; they happen often in hospitals across the country, just on a different scale. Bed capacity is something hospital leaders manage every day – only 1 of 3 hospital beds are available on any given day in the U.S., per research by the Robert Wood Johnson Foundation 2.  Of course, there’s further variation when looking at urban versus rural regions. Many systems are forced to go on ‘diversion’ (patients will literally be re-routed to other hospitals) when the reality is that they are bursting at the seams. 

Clearly, the pandemic has been devastating, yet it has (finally) propelled healthcare toward innovation and adoption of technology that was much needed in order to improve access to and utilization of quality and cost-effective care. Although the waves continue, organizations are starting to answer the following questions: What newly applied practices do we keep from the pandemic moving forward as we head into additional COVID-19 waves and the flu season? Can we more vigorously apply lessons of the past and present to tackle our future needs? Are our incentives aligned such that the solutions we pursue can be sustained and still “keep the lights on”?

Delayed access to care and, even worse, lack of access to care, have been among the most devastating consequences of the capacity crises during the pandemic.  Though many of our systems started to transition back to their usual state of affairs by July, other factors in addition to the current surge continued to highlight the ongoing need for creating and sustaining ‘good patient flow’.

Under “normal” circumstances, daily chaos is anticipated and actually expected, as hospitals experience the inability to move patients from the emergency room (ER) or operating room (OR) due to a “lack of beds” in the hospital. While this inevitably requires hospital leadership to ‘do something’ about it, it is a scenario that plays repeatedly throughout the day, every day.  

The chaos that comes from the lack of visibility into available beds, let alone appropriately available levels of care, can have negative downstream impacts not only on the patients but also on the frontline staff. Patients are subject to suffering the consequences of inappropriate levels of care, poor clinical outcomes, and/or poor provider/patient experiences.3 Staff are subject to the stress of caring for patients for whom they are not necessarily appropriately trained to care for.

Despite the known implications, this lose:lose cycle continues. These “risks” plus the impact of significant revenue losses from the pandemic highlight the urgent need to address poor, inefficient patient throughput. We are at a critical point where healthcare systems must do what is necessary to improve existing practices when it comes to bed management.  

Some examples of improvement include: 

– Create machine learning models for all locations and patient movements within the hospital, and adjust space and schedules accordingly

  – Place patients using sophisticated demand-supply model

  – Make data-driven internal transfer decisions

  – Right-Sized unit capacity

  – Look hard at the degree of specialization to pool capacity where possible

  – Smooth the patient flow from the OR

Take a magnifying glass to internal operational workflows – Identify practices that work, areas where support is needed, especially when it comes to discharge planning, and whether or not there are financial implications.

– Improve provider workflow

– Don’t let “a dime hold up a dollar”: take a hard look at staffing, hours of operations, and transportation

– Use predictive discharge planning to focus on case teams and social services

Identify clinical workup that can be prioritized according to disposition, treat outpatient setting 

– Prioritize discharge patients in queues for labs/clinical procedures

– Transition some procedures to outpatient

With the recent surge of COVID-19 cases across the nation and the impending flu season, hospitalizations will continue to rise.  Although health systems will be able to resurface earlier crafted emergency plans from previous surges, set up incident command centers more quickly, and have a more stable supply inventory, they will likely continue to manage their bed capacity through a very manual process.  It is imperative that we start to do things differently to achieve better outcomes!

Implementing operational change and deploying new but proven technologies that incorporate both artificial intelligence and lean principles will increase patient access, improve provider, patient, and staff experience, and, of course, smooth inpatient capacity. As a result, terms such as chaos and crisis can, in time, become things of the past. 


1. The Covid Tracking Project Nov. 10, 2020. Retrieved from

2. Blavin F., (March 1, 2020). Hospital Readiness for Covid-19: Analysis of Bed Capacity and How It Varies Cross The Country The Robert Wood Johnson Foundation.

3. Mohr et al., Boarding of Critically Ill Patients in the Emergency Department. Critical Care Medicine 2020; 48(8): 1180–1187

4. Agrawal S., Giridharadas M., (2020) Better Healthcare Through Math: Bending the Access and Cost Curves. Forbes, Inc. 

About Dr. Pallabi Sanyal-Dey

Dr. Pallabi Sanyal-Dey is the director of client services for ‘iQueue for Beds’ Product at LeanTaaS, a Silicon Valley software innovator that increases patient access and transforms operational performance for more than 300 hospitals across the U.S. Dr. Sanyal-Dey is also a visiting associate professor of medicine, providing career mentorship to trainees at the University of California, San Francisco Medical Center (UCSF) where she attends on the internal medicine inpatient teaching service. Prior to joining LeanTaaS, Dr. Sanyal-Dey was at UCSF, as an assistant clinical professor and an academic hospitalist at Zuckerberg San Francisco General Hospital where she directed clinical operations for the Division of Hospital Medicine, and oversaw the faculty inpatient services.

2021 Patient Experience Predictions

As 2020 draws to a close and headlines hint that the end might finally be in sight for the pandemic, the healthcare industry is considering COVID-19’s legacy. The sudden shift to contactless care, financial consequences of widespread social distancing measures and changing expectations of the patient experience have upended the world of healthcare and health IT – but which changes are here to stay? And what do these changes mean for the patient experience in 2021?

We asked several leaders across Experian Health for their predictions in the areas of patient access, collections, and identity management, and here is a preview of what they had to say:

“Patients will choose providers that give them control over their healthcare experience”

Patients have more opportunity today than ever before to manage their healthcare experience from the comfort of their own home, whether that be through patient portals, online self-scheduling and registration or online payment tools.

As lockdowns and social distancing prevented patients from presenting in person, providers were forced to offer patients with more options for self-service. Unsurprisingly, this was a move a lot of patients have been waiting for and many welcomed this new technology with open arms.

Jason Kressel, senior vice president of consumer products and analytics at Experian Health, expects that, as patients become more accustomed to this level of self-service, more than half of consumers will change providers in favor of one that offers premium digital healthcare services:

“Providers who can meet patients where they are—through web-based services and via their mobile devices—will have the most success with retaining and attracting patients.”

Online self-scheduling can put patients in the driver seat while also avoiding unnecessary contact while many remain cautious about on-site visits. With access issues removed, the patient experience will improve, in turn improving health outcomes (and providers’ bottom lines!).

“With hospital finances on shaky ground, collections will be a top priority for survival”

As COVID-related unemployment leads to an unstable insurance landscape, many providers are worried about maintaining effective collections processes, and they cannot afford to spend time chasing payments. Guarding against uncompensated care and tightening up the collections process will be essential.

Automated collections software can help collections teams focus their efforts on patients who are most likely to pay, while also helping patients manage their financial obligations with as little stress as possible. Providers can also quickly determine which patients qualify for financial assistance, helping them get them on the right payment pathway for their circumstance without delay. Not only will this provide a much better patient financial experience, it’ll prevent “lost coverage” and allow providers to collect a larger portion of dollars owed.

“The surge in portal usage means providers need to watch out for fraudsters”

What does the rapid growth in portal uptake mean for data security? The speedy rollout of telehealth and other digital services has exposed security concerns for many providers, who fear a rise in fraudulent activity in 2021 as cybercriminals sniff out opportunities to steal patient data.

To protect patient information and avoid costly reputational damage, providers must adopt more sophisticated identity management solutions. By combining cutting edge identity proofing, risk-based authentication and knowledge-based questions, providers can more easily verify a patient’s identity when they log on to their portal, greatly eliminating the risk of fraud.

Interested in learning more about other trends that could affect the patient experience moving forward?

View the Experian Health 2021 Patient Experience Forecast.

The post 2021 Patient Experience Predictions appeared first on Healthcare Blog.

5 Steps for Interoperability Excellence for Healthcare Providers

5 Steps for Interoperability Excellence for Healthcare Providers
Shanti Wilson, Consultant, Freed Associates 

As if 2020 couldn’t be
any more challenging for healthcare providers, new federal rules on
interoperability and patient access, granting patients direct access to their healthcare
data, begin taking effect this November and continue into 2022. These rules,
while ultimately beneficial to patients, bring an additional level of
operational complexity to many revenue-stressed healthcare organizations. 

If anything, the 2020 pandemic has illustrated the vast potential of interoperability. For example, consider the huge increase in 2020 in virtual care visits, projected to be more than 1 billion by year’s end, and with an estimated 90% related to Covid-19. Many of these new virtual health patients will move through different care networks, using different health plans, and seeking remote access to their health records. These are precisely the type of patients’ interoperability is meant to help. 

What should healthcare providers be doing now to ensure they’re not only compliant with new interoperability rules, but also applying them as optimally as possible to benefit their patients and organizations? In this article, we review the upcoming rules and suggest five key steps providers can take to ensure their interoperability implementations proceed as smoothly as possible.  

What’s Ahead with

After several years of discussion on interoperability standards, the Office of the National Coordinator (ONC) for Healthcare IT and the Centers for Medicare & Medicaid Services (CMS) issued their final rules on interoperability in the spring of 2020. The new rules, covering both health systems and health plans, are intended to ensure that patients can electronically access their healthcare information regardless of health system or type of electronic health records (EHR) and covering all CMS-regulated plan types, including Medicare Advantage, CHIP, and the Federally Facilitated Exchanges. 

Starting Nov. 2, 2020, healthcare systems must begin complying with interoperability rules preventing information blocking, which means not interfering with patients’ access to or use of their electronic health information. Providers must also attest they are acting “in good faith” regarding preventing information blocking, with any non-compliance flagged on the National Plan and Provider Enumeration System. By May 1, 2021, hospitals, psychiatric hospitals, and critical access hospitals with an EHR must send notification of their patients’ admission, discharge, and transfer (ADT) events to providers. 

Interoperability will replace the current fragmented and error-prone ways of exchanging vital healthcare information. Near-term benefits of interoperability include improved care coordination and patient experience, greater patient safety, and stronger patient privacy and security. Longer-term benefits include higher provider productivity, reduced healthcare costs, and more accurate public health data.  

For providers, the good
news about interoperability is that they’ve had years to think about and
implement many of its fundamental tenets, based on their work meeting
meaningful use requirements. That’s borne out in a 2019 HIMSS survey of
healthcare organizations which found nearly 75% of respondents past the
“foundational” level of interoperability – “foundational” defined as allowing
data exchange from one IT
system to another, but without data interpretation.  

Five Steps for
Interoperability Excellence 

While healthcare systems
will achieve significant interoperability gains through technology investments,
they should not consider technology as the ultimate sole key to
interoperability success. If anything, financial and political considerations
may be far more important to your organization’s interoperability success. Here
are five critical non-technology factors to consider: 

1. Determine your “master”
interoperability strategy

All pertinent stakeholders in your organization should be on the same page about your interoperability strategy, resources, and timing. Know up-front that those implementing interoperability may not have previously worked with patient-centric analytics, partners, or departments in your organization. Plan your resources and timing accordingly. Your strategy should focus on the value-add of interoperability internally, such as access to additional data points on your patients, and externally, such as how you describe the upcoming benefits of interoperability to your patients.

2. Convey your vision, expectations
and expected return

An interoperability implementation is
a massive change management initiative, which requires continuous, top-down
leadership and championship, and proper expectation-setting. Communicate where
your organization currently stands regarding its interoperability capabilities,
and where you wish to have it go. Convey how the organization plans to get to
its future desired state. And perhaps most importantly, share the likely return
on investment in this effort. Be as specific as possible. For example, if you
believe interoperability gains will ultimately enable a 5% decrease in your
hospital readmissions, state that.

3. Examine workflows and identify
specific use cases

Every type of ADT event in your
organization, and its corresponding workflows and system interactions, should
be under review. Consider all types of clinical use cases, the types of data to
be exchanged, and those involved in providing patient care. This will help
determine your optimal approach to data-sharing and how your organization can
strategically use the additional data you receive from other health

4. Rigorously prep your data

Standardized data collection and reporting
which produces quality data is the heart and soul of successful
interoperability. Be sure your organization’s data is clean and meaningful, and
will ultimately be understandable and useful to your patients. 

5. Think big-picture differentiation

There’s nothing in the ONC and CMS
interoperability rules that says you need to stop at mere rules compliance.
Consider your pursuit of interoperability as a singular opportunity to be a
patient-centric leader in your market. Let everyone relevant know of the
success you’ve achieved. 

While interoperability
offers a chance for healthcare systems to achieve multiple operational gains,
when handled well, it is ultimately a patient-centric endeavor. Always keep the
needs and interests of your patients at the core when facilitating access to
their personal health data. It’s the ultimate smart long-term interoperability

Shanti Wilson is
a consultant with 
Freed Associates,
a California-based healthcare management consulting firm.

M&A: Olive Acquires AI Prior Authorization Company Verata Health

Olive Acquires AI Prior Authorization Company Verata Health

What You Should Know:

– On the heels of $225.5 million dollars in funding and a
$1.5B valuation this week, Olive today announced its acquisition of Verata
Health to create a combined AI prior authorization solution for providers and
payers under the Olive name.

– Prior authorization is a $31 billion dollar issue in
healthcare, and one of the top reasons patient care is delayed. Olive is now
able to reduce write-offs by over 40% and cut turnaround times for prior
authorizations by up to 80%, ultimately offering hospitals $3.5 million in

Olive today, announced
the acquisition
of Verata Health to solve prior
authorizations for providers and payers via artificial
as a combined solution under the Olive name. The acquisition
follows Olive’s recent $225.5 million financing round to bolster the company’s
R&D war chest and drive the growth of Olive’s AI workforce for providers
and payers. With Olive’s recent momentum, Verata’s suite of AI tools will
deepen Olive’s impact as it automates the $31 billion problem of prior authorizations
in healthcare.

Leverage Powerful Prior Authorization AI

Verata is a leading healthcare AI company, enabling
Frictionless Prior Authorization® for providers and payers. Seamlessly
connected to the nation’s top electronic health record
systems, Verata’s AI technology automatically initiates prior
authorizations, retrieves payer rules, and helps identify and submit clinical
documentation from the EHR.
When payers leverage its AI platform, Verata enables point-of-care
authorizations for providers and patients, dramatically accelerating access to

Solving the $31B Prior Authorization Burden

Prior authorizations were the most costly and time-consuming transactions for providers in 2019 and are among the top reasons patient care is delayed. As cash-strapped hospitals and health systems strive to meet patient, payer, and provider needs, the demand for AI technologies to increase efficiency and improve the patient experience has become critical. To help improve patient access to care and remedy the $31 billion prior authorization challenge, Olive and Verata’s combined prior authorization solution streamlines the process for providers, patients, and payers by reducing write-offs by over 40% and cutting turnaround time for prior authorizations by up to 80%.

Acquisition Will Provide End-to-End Prior Authorization

By integrating Verata’s solution, Olive is able to provide customers with a true end-to-end prior authorization solution. The solution starts with determining if an authorization is required, includes touchless submission of the prior authorization request, ends with automating denied claim appeals, and grants hospitals a 360-degree view of their authorization performance. This means patients not only get the care they need faster but also eliminates confusing bills patients receive post-service stating their claim has been denied by their insurance.

As part of the acquisition, more than 60 Verata employees
will join the Olive team following the acquisition, bringing Olive’s total
employee count to approximately 500. Olive’s senior executive team will
continue to grow as well:

– Lori Jones, Chief Revenue Officer, will retain her title
and will also take on the role of President, Provider Market

– Dr. Jeremy Friese, Chief Executive Officer at Verata, will
join Olive as President, Payer Market

– Dr. YiDing Yu, Chief Medical Officer at Verata, will
become Olive’s Chief Medical Officer

“A broken healthcare system is one of the biggest challenges humanity faces today and prior authorization issues, in particular, are costing our nation billions of dollars. After partnering with Verata earlier this year, we saw incredible potential for Verata’s technology to reduce the amount of time and money spent on prior authorizations, and to eliminate delays in patient care,” said Sean Lane, CEO of Olive. “This acquisition allows Olive to accelerate innovation in areas where we can drive the biggest impact, and further expands our solutions to providers and payers seeking to transform healthcare.”

Financial details of the acquisition were not disclosed.

M&A: CarepathRx Acquires Pharmacy Operations of Chartwell from UPMC for $400M

CarepathRx Acquires Specialty Pharmacy Operations of Chartwell for $400M

What You Should Know:

CarepathRx will
acquire the University of Pittsburgh Medical Center’s pharmacy operations in a
$400M deal.

The company fully
integrates pharmacy operations, expands healthcare services, improves
ambulatory access, minimizes clinical variation and creates new health system
revenue streams.

– CarepathRx serves more than 15 health systems and 600
hospitals, with more than 1,500 employees nationwide, 400 payor contracts.
Already CarepathRx has treated more than 100,000 patients.

CarepathRx, a leader in pharmacy and medication management
solutions for vulnerable and chronically ill patients, announced today a
partnership with UPMC’s Chartwell subsidiary that will expand patient access to
innovative specialty pharmacy and home infusion services. Under the $400M landmark
agreement, CarepathRx will acquire
the management services organization responsible for the operational and
strategic management of Chartwell while UPMC becomes a strategic investor in CarepathRx. 

This new partnership expands CarepathRx’s specialty and home infusion capabilities. “Our partnership with UPMC and Chartwell is an important step for CarepathRx. We set out to create a new approach to pharmacy care in the market—one that is centered on the patient and that works collaboratively with both the provider and the payor of health care,” said Figueroa, chief executive officer of CarepathRx. “We welcome the team at Chartwell to the CarepathRx family and are thrilled to partner with UPMC to help us achieve our mission.”

Optimize Your Hospital Pharmacy

Founded in 2019 by seasoned health care executive John Figueroa and middle-market private equity firm Nautic Partners LLC, CarepathRx has rapidly become a leader in delivering comprehensive pharmacy solutions to patients undergoing complicated medication therapies. By focusing on the most vulnerable patients, CarepathRx is seeking to break down the barriers of typical pharmacy care and medication management. Its suite of solutions caters to patients undergoing specialty and infusion therapies, often for a variety of chronic conditions. CarepathRx works closely with partners across the health care spectrum—including health systems, community physicians, home health agencies and payors. Today, CarepathRx delivers its services to more than 600 hospitals across the country.

The transaction is expected to close
within 30 days. Cantor Fitzgerald & Co. served as financial advisor to
Chartwell in the formation of the management services organization and
partnership with CarepathRx.

COVID-19: How Can Payers Prepare for Mandates and Support Pandemic Relief Efforts

Elizabeth Bierbower, Former President of Humana’s Group & Specialty Division

Healthcare can achieve optimum efficiency when patients are at the center of care. When patients have the necessary information to navigate their care journey, they will choose the path to high-quality care at the lowest costs. Cost-sharing and insurance premiums are rising consistently since the last decade for employer plans, which covers nearly half of the country’s population. Plan members are shouldering a part of the healthcare cost burden, so they want to keep it as low as possible. At the same time, they want maximum value for their money with access to quality care.

CMS identified this as an opportunity and issued the Final Interoperability and Patient Access rule. The rule allows patients to access electronic health data through any third-party application of their choice. The rule intends to allow patients to take control of their data and determine who can see which data. It will also make transferring data from provider to provider easier. So that patients can be ensured that their provider is fully aware of their medical history. 

The Challenge of Providing Members Access to Healthcare Data 

The biggest challenge that health plans will face is to extract data from multiple sources in-house, clean and scrub it, and ensure it is in the appropriate format as required by the Centers for Medicare and Medicaid Services (CMS). Some health plans have been in business for a really long time. Patient data has been accumulating through these years in legacy systems. Providing access to that data through certified third-party applications will require a lot of effort on the part of health plans. The health plans also have to ensure tight authentication standards so that only the people requested by the members have access to their healthcare data. 

In addition, there are multiple problems associated with provider data. Incorrect data in the provider database costs close to $3 billion annually. CMS has also issued warnings for inaccurate provider directories, high claim-reprocessing volumes, and substantial encounter-data rejection rates. Payers have been addressing the data issues with short term solutions. But now they have to resolve the provider data problems for good and make health data readily available to the members.

The COVID Crisis Upended The Payer Compliance Initiatives

Payers are in solidarity with providers and patients in this time of crisis. While providers work tirelessly to help an increased number of patients access the required care, payers are providing support through fast track reimbursements and reduced utilization management.

 Many health plans are focused on ensuring that their members have access to resources to fight COVID, which is why CMS extended the deadline for the Final Interoperability rule. Utilization patterns are witnessing a significant change. Many members are not receiving scheduled care as some elective surgeries are rescheduled and some provider offices are shut down. There has been a drop in certain kinds of utilization. Conversely, there has been a dramatic surge in telehealth office visits and behavioral health services.

The Road Ahead for Health Plans

Healthcare payers have endured significant claims-based, economic, and operational challenges during the pandemic. While they battle those bottlenecks, they also have to ascertain and prepare for the future and devise ways to ensure that their members have access to quality care.

Health plans will have to try to anticipate what utilization patterns will look like in the future, especially in the next year. Telehealth utilization will not be the same as it was pre-COVID. They will also have to ensure that members have access to care. They will have to reach out to members, especially those who are the most vulnerable. They will have to make sure members are not suffering from social isolation, they are taking their medication and they have access to transportation to get to the doctor.

Provider Alliance for CMS Compliance

CMS is handing over the reins of the care journey to the patients to improve care delivery through the Interoperability rule. Providers will play a key role in enabling access to healthcare data to patients by streamlining data and closing coding gaps. Payers must assist providers with their data needs to ensure compliance with the CMS rules.

As the pandemic ends and CMS comes out with more definitive long term rules and coverages, it is going to be important to ensure that providers are on the same page with payers. Health plans can partner with providers to educate them about the acceptable telehealth codes and what type of services are to be performed using those codes. Providers want to take care of their patients and they want to do it well. They want to leverage technology to ensure patient access to care and ensure their safety, especially for patients who suffer from multiple comorbidities.

About Elizabeth Bierbower

Elizabeth Bierbower is a strategic leader with more than thirty years of executive experience in the health insurance industry. She has experience scaling cost-effective and profitable growth strategies through internal innovation, and a reputation as being one of the industry’s most fiscally responsible and progressive leaders. Bierbower currently serves on the Boards of Iora Health, the American Telemedicine Association, and is on Innovaccer’s Strategic Advisory.

Previously Beth was a member of Humana’s Executive Management Team and held various roles including Segment President, Group and Specialty Benefits, and was an Enterprise Vice President leading Humana’s Product Development and Innovation teams.

Nuance Sells Off Transcription and EHR-Go-Live Services Businesses to DeliverHealth

Nuance Sells Off Transcription and EHR-Go-Live Services Businesses to DeliverHealth

What You Should Know:

–   Nuance announced that it’s planning to sell
two sections of its healthcare business – Health Information Management (HIM)
and Electronic Health Record (EHR) Go-Live Services – to a new independent
company, called DeliverHealth, in early 2021.

– Nuance will be a minority shareholder of DeliverHealth
and continue to provide its technology to the company.

Communications, Inc.,
today announced the planned sale
of the Health Information Management (HIM) Transcription business and the
Electronic Health Record (EHR) Go-Live Services business to a new independent
company, DeliverHealth Solutions LLC
formed by Assured
Healthcare Partners® (AHP®)
in partnership with Aeries Technology Group (Aeries).  

Transaction Details

The HIM Transcription business includes both Nuance Transcription Services (NTS) and the eScription technology platform. The transaction is expected to be completed in early 2021. As part of the self-off, Nuance will be a minority shareholder of DeliverHealth and will continue to provide its technology to the company. DeliverHealth plans to build on HIM, transcription, technology and EHR services already in place while expanding into intelligent, technology-enabled revenue cycle automation and clinical documentation improvement services within the EHR’s workflow in 2021. DeliverHealth will include both Nuance Transcription Services (NTS) and the eScription technology platform. Financial details of the transaction were not disclosed.

Sell-Off Accelerate Growth as Conversational AI Market

 The sale
demonstrates Nuance’s continuing execution to focus R&D investments in the
healthcare and enterprise markets – where the company has substantial
competitive advantages and opportunities for growth and value creation. In
2019, for example, Nuance sold its document imaging business to Kofax and
spun-off its automotive business into Cerence, Inc., an independent,
publicly-traded company.

Nuance’s goal with the sale is to enable:

– Existing customers with continued service quality, newly
expanded offerings, and enhancements from DeliverHealth in close collaboration
with Nuance

– Nuance to focus its innovation and market resources as a
pure-play conversational AI market leader while providing continuity of EHR
Go-Live Services and HIM Transcription businesses to existing and new customers
via DeliverHealth

– DeliverHealth to leverage a leading position in healthcare
professional and technology-enabled services, expand global market share,
advance growth plans for the EHR Go-Live and Optimization Services, and provide
enhanced HIM technology and services to a worldwide market in partnership with

Nuance’s growth and market leadership in healthcare are
driven by the accelerating adoption and development of its core cloud-based AI
solutions, including the Nuance® Dragon® Ambient eXperience™ (Nuance DAX™)
ambient clinical intelligence (ACI) solution, Nuance Dragon Medical One, Nuance
CDE One, and its array of diagnostic imaging solutions such as PowerScribe One™
and PowerShare™.

“The dramatic acceleration in the digital transformation of healthcare continues as organizations deploy the power of conversational AI and deeply integrated cloud-based solutions at scale to address physician burnout, expand patient access, and improve system efficiencies and the revenue cycle,” said Mark Benjamin, CEO of Nuance. “With this strategic transaction, we’re aligning our resources to increase our market and technical leadership position in high-growth, high-impact areas that help our customers in a transformative way to improve patient care and operational performance. At the same time, we’re enabling the medical transcription and EHR Go-Live Services businesses to reach their full potential as a separate, focused company benefiting from the enhanced investment and operational experience of AHP and Aeries and technology support from Nuance.”

Success at a glance: call center scheduling

The manual process for fielding scheduling calls isn’t an easy one. Calls can take up to 20 minutes, and call center agents may have to comb through binders or spreadsheets of provider calendars and scheduling rules to book a single appointment.

As a result, call center staff may only be able to place a handful of patients per day, despite receiving hundreds of scheduling calls. This not only contributes to a poor patient experience but can cause care delays and potentially push patients to seek care from surrounding competitors.

Prior to working with Experian Health, call center agents at Heritage Medical Associates were manually scheduling patients with the process described above, and only able to place three to five patients per day with calls lasting several minutes.

With Experian Health’s call center scheduling solution in place, call center agents now have access to all of the organization’s 135+ providers in a single digital platform. With an integration with Allscripts, call center agents can see all available appointments in real-time, identify the best provider and appointment for a patient’s specific care need and then book the appointment on the spot.

Heritage Medical Associates has seen several improvements since working with Experian Health.

  • Increased call center efficiency. The time spent on the phone for scheduling an appointment has been nearly cut in half — from seven minutes down to just four. With more time, call center agents can now place between 40 and 50 patients per day.
  • Improved patient experience. Patients who called in to book an appointment, reported higher levels of satisfaction as they were able to navigate to the right provider and appointment more quickly.
  • Enhanced physician satisfaction. By automating their scheduling rules, providers can ensure that any open appointment slots are booked according to their personal preferences. They can better predict their schedules and maintain control over their calendars with the new solution.
  • Improvements to the bottom line. As each individual provider and separate location becomes more efficient, Heritage Medical Associates as a whole has been able to control overhead and has seen quantifiable improvement to its bottom line.

“The physicians that I’ve talked with so far find that they have a more efficient and planned day, and it’s more relaxing. Their productivity is increased, and, at the same time, they’ve been able to reduce some of the stresses of their schedule.”

Jim Browne, Chief Executive Officer, Heritage Medical Associates

Learn more about how you can improve call center efficiency and the patient experience with guided search and scheduling.

The post Success at a glance: call center scheduling appeared first on Healthcare Blog.

4 Ways to Combat Hidden Costs Associated with Delayed Patient Care During COVID-19

Matt Dickson, VP, Product, Strategy, and Communication Solutions at Stericycle
Matt Dickson, VP, Product, Strategy, and Communication Solutions at Stericycle

COVID-19 terms such as quarantine, flatten the curve, social distance, and personal protective equipment (PPE) have dominated headlines in recent months, but what hasn’t been discussed in length are the hidden costs of COVID-19 as it relates to patient adherence.  

The coronavirus pandemic has amplified this long-standing issue in healthcare as patients are delaying routine preventative and ongoing care for ailments such as mental health and chronic disease. Emergency care is also suffering at alarming rates. Studies show a 42 percent decline in emergency department visits, measuring the volume of 2.1 million visits per week between March and April 2019 to 1.2 million visits per week between March and April 2020. Patients are not seeking the treatment they need – and at what cost?

When the SARS outbreak occurred in 2002, particularly in Taiwan, there was a marked reduction in inpatient care and utilization as well as ambulatory care. Chronic-care hospitalizations for long-term conditions like diabetes plummeted during the SARS crisis but skyrocketed afterward. Similar to the 2002 epidemic, people are currently not venturing en masse to emergency rooms or hospitals, but if history repeats itself, hospital and ER visits will happen at an influx and create a new strain on the healthcare system.

So, if patients aren’t going to the ER or visiting their doctors regularly, where have they gone? They are staying at home. According to reports from the Kaiser Family Foundation, 28 percent of Americans polled said they or a family member delayed medical care due to the pandemic, and 11 percent indicated that their condition worsened as a result of the delayed care. Of note, 70 percent of consumers are concerned or very concerned about contracting COVID-19 when visiting healthcare facilities to receive care unrelated to the virus. There is a growing concern that patients will either see a relapse in their illness or will experience new complications when the pandemic subsides. 

Rather than brace for a tidal wave of patients, healthcare systems should proactively take steps (or act now) to drive patient access, action, and adherence.

1. Identify Who Needs to Care The Most 

Healthcare providers should consider risk stratifying patients. High-risk people, such as an 80-year-old male with comorbidities and recent cardiac bypass surgery, may require a hands-on and frequent outreach effort. A 20-year-old female, however, who comes in annually for her physical but is healthy, may not require that level of engagement. Understanding which patients are at risk for the potential for chronic conditions to become acute or patients who have a hard time staying on their care plan may need prioritized attention and a more thorough engagement effort. 

For example, patients with a history of mental health issues may lack motivation or momentum to seek care. Their disposition to be disengaged may require greater input to push past their disengagement.  

Especially important is the ability to educate and guide patients to the appropriate venue of care (ER, telehealth visit, in-person primary care visit, or urgent care) based on their self-reported symptoms.  Allowing patients to self-triage while scheduling appointments helps them make more informed decisions about their care while reducing the burden on over-utilized emergency departments.

2. Capture The Attention of The Intended Audience and Induce Action

Once you’ve identified who needs care the most, how do you break through the “information clutter” to ensure healthcare messages resonate with the intended audience? The more data points, the better. It is important to understand the age of the patient, their preferred communication channel, and the intended message for the recipient, but effective communication exceeds those three data points. Consider factors like the presence of mental health conditions, comorbidities, or health literacies. Then, think beyond the patient’s channel of choice and select the appropriate channel of communication (text, phone call, email, paid social media advertisement, etc.), that will most likely induce action. As an organization, also consider running A/B tests to detect and analyze behavior. As you collect more data, determine what exactly is inducing patient action. 

Of note, don’t underestimate the power of repetition. Patients may need to be reminded of the intended action a few times in a few different ways before moving forward with seeking the care they need. Repetition is also shown to decrease no-show rates, a critical metric. Proactive, prescriptive, and tailored communication will help increase engagement. Moving past the channel of choice and toward the channel of action is key.

3. Engage Patients Through Personalized and Tailored Communication 

In addition to identifying the right communication channel, it’s also important to ensure you deliver an effective message.  Communication with patients should be relevant to their particular medical needs while paying close attention to where each person is in their healthcare journey. Connecting with patients on both an emotional and rational level is also important. For example, sending a positive communication via phone, email, or text to lay the foundation for the interaction shows interest in the patient’s wellbeing. 

A “Hey, here’s why you need to come in” note makes a connection in a direct and personalized way. At the same time, and in a very pointed manner, sharing ways providers and health systems are keeping patients safe (e.g., telehealth, virtual waiting rooms, separate entrances, and mandating masks), also provides comfort to skittish patients. Additionally, consider all demographic information when tailoring communications. And don’t forget to analyze if changes in content impact no-show rates. Low overall literacy may impact health literacy and may require simpler and more positive words to positively impact adherence. 

It may sound daunting, especially for individual health systems, to personalize patient communication efforts, but the use of today’s data tools and technological advancements can relieve the burden and streamline efforts for an effective communication approach. 

4. Use Technology to Your Advantage (With Caution)

Once you have developed your communication strategy, don’t stop there.  Consider all aspects of the patient journey to drive action.  A virtual waiting room strategy, for example, can help ease patient concerns and encourage them to resume their care. Health systems can help patients make reservations, space out their arrival times, and safeguard social distancing measures—all while alleviating patient fears. Ideally, the patient would be able to seamlessly book an appointment and receive a specific arrival time, allowing ER staff to prepare for the patient’s arrival while minimizing onsite wait time.

When implemented properly, telehealth visits can also improve continuity of care, enhance provider efficiency, attract and retain patients who are seeking convenience, as well as appeal to those who would prefer not to travel to their healthcare facility for their visit. Providers need to determine which appointments can successfully be resolved virtually. Additionally, some patients might not have the means for a successful telehealth visit due to a lack of internet access, a language barrier, or a safe space to talk freely.

To ensure all patients receive quality care, health systems should make plans to serve patients who lack the technology or bandwidth to participate in video visits in an alternative manner. For example, monitor patients remotely by asking them to self-report basic information such as blood sugar levels, weight, and medication compliance via short message service (SMS). This gives providers the ability to continuously monitor their patients while enhancing patient safety, increasing positive outcomes, and enabling real-time escalation whenever clinical intervention is needed.

It is important we ensure all patients stay on track with their health, despite uncertain and fearful times. Health systems can enhance patient adherence and induce action through the implementation of tools that increase patient engagement and alleviate the impending strain on the healthcare system. 

About Matt Dickson

Matt Dickson is Vice President of Product, Strategy, and General Manager of Stericycle Communication Solutions, a patient engagement platform that seamlessly combines both voice and digital channels to provide the modern experience healthcare consumers want while solving complex challenges to patient access, action, and adherence. . He is a versatile leader with strong operational management experience and expertise providing IT, product, and process solutions in the healthcare industry for nearly 25 years. Find him on LinkedIn.

How health plans can reduce ED visits and readmissions post-pandemic

Visits to emergency departments (ED) dropped by 42% in the early months of COVID-19, according to the CDC. In pre-pandemic times, this might have been a positive sign. Two-thirds of ED visits are thought to be avoidable, with emergency care used as a safety net in the absence of access to more appropriate services. Excessive emergency care also comes with a high price, often resulting in a poor patient experience. UnitedHealth Group estimates that the 18 million preventable visits per year cost the health system up to $32 billion annually.

Unfortunately, the rapid decrease in ED use during the pandemic isn’t a signal that care management and access challenges have been resolved. Social distancing, stay-at-home orders and fear of being exposed to COVID-19 have prompted patients to avoid seeking care in person altogether. Inevitably, as more individuals either postpone or forego the care they need, ED use will start to creep back up again.

For health plans, the worry is a sudden influx of their members returning to emergency departments with more complex care needs arising from delayed treatment. Medical costs could sky-rocket, while gaps in care could reach critical levels as health plans and providers struggle to keep track of ED admissions and readmissions.

As health plans look to curb ED utilization in the aftermath of COVID-19, digital tools can provide a valuable lifeline.

4 ways health plans can use digital tools to reduce unnecessary ED visits

1. Take action to engage members before acute episodes occur

Proactively involving members in their own care management can help head off unnecessary ED visits before they’re even a possibility. Understanding how the social determinants of health affect a member and how they access care can help health plans tailor their engagement strategies and close gaps in care.

Experian Health’s Member Engagement Solutions draw together all the insights needed to connect the dots between emergency visits, social and economic risk factors, and digital care coordination, so health plans can communicate with members in the most effective way.

2. Make it easier for members to access care when they need it

Part of the ED visit volume is based on members’ frustration of not being able to access care when they want or need it.

Health plans can prevent unnecessary ED visits by sending automated outreach prompts to encourage members to schedule appointments, via interactive voice response or text. A digital scheduling platform can give the member an easy way to book their appointment, without needing to call during office hours. With digital scheduling, health plan member engagement teams and call centers can facilitate member appointment scheduling with the right providers without the cumbersome three-way call.

3. Implement a real-time tracking strategy for ED admissions

One of the biggest challenges for health plans is not knowing when members are admitted to the emergency department.

A tool such as MemberMatch® can alert health plans of their members’ real-time ED encounters, so they can rally around active episodes of care – potentially avoiding unnecessary, out-of-network admissions and readmissions – and optimize the cost and quality of encounters across the continuum of care post-discharge. Using Experian Health’s leading referential matching system, a member’s care team can be notified via text, portal or email for quick insights that enable better care coordination.

4. Ensure better management of post-discharge follow-up care

Every health plan’s checklist for reducing readmissions should include a follow-up strategy when patients have visited the ED. Given that post-ED follow-up for members with chronic conditions is likely to be a STAR measure in the future, plans should prepare their proactive intervention strategy now.

USMD WellMed Health System used Experian Health’s Member Utilization Management Solutions for better care coordination for patients within 30 or 90 days of leaving hospital, significantly reducing their readmissions rate. Within just four months, the ROI trends gave them confidence to roll out Care Coordination Manager from USMD clinics to WellMed clinics too.

Reducing admissions and readmissions is not about making access to the ED more difficult, but making access to other services, care options, and care management solutions easier. With the right digital solutions, health plans can take action to make this unprecedented transition of care from the ED to other, more cost-effective arenas the ‘new normal’ and put the old model of ED over-utilization in the past.

Contact us to learn more about how Experian Health can help health plan reduce unnecessary ED visits.

The post How health plans can reduce ED visits and readmissions post-pandemic appeared first on Healthcare Blog.

Innovaccer Launches Member Engagement Solution to Scale-Up Digital Transformation Efforts with Payers

Innovaccer Launches Member Engagement Solution to Scale-Up Digital Transformation Efforts with Payers

What You Should Know:

–  Innovaccer
launches member engagement solution for healthcare payers to drive improvement
in healthcare cost and quality boosts member satisfaction and enhances member
enrollment and retention.

– Innovaccer’s solution create member-oriented care
plans, enhance connectivity with care managers, and drive interventions for
social determinants of health risks through the solution.

Innovaccer, Inc., a
leading healthcare
company, has launched its member engagement
for healthcare payers. The solution will enable payers to use a
more consumer-oriented approach and allow the network members to take charge of
their own healthcare journeys. The solution will empower them with the right
information, resources, and the network’s best-performing providers.

Creating a Patient-Centered Care Paradigm

U.S. healthcare is making strides toward a more
patient-centered care paradigm. The latest Interoperability and Patient Access
final rule is one of the initiatives that put patients at the center of care.
The rule made it mandatory for payers to share electronic health data with
patients, which will enable them to participate more in their healthcare

In addition to meeting the regulatory requirements, the
member engagement solution enables payers to provide on-demand, mobile-based
educational materials, lab and test results, clinical visit notes, personalized
health assessments, and digitized services to health plan members.

Enabling Payers to Become More Patient-Centered

Innovaccer’s solution enables payers to become more
patient-centered.  Payers can create member-oriented care plans, enhance
connectivity with care managers, and drive interventions for social
determinants of health risks through the solution.

“By building strong payer-beneficiary collaboration, we will be able to establish a more active, responsible, and value-driven care journey. Engaged members will know and understand exactly what is being done for the successful management of their medical conditions. A more informed and savvy member can potentially contribute to improving the quality of care, reduce excessive resource utilization, and decrease their costs,” says Abhinav Shashank, CEO at Innovaccer.

Humana Taps Cohere Health to Modernize Prior Authorizations for Musculoskeletal Treatment

Cohere Health Launches with $10M to Increase Transparency Across Care Journey

What You Should Know:

– Cohere Health partners with health insurer Humana to modernize
the prior authorization process for musculoskeletal treatment across 12 states.

– In addition, the company has closed an additional $10M
in funding led by Flare Capital Partners and Define Venture, bringing the
company’s total funding to $20M.

Health insurer Humana has signed an agreement with healthcare collaboration company Cohere Health to improve the prior authorization process for musculoskeletal treatment across 12 states, starting Jan. 1, 2021. Cohere aligns physicians, patients, and health plans on a patient’s optimal healthcare experience—enabling access to higher quality care while at the same time minimizing administrative burden and siloed decision-making.

The partnership leverages CohereNext Platform’s prior authorization capability which grants authorizations across an entire episode of care, in effect pre-authorizing a complete treatment regimen from the initial diagnosis to treatment plan selection, and, ultimately, to the patient’s return to good health. Cohere’s approach aims to expedite evidence-based treatment plans to improve the healthcare experience for doctors and patients alike.

Humana to Leverage CohereNext Platform to Streamline
Prior Authorizations

As part of the partnership, Humana will employ the CohereNext Platform to streamline prior authorizations in musculoskeletal treatment in Alabama, Georgia, Indiana, Kentucky, Michigan, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, and West Virginia. The platform will initially serve approximately 2 million members and more than 3,500 physician practices.

This partnership supports Humana’s vision to reimagine and modernize processes for prior authorization by reducing approval times and improving the delivery of care, all while preserving important benefits such as safety, predictability, and cost containment.

Cohere’s solution will initially focus on prior
authorization; the company is developing additional use cases such as
value-based contract performance, improving physician and patient engagement,
and optimizing health plan clinical programs. By facilitating physician and
health plan collaboration, Cohere’s technology will help accelerate the
evolution to value-based care models.

“Through this strategic initiative and collaboration with Cohere Health, Humana is building on its commitment to reduce the complexity and friction of prior authorization for our physicians and members,” said William Shrank, MD, MSHS, Chief Medical Officer, Humana and Board Member, Cohere Health. “Cohere’s solution was co-designed with physicians and represents a major leap forward in improved physician experience and the adoption of evidence-based medicine.”

Cohere Health Closes Additional $10 Million in Funding to
Accelerate Delivery of Patient Journey Platform

In addition, the company announced it closed an additional
$10 million in funding led by Flare
Capital Partners
and Define Ventures,
bringing the company’s total funding to $20 million. The funding will be used
to enhance the company’s scalable CohereNext® platform that is built on
next-generation cloud and data technologies and provides interoperability to
existing healthcare infrastructure as well as the emerging digital health

Series A extension comes just two months after Cohere Health’s initial $10 million Series
A funding, which was also led by Flare
Capital Partners with Define Ventures contributing as an investor and partner,
as well as participation from a leading national strategic partner.

The CohereNext Platform improves the physician experience
and quality by:

– Authorizations that begin with diagnoses and not billing

– Facilitating and auto-approving evidence-based treatment plans

– Delivering a peer review process with a true peer
specialist or sub-specialist

– Sharing quality performance relative to peers for specific
care paths and patient cohorts

– Providing tools, data and technology that optimizes
value-based payment

“The tragedy of COVID-19 has reinforced that the basic infrastructure supporting healthcare innovation is fundamentally broken. The shift from fee-for-service to value-based-care requires enabling interoperable capabilities to facilitate care around the interests of patients, and as a result, Cohere Health continues to rapidly grow and attract additional investments,” said Siva Namasivayam, CEO and founder of Cohere Health. “The additional funding will enable us to expand the CohereNext platform to impact more failure points across patient journeys so that physicians can deliver better outcomes and we can continue building our team, which has grown by more than 95 people this year.”

Patient acquisition and retention strategies to implement post COVID-19

A consumer-first healthcare revolution has been simmering for years. Despite efforts to create more human-friendly services, the industry still lags behind other consumer-centric sectors. Patients want healthcare to be simple, convenient and on-demand, but a persistent lack of coordination, accessibility and affordability leaves many struggling to navigate the healthcare landscape with ease. Is this about to change? Has COVID-19 flipped the switch?

The pandemic has prompted people to engage with their own care in a way the industry hasn’t seen before, with a surge in telehealth and virtual care. Infection-control forced much of the patient journey online, while providers were pushed to find new ways to communicate quickly and clearly. Now, those with an eye on the road to post COVID-19 financial recovery are optimizing these digital strategies to meet new consumer expectations and improve patient loyalty.

Embracing digital technology and automation throughout the entire patient journey will be key to patient acquisition and retention. Where should providers focus first?

4 consumer-led strategies to keep patients loyal

1. Prioritize convenience across the entire consumer experience

Eighty percent of patients would switch providers for convenience factors alone – ranking ‘convenient, easy access’ ahead of insurance coverage and quality of care. Creating a digital experience that gives patients the flexibility and simplicity they desire should be priority number one in any patient loyalty plan.

Providers can start by reviewing their digital platforms. Encourage patients to use their patient portal to access information, book appointments and manage their healthcare when appropriate. Telehealth and virtual care solutions can be future-proofed with reliable identity protection, so patients can safely access care from home and not worry about cumbersome log-in procedures.

2. Make patient access…accessible

The patient experience shouldn’t begin with time-consuming forms, long waits and error-prone manual intake processes. Rather, providers can make it easy for patients to complete as many tasks as possible BEFORE they set foot in the office by automating patient access.

Online patient scheduling lets patients book, cancel and change appointments online – which 77% of patients say is very important. It has the potential to reduce delays and no-shows, and can minimize the administrative burden for provider staff. While patients remain concerned about the risk of infection during COVID-19, providers can ease their concerns by reducing face-to-face contact with online pre-registration.

3. Respond to affordability and pricing pain points

One Experian Health study found that the top pain points in the consumer journey center on the financial experience, from shopping for health insurance to understanding medical bills. Patients may be unsure what their insurance covers, whether their deductible has been met and whether they can afford the out-of-pocket costs. By providing clear, upfront pricing information about coverage and financial responsibility, providers can protect their patients from unnecessary surprises and reduce the risk of missed payments.

Self-service patient payment tools can simplify the payment process too: patients can settle their bills anytime, anywhere, and get advice on financial assistance and best-fit payment plans.

4. Personalize the patient experience from end to end

A one-size-fits-all approach doesn’t cut it anymore. Patients are looking for communications and services tailored to their individual needs. That used to be both technically and logistically impossible, but not anymore. Providers today can use comprehensive data and analytics to personalize the entire healthcare journey, from customer relationship management to patient collections.

By combining automation, self-service tools and accurate insights into the patient’s circumstances, providers can help consumers make better decisions about their care and how to pay for it. To ensure data reliability and integrity, providers should consider partnering with a trusted data vendor, who can translate robust, multi-source consumer and financial data into a competitive consumer experience.

There is no question that COVID-19 has changed the way we do healthcare, but the industry is perfectly posed to harness the change in consumer behavior and shift towards greater patient engagement. By bringing together a myriad of digital tools, providers can create a healthcare experience that’s convenient, compassionate and in line with consumer expectations.

Interested in learning more about how we can help your organization welcome new patients through its digital door, and boost loyalty among existing patients?

Contact us.

The post Patient acquisition and retention strategies to implement post COVID-19 appeared first on Healthcare Blog.

CommonWell Enables Payer Access to Nationwide Interoperability Network

FHIR-based APIs Health Gorilla Becomes Largest CommonWell Connector

What You Should Know:  

– CommonWell Health Alliance enables payer access with the addition of a new service provider, DataFile Exchange to support the operational services specific to the Payment and Health Care Operations use case.

Health Alliance
today announced it is extending its interoperability
services to enable additional use cases beyond treatment and patient access,
starting with Payment and Health Care Operations data requests.

Data File Exchange Background

To support this effort, CommonWell has added a new service
provider, DataFile Exchange, to support the operational services specific to
the Payment and Health Care Operations use case. Together, DataFile Exchange
and Change Healthcare, the technology service provider for CommonWell, will
facilitate the automated exchange of data requests from a broader set of users,
including payers, record locator vendors and other qualified entities.

Why It Matters

Despite strides made in electronic clinical data exchange, existing payments and operations processes providing access to protected health information (PHI) remain archaic, predominantly manual, expensive, error-prone, and time consuming. The additional functionality provided by the new use case aims to end these outmoded processes, improve the quality of care, and drive efficiency across the health care continuum.

DataFile Exchange was founded by Janine Akers, an industry leader in the exchange of PHI. DataFile Exchange will work closely with CommonWell, its members, and Change Healthcare, which continues to act as the CommonWell technology service provider and data broker for the CommonWell network––in addition to building the functionality needed to support Payment and Health Care Operations data requests.

“Improving data exchange of Payment and Health Care Operations is critical, particularly as we look at ways to help our health care system do more with less time and resources,” said Janine Akers, founder and CEO of DataFile Exchange. “DataFile Exchange has broad industry experience with handling PHI, so it’s only natural for us to shift our focus to automating the exchange of PHI. We’re well-positioned to partner with CommonWell in its effort to help patients, providers and payers benefit from these next-level interoperability services.”

Four CommonWell Service Adopters who provide record
retrieval services––Change
CioxInovalon and Moxe Health––currently are participating in
a pilot to refine the use case, with the goal of making CommonWell services for
Payment and Health Care Operations purposes generally available for these underserved
areas in the coming few months.

Today, the CommonWell network enables the federated exchange
of patient information across more than 17,000 provider sites representing 100
million individuals on its nationwide network alone. Combined with its CommonWell
ConnectorTM and collaboration connections like the Carequality Framework,
connected provider sites can exchange data with more than 50,000 clinics,
hospitals, specialty centers and more. To date, more than 790 million health
documents have been exchanged across the CommonWell network.

Success at a glance: online self-scheduling after hours

It’s important to provide our patients with the absolute best access channels to quickly and seamlessly connect with the care they need. Experian Health’s solution guides our patients to the right care and digitally connects them with a confirmed appointment.” – Kaci Husted, Vice President, Benefis Health System

It’s shouldn’t come as a surprise that patients today want their healthcare experience to mirror the flexibility and convenience that they are now accustomed to with other industries. Notably, patients want easier and faster access to care, and preferably without having to pick up the phone to call and make an appointment.

Benefis Health System knew it needed to provide patients with a new and improved access experience. Patients were required to call the office during business hours to book an appointment, and while some may have been immediately connected with a scheduler, others would have to leave a voicemail or be placed on hold. The process was not only taking valuable time out of patients’ days but carried the risk of delaying care.

With online self-scheduling in place, patients can schedule an appointment online with any of Benefis Health System’s 300+ providers, regardless of time of day. The solution leverages powerful decision support, which guides patients directly into the appointment type and provider necessary for the treatment they need. It’s good for patients and providers, as the solution’s accuracy prevents any misplacement of patients to the wrong provider or appointment type.

Patients started using the self-scheduling solution almost immediately after it was available. Benefis Health System has since experienced the following results:

  • Improved access to care. Patients of Benefis Health System have used the system to book many appointments outside of office hours, with 50% of its patient base booking after hours.
  • Better access to urgent care. One of Benefis Health System’s urgent care centers has seen a large uptick in online self-scheduling. In fact, 52% of patients are scheduling appointments online for that location.
  • Ongoing improvements with analytics. Benefis Health System is leveraging analytics to track how many patients use online self-scheduling and can identify when and where they might fall out. They can see the pitfalls and where improvements may be necessary and make those changes in real time to drive better conversion rates. Currently, 23.6% of patients who start the process are converting to a booked appointment.

Interested to see how online self-scheduling can help your organization improve access to care?

Learn more.

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The benefits of online scheduling during a “twindemic”

In previous winters, anyone struck by a sore throat or fever might assume they had flu, and head to bed with a hot drink and some painkillers. This year, the looming specter of COVID-19 could prompt those with flu-like symptoms to seek medical care instead. Combined with a likely second wave of COVID-19 cases as lockdown requirements relax, healthcare organizations anticipate a surge in patients seeking tests and treatment this winter.

To protect against a possible “twindemic”, where COVID-19 and winter flu season collide, providers will want to ensure the patient intake and access process is as easy and efficient as possible—and not just for regular appointments with a primary care physician or specialist, but for pandemic- and flu-related services like COVID tests, flu shots, and more.

Online scheduling has been a game-changer during the pandemic: could it be the key to surviving a twindemic? With the right digital tools in place, providers can screen patients for their COVID-19 or flu risk before attending an in-person appointment, helping separate healthy patients from those suspected of having either illness. Providers can also leverage those same digital tools to streamline activity like flu shots, or even drive-through testing for COVID-19.

Four ways to leverage digital scheduling for a twindemic

These four steps could be key to protecting patients, streamlining workflows and reducing pressures on call centers during flu season as it collides with COVID-19:

1. Create screening questionnaires during patient scheduling

As soon as the patient logs on to book an appointment, they are asked to answer a few short questions about their symptoms. A screening questionnaire can triage people wanting to get tested, while the answers inform providers of the likelihood of a patient having COVID-19 and if that individual needs to quarantine. After being screened, the system can direct patients through the correct channel of care based on the information provided.

A similar questionnaire could be adapted during flu season for providers to assess and compare symptoms and risks ahead of time. Providers can even designate day and time slots available to patients for flu vaccinations, making it easy for patients to schedule on their own time and further minimizing the risk of unnecessary contact with other patients in office.

2. Direct patients to drive-through testing to minimize in-person tests

Depending on the answers given during screening, patients may be directed to virtual and disease-specific care, such as drive-through COVID-testing. An online scheduling platform can easily be used to book appointments for tests, presenting patients with any available time slots, either same-day or a few days out. The platform can also record information about the patient’s vehicle to quickly identify patients and avoid bottlenecks in the drive-through.

With so many patients hesitant to show for in-person visits today, a similar system for flu shots could serve providers well.

3. Use guided search to direct patients to the right virtual services

Virtual care has proven both necessary and valuable during the current pandemic. Not only has it kept patients in close contact with providers and specialists, but it has helped providers capture revenue lost from the cancellation or delay of in-person appointments.

Virtual care will be increasingly critical during a dual COVID-19/flu season. By asking the right questions during online scheduling, patients can be connected to the correct provider, whether virtual or in-person, for their needs and book an appointment quickly and easily.

4. Eliminate walk-through traffic at urgent care centers

Urgent care centers are already known to be the ‘doctor of choice’ for many patients, but this could pose a few challenges for both patients and providers during a dual pandemic. Rather than be a gathering spot for patients with both illnesses, urgent care centers may want to consider switching to an appointment-only system, where appointments must be scheduled online or by phone. This can help reduce the number of in-person visits and walk-in traffic, which will not only help keep everyone safe and healthy but contribute to a far better patient experience as patients wouldn’t have to sit and wait to be seen by a provider.

Interested in hearing more about how online scheduling could help your organization manage flu season as it collies with COVID-19?

Learn more.

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Success at a glance: improved collections, part one

Before working with Experian Health, call center operations at Sanford Health were disparate and disjointed, with each call center operating on a different phone system with different carriers. While some centers saw high abandonment rates, others were waiting around for calls. Although Sanford attempted to create balance by placing accounts in a work queue, the process for managing outbound collection calls remained manual and it was impossible to identify and strategically contact patients based on ability to pay.

Sanford took steps to improve collections with a patient-focused, hybrid approach that combines employee incentives with segmentation strategies.

Since working with Experian Health, Sanford now has a focused approach to managing accounts receivable (AR) by identifying patients with a certain propensity to pay. Collections Optimization Manager allows Sanford to quickly identify a pathway and delivery to resolution of the patient’s balance.

The analytical segmentation models within Collections Optimization Manager use precise algorithms that reveal those patients who likely are eligible for charity services, those who might prefer to pay in full at a discount, or those who might benefit from a payment plan. The solution then feeds segmentation data to PatientDial, which Sanford uses to route calls to 70 patient account representatives.

Sanford also implemented a re-designed, more user-friendly patient statement format. The improved cover page offers easy-to-understand information about the bill including the available options for payment.

In a larger effort to improve the patient experience, Sanford implemented an employee incentive program that appropriately rewards staff based on their collections’ performance.

Since working with Experian Health, Sanford has seen the following improvements:

Streamlined call center operations. With PatientDial in place, Sanford was able to consolidate its call center team members in 4 regions and seamlessly operate on centralized toll free and direct dial numbers. Where it used to take on average 56 seconds for a call to be answered, calls are now answered in 20 seconds or less. The system now comfortably manages an average of 12,000 inbound calls weekly.

Increased collections. The model in place has allowed Sanford to improve collections in a myriad of ways. In addition to increased collections from calls made through PatientDial, Sanford was able to see an additional $2.5M in patient payments by ensuring patient statements were sent to the new or correct address. The system found an additional $60K by identifying new guarantors for accounts of deceased patients. The segmentation capabilities from Experian Health also enabled Sanford to identify patients struggling with bankruptcy, allowing staff to focus their efforts on collectible accounts and more efficiently direct individuals to charity options.

Learn more about Sanford Health’s journey and how a similar approach could help your organization improve collections and employee satisfaction.

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Finding unidentified coverage without a Social Security Number (SSN)

Finding previously unidentified insurance coverage can feel a little like a game of hide and seek. Patients may not always be aware of their insurance or eligibility for Medicare and Medicaid, and, in an effort to both improve the patient financial experience and simultaneously improve collections, providers are often tasked with finding this information on the spot. Historically, providers have used demographic information like Social Security Numbers (SSN) as a means to verify patient identities and locate this information, but that tactic is increasingly unreliable as it is possible for more than one person to use the same SSN and SSNs are a lucrative route to stealing someone’s identity.

With this in mind, many health plans are no longer using SSNs as an identifying number for insurance coverage. In fact, the Centers for Medicare & Medicaid Services recently removed SSN-based Health Insurance Claim Numbers (HICNs) from Medicare cards and are now using Medicare Beneficiary Identifiers (MBIs) for Medicare transactions like billing, eligibility status, and claim status.

The latest health plans to remove this piece of demographic information is Health Net Medi-Cal and Health Net National. Effective September 25, 2020, the search options for eligibility for this plan have changed. Providers will ONLY be able to find and verify coverage with a subscriber ID.

“Providers are often tasked with finding this information on the spot.”

While Health Net Medi-Cal and Health Net National are the latest health plans to do away with demographic searches, it’s certainly not a surprising trend and more will likely follow suit.

Bridging the gap with historical data

Uncovering previously unidentified coverage is critical for providers as it helps to eliminate costly self-pay situations, bad debt write-offs and unwarranted charity designations. And, without the proper insurance information, patients also risk delayed access to care and other financial hardships.

With demographic searches on the decline, providers will need a more efficient and reliable way to search for coverage. As a data-driven company with a historical repository of claims data, Experian Health is uniquely positioned to help providers search for coverage.

Combining search best practices, multiple proprietary databases and historical information, Experian Health’s Coverage Discovery locates patients’ billable commercial insurances that were unknown or forgotten, and combs through Medicare and Medicaid coverage. This flags accounts that may have been destined as a write-off or charity and maximizes reimbursement revenue by identifying primary, secondary and tertiary coverage. Not only do fewer accounts go to bad-debt collections, but providers can automate the self-pay scrubbing process.

A tool like Coverage Discovery is even more beneficial for providers during COVID-19, where limitations of face-to-face contact make it more difficult to complete the usual coverage checks. Coverage Discovery empowers providers to facilitate coverage checks remotely, avoiding delayed reimbursements during a time when revenue streams are already feeling pressure.

“As a data-driven company with a historical repository of claims data, Experian Health is uniquely positioned to help providers search for coverage.”

Want to learn more? Contact us to see how Coverage Discovery can help find previously unidentified coverage and reduce bad debt.

The post Finding unidentified coverage without a Social Security Number (SSN) appeared first on Healthcare Blog.

How health plans can close more gaps in care with digital scheduling

Four in ten Americans live with multiple chronic conditions. For these individuals, life is punctuated with physician appointments, visits to the pharmacy and referrals to different specialists. Their care should be coordinated with orchestral precision, but the reality is somewhat less harmonious. Snail-paced scheduling systems, poor communication and mismatched patient records can lead to a lack of proper support for patients, confusion about how the care plan is managed, and potentially dangerous (and costly) gaps in care. For health plans, quality markers are missed and incentive payments start to dwindle.

To help close these gaps, health plans must embrace a more innovative, consumer-focused approach to care coordination. Digital scheduling platforms make it easy for call center agents to help members find and book appointments, eliminating the need for a three-way call between the member and provider. Members are much more likely to be placed with the right clinician, at the right time and for the right appointment, while health plan call centers can operate far more efficiently. The automation and data integrity of digital systems makes it much easier to track and book appropriate post-discharge appointments and routine care management.

Digital scheduling has the potential to improve health outcomes, drive up operational efficiency and yield big savings down the line. It’s about more than just matching consumer expectations, though a great member experience is certainly a competitive advantage for health plans. Better coordinated care could be life-changing for patients with chronic conditions. And with more members switching plans and seeking call center support in light of COVID-19, there’s a short-term urgency to tighten up communications and direct members to the care they need. Could a digital scheduling platform help your health plan close gaps in care and create a better member experience?

Learn more.

The post How health plans can close more gaps in care with digital scheduling appeared first on Healthcare Blog.

Seniors navigating healthcare technology in a post-COVID world

Products referenced in this article:

With just a few clicks, patients can book appointments, speak to their doctor, access billing information and pay for care, all without leaving their homes. Online health services have been a lifesaver for many during the pandemic, and the reliance on digital tools has sky-rocketed over the last few months. But for some older consumers who may be less comfortable using digital devices, this shift towards “healthcare from home” feels daunting and isolating.

Many seniors are not immersed in the digital culture and navigate life just fine without a touchscreen. The sudden shift in healthcare delivery channels has demanded many to venture into unfamiliar technology in a rushed and urgent manner. Others face barriers related to things like dementia, hearing loss and vision loss.

Closing the digital divide

Whatever their age, those left out of the digital loop face a higher risk of missed appointments, delayed care and anxiety about how to get tests and treatment. Providers will want to ensure that all of their digital offerings are designed to help patients of every age access care in a way that works for them. That means creating a consumer experience with pathways and channels to suit different patient needs and expectations, including “analog” options for those who aren’t inclined to learn new technologies.

4 ways to make digital health technology more senior-friendly

1. Use data to determine what’s working and what’s not

The starting point for providers who want to improve seniors’ digital engagement is to understand how they’re actually using it (or not) right now. Non-clinical data can give insights on technology engagement, lifestyle and socioeconomic circumstances across all ages in a patient population. When providers know what patients are looking for, and where the gaps are, they can tailor their services to meet their patients’ needs.

For example, let’s say a proportion of an organization’s older members have smartphones or tablets, but aren’t using them to access their patient portals. It’s likely they have the skills so but may not be aware of the service. This can be solved with a simple omnichannel outreach campaign to provide step-by-step instructions explaining how to get started.

One way for providers to capture useful data is with “Z codes” — the ICD-10-CM codes included in categories Z55-Z65. These identify non-medical factors that may influence a patient’s health status. Utilizing Z codes will enable better tracking of seniors’ needs and identify solutions to improve their health and wellbeing.

Providers can also leverage data to better understand seniors’ activity in the continuum of care. Are older patients continually presenting for care at a facility that is out of network? A tool like MemberMatch can deliver these insights in real time, alerting care teams as early as possible so that they can rally around active episodes of care proactively and efficiently. This helps risk-bearing organizations optimize the quality and cost of member activity in the continuum of care, leading to better outcomes for patients and a better bottom line for organizations responsible for their health.

2. Give patients choices about how they access services

Adoption of healthcare technology is increasing among older adults: 76% of over 50 say they welcome services to help them “age in place”, or live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level. At CareMount Medical, 27% of primary care appointments made using Experian Health’s online scheduling tool are initiated by those aged 60 and over. The demand is there; support should follow.

That said, an omnichannel approach is still important. Given a choice, more than half of people aged 50 and over prefer their health be managed by a mix of medical professionals and technology. This means giving patients the option to easily schedule appointments by phone. Automated outreach and integration, combined with practice management systems, will ultimately make patient scheduling easier.

3. Make virtual care easier to use

More than half of seniors cancelled or delayed appointments due to COVID-19. Despite the promise of safety measures, many are hesitant to return. Virtual care may be the answer.

Providers are quick to learn that telehealth is not a panacea, in particular for the senior population. As some patients may not have the technology and skills to access telehealth, providers may want to consider a hybrid “facilitated telehealth” model where medical professionals visit patients’ homes to help them get set up for telehealth visits.

4. Create a smoother patient financial experience

As older patients become newly eligible for Medicare, many are unclear about their coverage status. To take the burden off the patient, providers should consider a tool such as Coverage Discovery, which allows staff to find MBI numbers quickly. This often proves helpful, particularly for new Medicare beneficiaries who may not have received their MBI card yet.

A way to ease the stress of payments is to offer more transparent pricing so patients know what to expect as they start their healthcare journey. Experian Health’s Patient Financial Advisor gives a breakdown of their bill and payment options, helping them feel financially confident and more in control of their ability to pay – resulting in fewer collections issues.

As older patients become more accustomed to paying for other everyday items through their smartphones or laptops, online patient payment solutions will become less foreign and more convenient, allowing them to manage medical payments in a time and place that suits them.

It’s never been more important to help older patients stay connected, access care and feel supported during their healthcare journey. Contact us to explore how Experian Health’s solutions can help you close the digital divide.

The post Seniors navigating healthcare technology in a post-COVID world appeared first on Healthcare Blog.

Is COVID-19 another catalyst for price transparency?

Few of us would buy a new car or TV without
checking the price tag first. Why should our healthcare be any different? Yet
this is exactly what many patients are forced to do when they need medical tests
or treatment.

Following the breadcrumbs on a provider’s
website is a time-consuming and confusing way for patients to piece together a price
estimate. Even with a rough idea of the cost of care, variations in health plan
pricing often bump up the final bill. The lack of transparency is stressful for
patients and costly for providers, who end up chasing slow payments and losing
revenue to bad debt. But could things be about to change?

Many providers have been proactive in
offering transparent pricing, and thanks to recent regulatory changes, this could
soon be an industry-wide requirement. The CMS
Price Transparency Final Rule
mandates that by 1 January 2021, hospitals
should publish consumer-friendly pricing information on certain ‘shoppable’
services, to help patients understand and plan their bills ahead of time. The
proposed Health
PRICE Transparency Act
would similarly compel providers to publish real
cash prices alongside rates negotiated with insurers. As households, businesses
and public bodies grapple with the economic impact of COVID-19, any additional
clarity around pricing that could help make a dent in healthcare-related debt
is to be welcomed.

Liz Serie,
Director of Product Management and Patient Experience at Experian Health, says
that regardless of changes to the regulatory landscape, pricing transparency is
here to stay:

“It’s great for the patient because they
have visibility, transparency and clarity about what they owe. They can prepare
financially before their visit, so they can focus on what matters most –
healing. Providers are excited about price transparency tools because they let
patients pick and plan payment options, reducing the total cost to collect. And
with more reliable billing data, it’s a win from a decision-making perspective

Transparency is becoming the norm in other
aspects of healthcare consumer experience, and billing should be no different.

4 steps to fast and simple patient-friendly

1. Remove the guesswork with accurate, upfront pricing estimates

No one wants to play detective with their deductibles. Giving patients pricing information upfront puts them in control of their payments, improving their engagement and increasing the likelihood of faster collections – a top priority for providers today as they continue to feel the effects of COVID-19 on the bottom line.

A Patient
Estimates tool
can generate accurate, easy-to-understand estimates based on
known treatment costs, payer rates and real-time benefits data. Estimates and
secure payment options can be sent straight to the patient’s mobile device,
improving the patient financial experience with a single text message.

2. Give patients 24/7 control through their online portal

With COVID-19
pushing even more of our lives online, a 24/7 patient portal is a must for
providers that want to stay competitive.

Yale New Haven
Health (YNHH) used PatientSimple
to give patients a mobile-friendly, self-service portal through which they can
generate price estimates, choose payment plans, and monitor payment
information. Sharlene Seidman, Executive Director Corporate Business Services
at YNHH says patients have welcomed online access:

“ROI is not just
tangible dollars in additional revenue, it’s patient satisfaction and improving
the financial experience.”

3. Minimize delayed payments with quicker insurance checks

Millions of Americans have experienced sudden job
losses or changes to their insurance status in the wake of the pandemic,
causing confusion about their current coverage. Payment delays and denied
claims are an inevitable side-effect. Providers can help by offering fast,
automated insurance eligibility verification, so patients can confirm coverage at the point of
service and take the next steps with confidence.

4. Move to mobile for a more convenient patient experience

Imagine if your patients could have all the information they need about their healthcare account, right there in their pocket. Patient Payment Solutions offer real-time pricing estimates based on provider pricing, payer rates and benefit information, so patients can review their bill at a time and place that suits them. There’s also the option to offer secure and contactless payment methods, so they can settle their bill at the click of a button.

the average family of four could save up to $11,000 a year if they had the
option to choose care on the basis of more transparent pricing. Savings on this
scale mean that demand for clear information about out-of-pocket expenses is
going to soar, whatever happens with price transparency regulations.

Learn how Experian Health can help your
organization support patients and improve collections through more transparent

The post Is COVID-19 another catalyst for price transparency? appeared first on Healthcare Blog.

Improving patient intake during COVID-19 starts with patient experience upgrades

Despite the majority of elective procedures
being up and running again, patients are still keeping their distance. Nearly
half of Americans
say they or a family member have delayed care since the
beginning of the pandemic, while visits to the emergency room and calls to 911
have dropped
. Patients are avoiding care, but it’s not for the reason
you’d expect.

Beyond obvious worries about catching and
spreading the virus, a second concern is becoming apparent: patients are
fearful of the potential cost of medical care. With so many furloughed, laid
off or losing their insurance coverage, medical care has become unaffordable for millions of Americans. It’s especially tough for
those who fall into the coverage
, where their income is too high to grant access to Medicaid coverage,
but too low to be caught by the ACA safety net.

If patients continue to delay care, it’s
only a matter of time before their symptoms worsen, leading to more complex and
expensive treatment or even risking their lives. For the hospitals and health
systems with revenue levels at a record low, encouraging patients to return for
routine care is a matter for their own financial survival too.

The answer lies in making sure patients feel safe and comfortable both when they come in for care, and when they look at their financial responsibilities.

5 ways to ease the return to routine care

1. Reassure patients about safety measures before and during their visit

Patients are understandably anxious about
what their visit is going to be like. Will they have their temperature taken?
What should they do if they have symptoms of the virus? Will seating areas be
spaced out and sanitized? Pre-visit communications and proactive
information on arrival will help them feel comfortable and eliminate the shock
factor of seeing more stringent infection control measures.

2. Minimize unnecessary contact by shifting patient intake online

From online scheduling and
pre-registration to telehealth and contactless payment, there are many ways to
keep face-to-face interactions to a minimum. Not only will this help reduce the
spread of the virus, it’ll make the whole patient experience more convenient
for patients. Exploring a virtual and automated patient intake experience can also free up staff to work on other tasks, thus also protecting the
organization’s bottom line through efficiency savings.

3. Encourage patients back to care with automated outreach campaigns

With so much uncertainty at the moment,
patients may be unsure if it’s even appropriate to come in for routine care.
Use automated outreach to prompt them to
book appointments and schedule follow up care. A digital scheduling platform
can help you set up text-based outreach campaigns, to reassure patients that
it’s safe (and essential!) to come in for any overdue care – without placing
any undue burden on your call center.

4. Provide price transparency before and at the point of service

With healthcare experts pointing to financial
worries as a major barrier to care, anything providers can do to improve the
patient financial experience is an advantage. Price transparency is the first step.
When patients have clear and accessible payment estimates upfront, they can
plan accordingly and/or seek financial assistance as quickly as possible,
reducing the risk of non-payment.

5. Screen for charity care eligibility with faster automated checks

Once those payment estimates have been
generated, the next step is to confirm whether the patient is eligible for financial support, in the event that they’re unable to cover their bill. Checking eligibility
for charity assistance is a time-suck for patient collections teams, but with
access to the right datasets, it’s a perfect candidate for automation.

These steps become even more urgent as
providers face the prospect of a ‘twindemic’ – or a surge in COVID-19 cases
colliding with flu season.
By avoiding delays to care, patients can avoid the need for more serious and
expensive treatment further down the line, when hospitals are likely to be
under even greater pressures.

Contact us to find out more about how our
data-driven, automated patient intake
can help make your patients feel as safe and
comfortable as possible, both physically and financially.

The post Improving patient intake during COVID-19 starts with patient experience upgrades appeared first on Healthcare Blog.

Fast track the path to closing gaps in care

The rates for closing gaps in care are
some of the most widely used, quantitative metrics to measure quality, allocate
incentives, and control costs. Unfortunately, health plans face numerous
obstacles closing gaps in care, from social determinants of health to
inconsistent coordination of care, and don’t always have a care gap closure
program in place. Thankfully, digital solutions like web-based scheduling and
automated outreach can help health plans jump many of these hurdles while also
helping to close gaps in care.

Call center scheduling
Many health plans are still grappling with the difficulty of three-way scheduling calls between themselves, members and providers. Calls are lengthy and cumbersome as agents dig through binders of provider schedules and scheduling rules to determine and book the right appointment for each member. Members are often put on hold, sometimes more than once, and are much more likely to drop out of the scheduling process entirely when faced with this experience. As a result, these members may face significant care delays, or in some cases miss their necessary follow-up care entirely.

With web-based scheduling, member engagement call centers can eliminate three-way calls. Guided search helps to narrow down the right provider for each member and the scheduling platform allows for immediate, on-the-spot appointment selection. Health plans can more efficiently close gaps in care as members can quickly and easily schedule their appointments. This has proven to cut call times in half, and increase scheduling rates by 140%. To learn more, read this case study.

Automated Outreach
Health plans typically have a list of individuals to follow up with on a regular (bi-weekly or monthly) basis to book whatever care service is needed to close the gap in care. Now, health plans have the ability to automate this outreach via interactive voice response (IVR) or text message (SMS) while simultaneously enabling members to schedule appointments on-the-spot, either through a link in the text or during the IVR call.

The automation improves the member experience with convenient access and helps close more gaps in care – all without a single call center agent.

The ultimate combination for closing gaps in care
Used alone, automated outreach and call center scheduling are both effective for closing gaps in care. When used together, health plans can fast track the path to closing gaps in care and further improve efficiencies.

Members can first be reached via automated
outreach, prompting the individual to schedule an appointment. This allows
members the opportunity to self-schedule and essentially self-close their gap
in care, without a single live agent phone call. From there, call center agents
can pinpoint the members who didn’t schedule as part of the outreach campaign
and then call them directly to book the necessary care.

We know that despite the flexibility
and convenience offered by digital solutions, like automated outreach, there
are still individuals who prefer to schedule over the phone and have personal
interaction when booking care. The combination of web-based scheduling and
automated outreach enables omnichannel access for health plans while helping
call center agents focus their attention on the members who need their help

Contact us to learn more about how Experian Health can help health plans fast track the path to closing gaps in care.

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Success at a glance: 24/7 patient access

The age of consumerism has been a catalyst in the shift towards patient-centered care, driving hospitals and health systems across the board to evaluate and improve their current methods of patient access. For one multi-specialty medical group, fast and easy access to care meant providing strategic tools for patients to use beyond the four walls of the organization and outside of the traditional hours of the practice.

In order to provide a more flexible and convenient method to access care, CareMount Medical, the largest independent multi-specialty group in New York State, turned to Experian Health to enable online self-scheduling. With it in place, patients now have the ability to schedule an appointment online, across any specialty, any time of day or night.

Providers’ scheduling protocols are automated within the solution to accurately match patients with the right provider and appointment based on care need. Those same protocols are also used to prevent overbooking, allowing providers to maintain close and comfortable control over their calendars.

Improved call center efficiencies. Automated scheduling relieves call center staff of the associated administrative work, allowing more time for nurses and other credentialed staff to answer health questions and concerns over the phone.

Increased patient acquisition and retention. In addition to attracting new patients, the solution has proven valuable for patient retention. Since implementation, the organization has seen on average 30 online appointment bookings per provider per month.

Higher patient satisfaction. Patients are no longer required to call to schedule an appointment during office hours. This level of convenience gives patients more control over their day and has contributed to rising patient satisfaction scores for the organization as a whole.

Continued Improvements. Real-time analytics and dashboards provide direct line-of-sight into scheduling activity, helping leaders at CareMount Medical to both identify areas for improvement and fine-tune the process to further improve online bookings.

“Experian Health’s guided search and scheduling solution adds immediate benefits for our patients, supporting our commitment to provide our patients with cutting-edge technology in the convenience of their home.”

Scott D. Hayworth, MD, FACOG, President & CEO, CareMount Medical

Learn more about how your organization can improve patient access with patient scheduling from Experian Health.

The post Success at a glance: 24/7 patient access appeared first on Healthcare Blog.

Designing A Digital Experience to Drive Revenue and Patient Engagement

 Designing A Digital Experience to Drive Revenue and Patient Engagement
Bill Krause, VP and GM, Digital Experience and Consumer Engagement at Change Healthcare

With the rise of healthcare consumerism, people are looking to hospitals, health systems, and physician practices to deliver the same user-friendly, digital experiences they receive from other industries. A recent survey found that more than 80% of consumers surveyed believe “shopping for healthcare should be as easy as shopping for other common services.” Specifically, they want streamlined access points online where they can shop for and purchase healthcare, easily make appointments, understand what they need to pay, make payments, and set up payment plans – or even obtain financing for care if the estimated costs exceed their budgets. 

These types of digital experiences help providers recruit new patients and keep them engaged, which leads to better outcomes for both the health of the patient and the financial health of the practice. Unfortunately, most healthcare organizations aren’t ready to provide this level of convenience. In part, this is because they have relied on patient portals as their main digital engagement tool to date.

The problem with portals

There are a few reasons why patient portals underdeliver. First, portals are only for patients that have an existing relationship with a provider. However, the patient experience begins when consumers start shopping for care. Relying on a portal alone is a missed opportunity to generate new patient business.  

Second, portals don’t mirror what consumers expect from digital solutions. The interfaces are clunky, the functionality is limited, and the technology only supports a pull strategy, meaning that it waits for the patient to come to it rather than periodically reaching out and prompting the individual to take action.

Third, a patient must be logged into a portal before they can do anything with it. This makes it harder to schedule appointments with new physicians because there is not an established connection. In these cases, the patient must pick up the phone, wait on hold, set up an account, possibly wade through insurance approval and pre-authorization, and then make the appointment. 

Finally, portals aren’t ideal for communicating costs. While some allow the patient to pay co-pays, they aren’t designed to give realistic cost estimates, offer payment plans, suggest alternative funding sources, and so on.

Taken together, these challenges result in low, inconsistent portal use. Even if a hospital indicates that 50% of its patients access the portal, one-time or limited use should not be viewed as patient engagement. Instead, to realize true engagement, organizations should be thinking about ways to foster two-way conversations to keep new and existing patients focused on their health and how the hospital, health system, or physician practice can meet their needs. This improves patients’ experience and builds loyalty, while also reducing leakage and growing revenue. 

What are the risks of poor digital engagement? 

Without a well-considered plan for providing a retail-like shopping experience that includes transparent cost information, healthcare organizations run the risk of losing patients. This is especially important as the marketplace becomes more competitive and focused on patient experience, and retail clinics continue to pop-up around the country. 

In addition to market changes, regulatory pressures are also making patient-centric financial communications a necessity. Several states are implementing price transparency regulations, and a federal requirement is right around the corner. To meet these standards, organizations will need effective tools that reliably determine and share prices with patients in advance of their appointments.

So where do organizations go from here? 

It’s clear that patient portals are not the answer. But how can organizations do a better job of giving patients the convenience they seek? Here are four best practices to consider.

1. Evaluate your organization’s digital tools.

The first step is to take a hard look at the digital solutions you currently provide and compare them to those available from other industries, such as travel, retail, and financial services. Consumers want a digital, retail-like shopping experience where they can search local providers, compare reviews and costs, schedule their treatment, and even pay – all in one intuitive place.

Don’t be fooled into thinking that only younger people want these tools. Research shows that more and more older adults are embracing mobile activities like online banking. In fact, The Harris Poll found that 80% of Baby Boomers (individuals between 56-76 years old) “wish there was a single place to shop for and purchase care.” 

Digital tools designed to improve access and transparency while making it easier to pay create more engaged consumers and provide a better patient experience. Achieving this dual dynamic requires digital tools are part of a comprehensive end-to-end solution.  

2. Streamline access to shoppable services

These are elective procedures and screening tests that an individual can schedule in advance and include things like planned joint replacements, colonoscopies, and mammograms. Healthcare organizations offer standardized pricing for these services, allowing patients to shop around for the best price, location, and experience. 

When patients are able to use a digital tool to research a service, set an appointment, and make a payment, it can drive patient satisfaction and increase the chances the individual will choose to have the procedure with the organization supplying the tool. With 67% of consumers stating they would “shop for healthcare entirely online, like any other products and services,” streamlining access to shoppable services will drive engagement and revenue. 

3. Adopt tools that help people understand their care costs.

More than half of consumers surveyed for The Harris Poll said they have “avoided seeking care because they weren’t sure what the price would be.” The biggest hurdle to accessing care is price transparency, resulting in patients not getting the treatment they need and in poor revenue management for a practice. 

Patients are more likely to pay their portion up front when they understand what they owe and feel confident that the cost information provided has taken into consideration their current insurance, deductibles, and co-pays. A key to accurate estimates is an automated solution that checks the patient’s insurance digitally, determines the benefits, reviews the amount of any deductible, and verifies whether the individual has already met their deductible. When a patient financial tool also offers the ability to make payments or set up a payment plan, it can increase patients’ propensity to pay, boost the amount of self-pay funds the organization collects, and substantially reduce the cost-to-collect.

4. Enable digital appointment scheduling

Consumers view scheduling and rescheduling appointments as a very difficult task.  Digital solutions can address this pain point. Mobile tools and apps that patients can use to schedule appointments monitor wait times, digitally complete forms, and check-in for appointments are essential to breaking down some of the barriers to patient access. 

Before onboarding a tool like this, organizations must think through the change management challenges in getting all stakeholders on board. Historically, physicians have been hesitant to open up their calendars to permit digital scheduling. However, transparency and standardization are becoming increasingly important to meet patient demand and are necessary to make these types of tools work smoothly.

Although digital tools are gaining popularity among all generations, there are still people who prefer to pick up the phone to price, schedule, and pay for care. In addition to digital solutions, organizations should have service-oriented call centers to work with these patients. Such centers should have well-trained professionals who are available during and outside of traditional business hours so patients can access the information they need when they need it.

Relying on the status quo is not wise

Healthcare is only going to become more consumer-driven as high-deductible health plans continue to disrupt the industry. Hospitals, health systems, and physician practices cannot afford to rely on outdated technologies that don’t facilitate two-way conversations or the digital experience patients expect. To compete today and in the future, organizations need a comprehensive, retail-like solution that offers a seamless user experience and spans the entire patient journey. Tools and technologies used in combination with putting the patient first will build loyalty while also improving an organization’s clinical and financial outcomes.

About Bill Krause

Bill Krause is the Vice President of Experience Solutions at Change Healthcare. Serving the healthcare industry for over 12 years, Bill leads innovation and solution development for patient experience management at Change Healthcare. In this role, he is responsible for the development and execution of strategies that enable healthcare organizations to realize value through leading-edge consumer engagement capabilities.

Previously, Bill provided insights and direction into new product and service strategies for McKesson and Change Healthcare. He also managed business development planning, partnerships, and corporate development across a variety of healthcare services and technology lines of business for those companies.

Prior to McKesson, Bill worked at McKinsey & Company as a strategy consultant, serving a variety of clients in healthcare and other industries.  He received his MBA from Harvard Business School and his undergraduate degree from the University of Virginia. He also served as a lieutenant in the United States Navy.

Improve the patient experience with digital patient intake

Imagine if every time you wanted to sign up
to buy groceries online, book a vacation, or apply for a job, you had to fill
out a paper registration form. For 21st century consumers who are
accustomed to sleek digital and self-service experiences in industries such as
retail, travel and banking, such an antiquated and cumbersome process seems
unthinkable. Unfortunately, when it comes to healthcare services, we don’t have
to use our imagination. Too often, we’re still required to fill out
time-consuming, repetitive and tedious forms before accessing services.

For providers who want to stay competitive,
the long waits and wasted time that arise from paper-based registration system
do nothing to win consumer loyalty. And on top of the disappointing patient
experience, manual intake processes often lead to delays and errors that can
disrupt the billing cycle, costing time and money further down the line.

In fact, up
to half of denied claims
occur because of issues around the point of
registration, such as identification errors, sub-standard data analytics and
inefficient workflows. And at a time when patients and staff are trying to
minimize face-to-face contact due to COVID-19, manual registration seems like
an unnecessary extra touch point.

Is it time to say goodbye to paper-based
paper registration?

Reimagining the patient intake
experience for the digital age

During registration, patients can be asked
to provide personal details, submit their medical history, and confirm payer
information. They may also need to schedule
, organize billing, or sign up for care management programs. It’s
often a patient’s first glimpse of how a provider is going to look after them,
so making the registration experience as stress-free as possible is a great way
to build
customer loyalty from the start

As the competition for consumer business
heats up, providers should look for ways to give patients the virtual and mobile-friendly
experience they desire, with as little time as possible spent in waiting rooms
filling in forms. By letting patients tick off their registration to-do list
online or via a mobile device – before even coming into hospital – providers
can improve patient satisfaction, while using automated workflows to drive down
costly errors and increase revenue.

Here are two examples of how healthcare providers have embraced
self-service registration and automated pre-registration workflows to benefit
both their consumers and bottom line:

1. Schneck Medical Center used automated pre-registration to double their productivity

For the patient access team at Schneck Medical Center, getting the correct patient information in a timely manner during registration was a challenge. By introducing  eCare NEXT®, they were able to automate pre-registration workflows so the majority of manual, repetitive patient tasks could be completed automatically, freeing up staff to focus on patients who needed specific attention before being cleared. With Registration QA added to the mix, they could track and correct errors and spot opportunities to improve performance in real-time, for a better patient experience and more efficient operations.

Skylar Earley, Director of Patient Access and Communication, said that by using Experian Health’s patient intake solutions, “we were able to make some fairly minor workflow changes, but double our pre-registration productivity on a daily basis and then repurpose some labor to different areas in patient access.”

2. Martin Luther King Jr. Community Hospital (MLKCH) used automated registration to reduce claim denials

Seeing that a large portion of claim denials were
originating during patient registration, MLKCH introduced an automated registration workflow to eliminate unnecessary manual tasks and increase
the accuracy of the data being collected.

For Patient Access Manager Lori Westman, the results
have been impressive:

“We get fewer denials because we’re getting true verification data, and our patient volumes continue to increase. So the fact that we can take off at least two to three minutes on half of our registrations is speeding up the work for the team, and the turnaround time is much better for the patients.”

By reducing paper-based tasks and
introducing automated pre-registration options, these providers were able to
make life easier for patients while slimming down their workflows. Is it time
for your organization to do the same?

Download our free eBook to find out more about how automated
patient intake workflows could help you create a seamless, more efficient
patient registration experience.

The post Improve the patient experience with digital patient intake appeared first on Healthcare Blog.

Three benefits of automated outreach

No thanks to COVID-19 and the subsequent delay of elective procedures, many healthcare providers today are struggling to ensure their patient populations are getting the care they need. While online scheduling and referral coordination solutions can no doubt help improve patient access, especially as those who cancelled or postponed appointments look to reschedule, it’s the use of automated outreach combined with the ability to schedule appointments in real-time that can take it one step further and help providers close gaps in care.

Automated outreach via
interactive voice response (IVR) and text messaging (SMS) is now effectively
closing gaps in care and streamlining the entire scheduling process from start
to finish.

Healthcare organizations leveraging
automated outreach are seeing numerous benefits. Among them:

  1. Extended Outreach Capabilities – An automated and technologically advanced outreach system has far greater capacity to reach patients, when compared to the bandwidth of traditional call centers. The system enables thousands of automated calls per day that don’t require an agent to personally facilitate.
  2. Increased Appointment Bookings – Reaching more patients means more successfully booked appointments, and in turn, fewer gaps in care. Our technology successfully automates the process all the way through the booking itself, scheduling far more appointments with much less effort.
  3. Higher Patient Satisfaction – Automated outreach ensures that patients are notified on-time about any necessary follow-up care, and then provides the opportunity to quickly and easily book appointments that fit their schedule. This convenience and simplicity fosters patient engagement and satisfaction.

Using a targeted outreach list, an
automated calling and texting system manages the bookings, coordination and
follow-up, completely lifting the burden off of the organization and its call
center. Additionally, this type of technology can track metrics (i.e. response
rates, booking rates, opt-outs, etc.) in real-time, allowing health plans to easily
identify areas for improvement and make the necessary changes to their
processes. For these reasons – as well as the benefits outlined above – a
growing list of both providers, payers and ACOs are choosing to employ
automated outreach technology today.

Learn more about automated
outreach and how it fits into an omnichannel access strategy.

The post Three benefits of automated outreach appeared first on Healthcare Blog.

Adapting to meet patient expectations during COVID-19

Download our free eBook to find out how digital health solutions can help your organization improve the patient journey now and beyond COVID-19.

You can also check out our free COVID-19 Resource Center, where you can get free access to telehealth payer policy alerts to help avoid payment denials and delays.

The post Adapting to meet patient expectations during COVID-19 appeared first on Healthcare Blog.

T2 Tech Group Acquires Remote Patient Scheduling Service from Revint Solutions

T2 Tech Group Acquires Remote Patient Scheduling Service from Revint Solutions

What You Should Know:

– T2 Tech Group, a Los-Angeles based leading IT consulting, advisory, and project management services provider, has just acquired the patient access and scheduling services division from Revint Solutions.

– The coronavirus pandemic has created a vast backlog of
patient appointments and compounded the strain on the healthcare industry. This
acquisition allows T2 Tech Group to implement a comprehensive solution, T2 Flex
Force, LLC, that brings cutting-edge virtual workforce technology to hospitals
and healthcare systems to further increase efficiencies in delivering exemplary
patient experiences during the patient access and appointment scheduling

Tech Group
, an industry-leading IT consulting, advisory and
project management services provider, today announced the acquisition
of the patient access and scheduling services division from Revint Solutions, a
provider of revenue
and recovery services for hospitals and health systems. The
acquisition allows T2 Tech Group to implement a comprehensive solution, T2 Flex Force,
, that brings cutting-edge virtual workforce technology to hospitals and
healthcare systems to further increase efficiencies in delivering
exemplary patient experiences during the patient access and appointment
scheduling process.

Revint selected T2 Tech because of the firm’s deep
understanding of the healthcare industry, as well as technology and
project management expertise. The acquisition also comes on the heels of a
strategically planned investment in a virtual workforce management technology
solution. T2 Tech Group will leverage this technology to enhance the
capabilities of the new T2 Flex Force remote workforce offering, which provides
patients immediate access to a person to help schedule appointments for primary
care and specialist visits. 

Post-Acquisition Plans

As part of the deal, T2 Tech is employing all of Revint’s
employees in this division and providing services to an existing roster of
national health systems and hospitals. Powered by T2 Tech’s technology and
positioned as a leader in remote workforce management, T2 Flex Force also has
the capabilities to expand its service lines beyond scheduling, within the
healthcare industry and other verticals. 

“Revint developed an effective patient access and scheduling solution and we’re excited to take it to the next level by leveraging our technology, as a virtual workforce becomes a long-term reality for many organizations,” said Kevin Torf, managing partner of T2 Tech Group. “The demand for efficient, reliable and secure professional patient access and scheduling services continues to grow and we’re confident that T2 Flex Force will provide a valuable solution for hospitals and health systems during a time when it’s needed most.” 

Technology key for hospital financial recovery following COVID-19

Financial recovery after COVID-19 is likely to
be a slow burn for most healthcare organizations, according to a recent
. Nearly 90% of
healthcare executives
expect revenue to drop below
pre-pandemic levels by the end of 2020, with one in five anticipating a hit greater
than 30%.

While the return of elective procedures will
be a lifeline for many hospitals and health systems, the road to financial
recovery remains fraught with obstacles:

  • Five months of canceled and postponed procedures need to be rescheduled
  • Worried patients must be reassured of hygiene measures, so they feel safe to attend appointments
  • Patient intake and payment processes must be modified, in order to minimize face-to-face contact
  • As the rate of infection continues to grow, providers must find new ways to also grow their revenue and protect against a further dent in profits.

The healthcare industry is unlikely to see the recovery curve hoped for across the wider economy, but digital technology, automation and advanced data analytics could help provider finances to bounce back more quickly.

4 ways technology can accelerate your
post-pandemic financial recovery

1. Easy and convenient patient scheduling unlocks your digital front door

Patients want to reschedule
appointments that were postponed or canceled over the last few months. To
manage the backlog and minimize pressure on staff, consider using a digital
patient scheduling platform
, so patients can book their
appointments online.

A self-scheduling system that
incorporates real-time
and calendar reminders will help to create a
positive consumer experience, while offering analytics and behind-the-scenes
integration to keep your call center operations running smoothly.

2. Secure and convenient mobile technology can enhance your telehealth services

is the top choice for many hospitals looking to boost revenue growth and
counter the impact of COVID-19, with two-thirds
of executives
expecting to use telehealth at least
five times more than before the coronavirus hit.

Many new digital
tools and strategies
designed to improve the patient
journey as a whole can support telehealth delivery, and help to meet growing
consumer demand for virtual care.

For those beginning
their telehealth journey, our COVID-19
Resource Center
, which offers free access to
telehealth payer policy alerts, may be the place to start.

3. A digital patient intake experience can lessen fears of exposure

Although many providers are starting
to open up for routine in-person appointments again, patients may wonder if
it’s safe. Proactive communication about the measures in place to protect staff
and patients will be essential.

Another way to minimize concern is to allow
as many patient intake tasks as possible to be completed online. Automating
patient access
through the patient portal can give
patients quicker and more convenient ways to complete pre-registration, while contactless
methods are a safe way to settle bills
without setting foot in the provider’s office.

4. Optimize collections to bolster financial recovery

Automation can also play a huge role in helping providers tighten up their revenue cycle, find new ways to enhance accounts receivable collections and avoid bad debt.

Tools such as Coverage Discovery and Patient Financial Clearance enable providers to find missing or forgotten coverage, and help the patient manage any remaining balances in a sensitive and personalized way.

Palo Pinto General Hospital uses automated coverage checks to find out whether a patient is eligible for charitable assistance within three seconds, so self-pay accounts can be directed to the most appropriate payment plan before the patient even comes in for treatment. With fewer accounts being written off, Palo Pinto has seen a noticeable improvement to their bottom line.

The pandemic has been a wake-up call for an industry that has been traditionally slow to adopt new technologies. Ahead of a second wave of COVID-19, providers must move now to take advantage of automation and digital strategies to speed up financial recovery. Contact us to find out how we can help your organization use technology to improve the patient experience, increase efficiencies and kickstart your revenue cycle.

The post Technology key for hospital financial recovery following COVID-19 appeared first on Healthcare Blog.

Success at a glance: online self-scheduling

Many patients today are forced to call the doctor to schedule an appointment. These phone calls are often inconvenient: patients are required to call during a provider’s business hours, a single call can sometimes take up to 20 minutes, or the patient may end up playing phone tag until an appointment is finally booked. The entire process bodes for a poor patient experience, but also hinders access to care as staff are only able to manage a number of phone calls per day.

Like many healthcare organizations today, The Iowa Clinic wanted to improve access to care for its patients, removing the many barriers that come with having to call to schedule an appointment. Requiring a solution that could both improve patient satisfaction and operational efficiencies, the clinic, which schedules more than 600,000 appointments per year across multiple specialties, turned to online self-scheduling.

With online self-scheduling, patients of The Iowa Clinic have the ability to self-schedule directly into provider’s calendars in real time from a computer or mobile device. During the booking process, patients are asked a series of brief questions and their answers are used to guide them to the right provider and appointment based on their specific care need. Appointments can be booked any time of day or night.

Since implementing online self-scheduling, The Iowa Clinic has not only improved access for patients, but has enhanced operations throughout the call center, seen growth in patient acquisition and has achieved higher than average show rates. Results include:

  • At least 15% of all appointments booked came from online during the first eight months
  • The centralized call center has seen a 30% reduction in the number of scheduling calls
  • At least 8 new patient appointments are booked online per provider per month
  • Patient show rates are at 97% for appointments scheduled online

Learn more about online self-scheduling and how it can help to improve patient access for your organization.

“Patient Schedule allows us to improve the experience by offering a simple, convenient way to schedule an appointment online.”

– C. Edward Brown, CEO, The Iowa Clinic

The post Success at a glance: online self-scheduling appeared first on Healthcare Blog.

How ADT-Based E-Notifications Can Enable Better Safety for COVID-19 Patients

Why E-Notifications Are More Important Than Ever Amidst the COVID-19 Pandemic
Jay Desai, CEO & Co-Founder, PatientPing

As COVID-19 continues to impact the country, providers across the continuum face new challenges delivering care and ensuring safety for their patients and themselves.  During this period, sharing real-time information about patients’ care encounters across provider types and care settings matter more than ever. In particular, hospitals sharing admission, discharge, and transfer (ADT) events with COVID-19 patients’ community-based providers is critical to ensure the best treatment course and safer more seamless care transitions for infected and recovering patients. 

Real-time ADT-based notifications include information about a patient’s current care encounter, demographic details, information about the provider or institution sending the notification, and, as permissible, clinical information. This data enables providers across the continuum to make informed and coordinated decisions about their patients’ treatment and care transition plans. Even before the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) recognized the importance of such ADT notifications in supporting patient care and finalized a new Condition of Participation (CoP) as part of the recently published Interoperability and Patient Access Final Rule (85 FR 25510). The CoP requires hospitals to share electronic patient event notifications, or e-notifications, with other community providers, such as primary care physicians (PCPs) and post-acute care providers, to facilitate better care coordination and improve patient outcomes. 

The necessity and benefit of these e-notifications has come into stark relief as providers and the healthcare system more broadly fight COVID-19. ADT-based e-notifications are an accessible and easy way to help enable better safety for COVID-19 patients and their providers while also ensuring efficient use and appropriate allocation of scarce resources. For example, ADT-based e-notifications can:

Enhance Safety for Patients Protecting patient safety and providing appropriate treatment is especially urgent during a crisis like COVID-19 when resources are limited and staff is stretched.  E-notifications allow hospitals that treat COVID-19 patients to more rapidly get in touch with a patient’s other providers and obtain important medical histories to help guide treatment and clinical decision-making.  Traditional exchange of data facilitated by phone calls, faxes, or labor-intensive data searches can introduce treatment delays, unnecessary or harmful interventions, and frustrations for providers. The faster information can be exchanged and a patient’s history is known by the hospital care team, the easier it is to effectively and safely treat the patient with the most appropriate interventions. 

Enhance Safety for Providers: Hospital e-notifications are especially important for post-acute and other community-based providers that will continue treatment for COVID-19 patients discharged from the hospital. Because e-notifications provide context about the patient’s most recent encounter, including diagnoses where permissible, they help guide the continuation of care.  Receiving e-notifications from hospitals allows such providers to appropriately prepare staff and put safety measures in place prior to treating COVID-19 patients. In particular, Skilled Nursing Facilities need time to properly and safely intake infected patients while Home Health Agencies need to prepare and equip their nurses for visits to homes of infected patients.

Open Hospital Beds for the Sickest Patients: Through real-time e-notifications, hospitals are able to more easily and quickly communicate and share information with COVID-19 patients’ other community-based providers who will care for recovering patients after they are discharged from the hospital. This exchange of information allows hospital care teams to more seamlessly and quickly transition recovering COVID-19 patients to the next level of care, which opens scarce hospital beds for the sickest patients.

Improve Care for COVID-19 Patients: Real-time e-notifications from hospitals allow PCPs and care coordinators to know when their patients have inpatient or ED events. In particular, discharge notifications can trigger critical follow-up services, including telehealth-based visits, to ensure COVID-19 patients recover safely and fully after they leave the hospital. Engaging COVID-19 patients after a hospitalization can help prevent readmissions and keep patients healthy in their homes. At the same time, PCPs are able to support the financial viability of their practices by being able to provide and bill for Transitional Care Management Services and ensure patient engagement in ongoing preventive and other clinical care.

Bolster Public Health Response: Aggregated and de-identified ADT-based notifications offer wide-ranging and powerful real-time data for local, state, and federal public health officials to detect emerging COVID-19 hotspots and intense ED, hospital, ICU strain.  Real-time data about the hospital and ED utilization can help public health officials direct and allocate scarce resources to the highest need areas quickly.

These are just some examples of how ADT-based e-notifications can play an important part in helping healthcare organizations effectively, efficiently, and safely deliver care for their patients during the ongoing pandemic – and beyond. 

About Jay Desai, CEO & Co-Founder, PatientPing

Jay started PatientPing in 2013 with one goal in mind: to connect providers everywhere to seamlessly coordinate patient care. Prior to founding PatientPing, Jay worked at the CMS Innovation Center (CMMI) where he helped develop ACOs, bundled payments, and other payment initiatives. Jay’s passion lies at the intersection of technology, policy, and community building. He has an MBA in healthcare management from Wharton and a BA from the University of Michigan. 

Five Keys to Tackling Flu Season as it Collides with COVID-19

With a vaccine for COVID-19 thought to be at least a year away, healthcare providers are steeling themselves for even more cases in the fall. The big worry is that a surge in cases will hit the health system just as flu season takes hold. In a recent interview, Dr. Robert Redfield, Director of the Centers for Disease Control and Prevention (CDC), warned that “the assault of the virus on our nation next winter [may] actually be even more difficult than the one we just went through… we’re going to have the flu epidemic and the coronavirus epidemic at the same time.”

Healthcare organizations are accustomed to
an influx of sick patients between October and March: around
people died and more than 700,000 were hospitalized during last
winter’s flu season. With 130,000
losing their lives to COVID-19 in just four months, what could
happen when the two respiratory diseases collide?

Large numbers of patients with either virus
(or potentially with both) will put renewed pressure on staff and services that
are already under immense strain. Hospitals will need to prepare to manage both
groups of patients as efficiently and safely as possible.

Five ways to ease stress, paperwork and
patient concerns ahead of a dual epidemic

1. Use data to drive your patient engagement strategy

Create a flu
preparedness patient engagement strategy
to keep patients informed of how
best to protect themselves in the context of a dual epidemic. As a result of
the coronavirus pandemic, patients may be more familiar with telehealth
services as a “contact-free” alternative to in-person appointments, so you’ll
want to continue to promote these to minimize the spread of infection.

With consumer
, you can segment patients according to risk and automate your
communications, so they get the most relevant message at the most convenient

2. Relieve pressure on staff with automated patient scheduling

Digital scheduling gives
patients the option to book appointments online, at a time and place that suits
them. This reduces pressure on call center staff and can give providers control
over the volume and timing of in-person appointments, thus helping to reduce
the spread of germs.

An online
patient scheduling platform
can automate the entire scheduling process,
integrating in real-time with your records management systems and connecting to
your referral providers’ systems for a seamless patient and staff experience.

3. Screen patients proactively to discover their needs ahead of time

Asking patients to fill out electronic
questionnaires before their visit means their access needs can be identified
and addressed before they come in. Do they need help to find transportation?
Will they face any challenges in picking up a prescription? Is there something
that could stand in the way of follow-up care?

Screening for social
determinants of health
can answer these questions so you can
direct patients to the most appropriate care and support.

4. Enable digital patient registration for a quick and easy intake experience

Speed up the registration process by giving patients the option to complete their intake admin by phone or through their patient portal. Not only will this reduce the spread of infection in busy waiting rooms, it’ll make for a more enjoyable patient experience and free up limited staff resources for other priorities.

With automated
and consumer-facing mobile
experiences, you can improve the patient experience, operational efficiencies
and data accuracy all at the same time.

5. Minimize in-person interactions with contactless payments

Encourage patients to clear their balances without
having to hand over cash or access payment kiosks. Self-service digital
payment tools
allow patients to make contactless
payments through their patient portal or from their mobile device.

It’s in line with consumer expectations, and
it could also increase patient collections: Saratoga Hospital
saw point-of-service collections increase by 50% after implementing more
user-friendly patient payment options.

“The combined pressure from two viruses hitting health systems at once means it’s even more important for providers to leverage data for speed and accuracy. Automated workflows can help accelerate operational efficiency, as well as create a better patient experience during what’s already an extremely stressful time.”

Karly Rowe, Vice President of Product Development for Experian Health

Find out more about how Experian Health’s expertise in data and analytics can help your organization prepare for the coming flu season so you can offer your patients a safe, accessible and stress-free experience.

We have also developed a checklist of action items for providers to consider as you prepare for both flu and COVID-19. How ready are you? Which actions is your organization instituting now?

The post Five Keys to Tackling Flu Season as it Collides with COVID-19 appeared first on Healthcare Blog.

Five keys to tackling flu season as it collides with COVID-19

With a vaccine for COVID-19 thought to be at least a year away, healthcare providers are steeling themselves for even more cases in the fall. The big worry is that a surge in cases will hit the health system just as flu season takes hold. In a recent interview, Dr. Robert Redfield, Director of the Centers for Disease Control and Prevention (CDC), warned that “the assault of the virus on our nation next winter [may] actually be even more difficult than the one we just went through… we’re going to have the flu epidemic and the coronavirus epidemic at the same time.”

Healthcare organizations are accustomed to
an influx of sick patients between October and March: around
people died and more than 700,000 were hospitalized during last
winter’s flu season. With 130,000
losing their lives to COVID-19 in just four months, what could
happen when the two respiratory diseases collide?

Large numbers of patients with either virus
(or potentially with both) will put renewed pressure on staff and services that
are already under immense strain. Hospitals will need to prepare to manage both
groups of patients as efficiently and safely as possible.

Five ways to ease stress, paperwork and
patient concerns ahead of a dual epidemic

1. Use data to drive your patient engagement strategy

Create a flu
preparedness patient engagement strategy
to keep patients informed of how
best to protect themselves in the context of a dual epidemic. As a result of
the coronavirus pandemic, patients may be more familiar with telehealth
services as a “contact-free” alternative to in-person appointments, so you’ll
want to continue to promote these to minimize the spread of infection.

With consumer
, you can segment patients according to risk and automate your
communications, so they get the most relevant message at the most convenient

2. Relieve pressure on staff with automated patient scheduling

Digital scheduling gives
patients the option to book appointments online, at a time and place that suits
them. This reduces pressure on call center staff and can give providers control
over the volume and timing of in-person appointments, thus helping to reduce
the spread of germs.

An online
patient scheduling platform
can automate the entire scheduling process,
integrating in real-time with your records management systems and connecting to
your referral providers’ systems for a seamless patient and staff experience.

3. Screen patients proactively to discover their needs ahead of time

Asking patients to fill out electronic
questionnaires before their visit means their access needs can be identified
and addressed before they come in. Do they need help to find transportation?
Will they face any challenges in picking up a prescription? Is there something
that could stand in the way of follow-up care?

Screening for social
determinants of health
can answer these questions so you can
direct patients to the most appropriate care and support.

4. Enable digital patient registration for a quick and easy intake experience

Speed up the registration process by giving patients the option to complete their intake admin by phone or through their patient portal. Not only will this reduce the spread of infection in busy waiting rooms, it’ll make for a more enjoyable patient experience and free up limited staff resources for other priorities.

With automated
and consumer-facing mobile
experiences, you can improve the patient experience, operational efficiencies
and data accuracy all at the same time.

5. Minimize in-person interactions with contactless payments

Encourage patients to clear their balances without
having to hand over cash or access payment kiosks. Self-service digital
payment tools
allow patients to make contactless
payments through their patient portal or from their mobile device.

It’s in line with consumer expectations, and
it could also increase patient collections: Saratoga Hospital
saw point-of-service collections increase by 50% after implementing more
user-friendly patient payment options.

“The combined pressure from two viruses hitting health systems at once means it’s even more important for providers to leverage data for speed and accuracy. Automated workflows can help accelerate operational efficiency, as well as create a better patient experience during what’s already an extremely stressful time.”

Karly Rowe, Vice President of Product Development for Experian Health

Find out more about how Experian Health’s expertise in data and analytics can help your organization prepare for the coming flu season so you can offer your patients a safe, accessible and stress-free experience.

We have also developed a checklist of action items for providers to consider as you prepare for both flu and COVID-19. How ready are you? Which actions is your organization instituting now?

The post Five keys to tackling flu season as it collides with COVID-19 appeared first on Healthcare Blog.

BJC HealthCare Taps Patientco to Provide Seamless Patient Payment Experience

BJC HealthCare Taps Patientco to Provide Seamless Patient Payment Experience

What You Should Know:

– BJC HealthCare has signed an agreement with patient payment platform
Patientco to offer a seamless patient financial experience, helping patients navigate their medical expenses and pay their bills.

– Patientco’s platform provides patients with a single
billing statement outlining their outstanding balance and will help BJC streamline its payment process by reducing the number
of bills associated with one visit as well as offering digital billing options
via email or text.

BJC HealthCare, a leading health system with 15
hospitals and multiple community health locations in the greater St. Louis,
southern Illinois and mid-Missouri regions has signed an agreement with  Patientco to deploy its next-generation patient payment technology platform across
the enterprise. BJC sought an improved, more consistent financial experience
for patients and Patientco will provide BJC with a seamless suite of
patient-friendly billing communication and payment tools.

Seamless Patient
Billing & Payment Experience

Patientco will
enable BJC to provide patients a single billing statement
outlining their entire patient balance, streamlining the process and reducing
multiple bills associated with one visit. Patients can also opt to
receive digital billing communication via email or text instead of receiving a
mailed paper statement. Patients will then be able to pay their bills
using their preferred device, at any time of day or night, regardless of
business hours through an integrated patient payment portal. To address
affordability concerns for patients, BJC will also support
online, self-service enrollment in flexible payment options, like payment

Together, these features will help patients easily understand, manage, and pay their medical bills. Additionally, Patientco’s technology directly integrates with the health information system (HIS), which supports a better experience for both BJC patients and team members. The BJC revenue management department will also have access to other cloud-based features from Patientco, including:

  • Digital mailroom for automated check and correspondence
  • Interactive chat to answer patient inquiries
  • Staff payment processing integrated within the HIS 
  • Enterprise-wide reconciliation 
  • Multi-PM/HIS auto posting
  • Real-time payment reporting
  • User audit reporting
  • Historical performance reporting    

“We understand that medical financial burdens can cause added stress for patients,” said Cole Elmer, BJC Vice President of Revenue Management. “Our goal is to provide an improved payment system that simplifies the billing experience and offers more convenience and additional options for patients.”

COVID-19: 4 Essential Patient Payment Strategy Components to Accelerate Cash Flow

Accelerating Cash Flow Amid COVID-19
David Shelton, PatientMatters CEO

In the past few months, the COVID-19 pandemic has shaken societies, economies, and human wellbeing to the core. While protecting public health and welfare are top priorities for hospitals, the harsh reality is that it takes cash to keep the doors open and serve patients effectively. Revenue is down significantly as a result of canceled elective surgeries, while the costs of medical supplies and in-demand personal protective equipment for workers have skyrocketed. Hospitals’ operating challenges are expected to continue, with Moody’s Investors Service predicting cash flow will remain low into next year.

Further exacerbating hospitals’ financial woes is the rise in coronavirus-related unemployment and part-time employment, and the subsequent loss of patients’ job-based health insurance. The Bureau of Labor Statistics reported that unemployment fell 2.2 percentage points to 11.1 percent in June, as businesses began reopening, however, even with this bit of good news, nearly 18 million people in America are still unemployed. Many more face financial uncertainty as regional spikes in virus cases threaten to slow rehiring and a return to normal. 

As consumer income goes down and debt goes up, many utility companies, auto lenders, credit card issuers, and mortgage holders are offering debt relief options to their customers. On the flip side, other organizations, including some hospitals, have attracted attention for the aggressive collection of unpaid bills, prompting several states to limit actions such as suing, coercive payment plans, and wage garnishment during the pandemic. Critics of these practices say there are better ways for hospitals to collect unpaid debt, especially when patients are dealing with the unprecedented financial and emotional stress caused by COVID-19. 

A Better Approach to Patient Collections

Experience shows that a personalized, patient-friendly approach to the financial side of healthcare yields better results. Hospitals that create a positive patient financial experience often see higher front-end collections, total collections, and patient satisfaction; and lower accounts receivable (AR) days and bad debt. 

To be most effective, personalized patient payment strategies must be comprehensive and incorporate four essential components to balance patient needs with hospital revenue goals: 1) data-driven technology, 2) customizable workflows, 3) staff training and 4) ongoing analytics. Considering the urgent need for hospitals to accelerate cash flow amid the pandemic, payment strategy implementation should also be done quickly and without detracting from other operational and clinical priorities.   

Essential component #1: Data-driven technology

A truly personalized payment solution relies on providing accurate bill estimates and determining patients’ ability and likelihood to pay prior to care. Advanced tools use current financial data and algorithms to assign scores based on credit information, payment history, and residual income. These results help registration staff understand each patient’s unique character traits so they can quickly identify and accurately explain personalized payment options to help patients meet their financial responsibilities.

Essential Component #2: Customizable Workflows

Payment solution technology cannot deliver results unless it is seamlessly integrated into existing hospital systems. Key functions from registration and bill estimation to payment planning and billing should be custom designed to create unified workflows for staff and streamlined experiences for patients.  

Essential Component #3: Staff Training

Talking about financial obligations can be the most confusing, frustrating, and stressful part of healthcare, for patients as well as registration staff. Scripting and guidance on how to tailor conversations to individual circumstances can increase patient satisfaction and trust, improve staff’s job satisfaction and productivity, and reduce staff turnover.

Essential Component #4: Ongoing Analytics

Cash flow will continue to be a challenge for hospitals long after the current COVID-19 crisis is past. Patient payment strategies should provide reporting and dashboards that allow leaders to monitor and manage staff and collection opportunities by shift, registrar, and other custom parameters. Disposition reports should show productivity and performance to ensure high-performance teams and optimum results over the long term.     

Positive Outcomes

Personalized patient payment strategies have been proven to increase collections by guiding patients through the financial maze and offering realistic ways to meet financial obligations. In the current landscape of record low margins for hospitals and extraordinary financial hardship for patients, these solutions provide a path toward increased revenue, higher up-front collections, lower bad debt, and improved patient satisfaction and peace of mind.  

About David Shelton

David Shelton serves as Chief Executive Officer for PatientMatters. He has served in senior healthcare management for more than 15 years, with experience in operations, technology development, and manufacturing. His expertise includes delivering business growth, streamlining operational management, and generating profitability for PatientMatters and its healthcare clients.

Success at a Glance: Improving Portal Security

“Precise ID satisfies both your security officer and your groups who are dealing with patient efficiency and happiness.”
— Kevin Romero, Director of Clinical Systems, AdvantageCare Physicians of New York

To help deliver on its mission to provide a 5-star patient experience, AdvantageCare Physicians implemented a patient portal. While a valuable enabler of patient self-service, the portal offered no true verification process for patients signing up to use it. This resulted in patients having trouble logging in, duplicate records and online issues that required assistance from IT help desk support.  

AdvantageCare Physicians, one of New York’s largest medical
groups, turned to the same technology trusted by banks, retailers, government
agencies and more: identity proofing. With PreciseID from Experian Health, the organization
was able to quickly and confidently authenticate patients and reduce risk
during portal enrollment.

Every patient in AdvanceCare Physician’s medical record has been assigned a universal patient identifier (UPI), which is used to identify and match patients with other organizations that are not affiliated with AdvanceCare Physicians. The improved matching and data exchange not only satisfies security and patient engagement needs but has helped the organization make a lot of progress towards improving patient satisfaction.

Automating the patient portal enrollment process allowed the
organization to remove manual processes and optimize resources while securing
patient information and supporting a positive patient experience.

To date, AdvantageCare Physicians has:

Reduced time spent by IT validating patient IDs on the backend by 80 percent.

Reduced overall call volume to its IT desk by 25 percent.

Reduced the amount of time spent managing password reset issues by 75 percent.

Learn more about PreciseID and how we can help.

The post Success at a Glance: Improving Portal Security appeared first on Healthcare Blog.

Ditch activation codes and automate portal enrollment with integrated identity authentication solutions

For many healthcare consumers, visiting patient portals to check medical records, schedule appointments, renew prescriptions and pay bills is a no-brainer. Accessible from multiple devices at any time of day, patient portals allow patients to manage their health from the comfort and convenience of their own home. COVID-19 has been a catalyst for even more patients to consider remote and virtual healthcare services. But with large healthcare data breaches increasing by nearly 200% between 2018 and 2019, one concern continues to lurk in the background: how do providers keep patient data safe?

Knowing the industry is prone to
dated cybersecurity measures, hackers zero in on the lucrative medical
identities market, with their top

  • patient
    medical records
  • billing
  • log-in
  • authentication
    credentials, and
  • clinical
    trial information.

As COVID-19 encourages more
patients online, the digital doors are open for even more identity thieves to try
to steal – and profit from – sensitive data.

Healthcare organizations need to be confident that the person logging on is who they say they are, both to reduce the risk of a data breach and minimize HIPAA penalties. One way to balance consumer convenience with data security is to automate the patient portal enrollment process with robust patient identification protocols, making it harder for hackers to access patient information but without burdening patients.

3 ways to automate patient portal enrollment

1. Ditch activation codes that are easily misplaced

Many healthcare organizations give new patients an activation code to use the first time they log in to their patient portal. Unfortunately, these tiny bits of paper or codes hidden at the bottom of lengthy enrollment documents are easily lost or forgotten. The patient has to call the office, taking up valuable staff time and resources to figure out how to log on – the opposite of streamlined and scalable.

Instead, providers should consider an automated portal sign-up process. Using a combination of out-of-wallet questions, device recognition, risk models and cross-checks with linked patient data, portal access can be secured through a single platform. It’s easier and more reassuring for patients, and with far fewer calls to IT support.

2. Automate patient identity checks

It’s not just the first log-in that matters. A portal without reliable identity authentication for each log-in attempt risks data breaches and duplicate records, all of which mean more work on the back-end.

used Precise ID to
improve and protect patient identities. In just six months, they reduced the
overall number of patient calls to their IT help desk by 25%, and reduced calls
related to password reset issues by 75%. The amount of staff time spent on
validating patient identities was also reduced by 80%. AdvantageCare saved time
and money, while offering patients a more secure and satisfying portal

3. Find quicker ways to integrate patient identity tools with existing systems

The more people who need to see patient data, the more
opportunities there are for cyber thieves to sneak in and access that sensitive
information. Being able to share data securely between multiple providers and across
different platforms is essential.

During the current COVID-19 crisis, integrating authentication tools with other healthcare information systems (HIS) quickly is a huge advantage. One example is Precise ID, which can now integrate directly with Epic’s MyChart portal, Allscripts’ FollowMyHealth platform and many other HIS systems within two weeks.

Jason Considine, senior vice president and general
manager of Experian Health’s Patient Experience Solutions says:

“Patients want to feel reassured that their data won’t wind up in the wrong hands. That’s even more important right now, as COVID-19 means more patients are choosing online services instead of face-to-face contact. With staff and cashflow under pressure, it’s even more important to get systems up and running as fast as possible. That’s why we’ve integrated with leading HIS systems to help them achieve interoperability within just two weeks.”

Patient portals have the power to transform
the healthcare experience for patients, but only if they can trust that their
data will be kept safe. Providers can protect their patients from identity
theft by adopting a multi-layered solution that incorporates best practice and cutting-edge
data security technologies.

Find out
about how Experian Health can help you
automate patient portal security to avoid medical identity theft, so you can
save money, avoid reputational damage and create a positive patient experience.

The post Ditch activation codes and automate portal enrollment with integrated identity authentication solutions appeared first on Healthcare Blog.

Webinar – A Pragmatic Approach to Patient Support Program Design — Implement Technology at the Right Time to Deliver Greater Program and Patient Insight

Sponsored by Covance Watch now Technology is often touted as a silver bullet, but often the promise falls short of the unrealistic expectation of a tech driven utopia. Knowing when to deploy which technologies requires a pragmatism that balances technology with people and processes to deliver the right balance of efficiency and risk. This session […]

The post Webinar – A Pragmatic Approach to Patient Support Program Design — Implement Technology at the Right Time to Deliver Greater Program and Patient Insight appeared first on PharmaVOICE.

4 Tips for Launching Telehealth Services

With COVID-19 leading to postponed and cancelled
medical appointments, more consumers are turning to “contactless care”. Recent
figures suggest telehealth adoption has shot up from just 11% in 2019
to 46%
over the course of the pandemic, and some providers
are seeing up to 175
the number of telehealth patients than pre-COVID. As
they grapple with the surge in patient volumes alongside regulatory change,
many are playing catch-up.

For patients, rushed implementation means the
telehealth experience can fall short of expectations. Compared to the easy
one-click services available with online retail and finance platforms,
telehealth can feel clunky and frustrating. Technical issues, not knowing how
to prepare for appointments, and a lack of awareness of available services can
all taint the consumer experience.

Providers looking to launch (or re-launch) a patient-friendly
telehealth service ahead of a possible second wave should aim to check off
these four considerations before rolling it out.

1. Prioritize easy online scheduling for virtual care

Allowing patients to book telehealth appointments when it suits them will help to reduce no-shows and minimize delays. A telehealth platform that integrates with physician calendars and other patient management and record management systems will keep things running smoothly at the operational level, while creating a convenient and secure way for patients to schedule care.

For example,
when Benefis
Health System
implemented Patient
, more than 50% of patients chose to book their appointments out
of normal working hours. Sam Martin, digital developer and web specialist at
Benefis, says:

“If you’re
not allowing your patients to schedule online, you’re behind the times. You can
only benefit from it. We’re seeing the number of online bookings continue to
grow every month, confirming that this solution is working for patients.”

2. Include quick and reliable coverage checks

With the
pandemic and resulting unemployment putting both provider and patient cashflow
under strain, any available commercial or government coverage must be
identified quickly.

should run automated coverage checks to find any missing coverage and select
the right financial pathway for each patient as soon as possible. Not only will
this create a more compassionate patient financial experience, it’ll allow the
collections team to focus their attention on the right accounts and minimize
the risk of write-offs.

Automated Coverage
screens for eligibility
through Medicare, Medicaid or commercial plans, without any collections agency
getting involved.

With this tool, Essentia Health were able to find
coverage for 16,990 accounts that were assumed to be self-pay or uninsured. Kathryn
, Patient Access Director, says:

“This has
helped patients because we’re actually billing their insurance versus billing
them for self-pay. It’s helping staff because they’re billing the insurance
company much quicker. There’s less rework.”

3. Get telehealth claims right first time

Given that
the pandemic may cost hospitals an estimated $200 billion
between March and June 2020, there’s no room for the added financial burden of
claim denials. But as telemedicine expands, so does its regulatory framework. Providers
must keep track of changing payer updates and coding rules so that claims are
submitted right first time.

An automated,
data-driven claims
management tool
can help providers analyze claims with greater confidence and
spot any errors well in advance of submission. Telehealth alerts can be
included as customized edits, to confirm whether the patient’s current plan
includes virtual care. To help providers manage this process, Experian Health
is offering free access to telehealth payer policy alerts through our COVID-19
resource center

4. Protect patient data

As with any
part of the digital patient experience, a multi-layered approach to protecting
sensitive information is a must. Ideally, this will include two-factor patient
identity authentication, device recognition and out-of-wallet checks whenever a
log-in attempt looks suspicious.

Automating this process with a tool such as Precise ID allows providers to integrate multiple data points to check that a
patient is who they say they are, in a way that’s HIPAA-compliant. This makes
it harder for thieves to access patient data, without burdening the patient
with extra checks as they manage their information.

Retaining patient volume and rebuilding revenue through
“contactless” care won’t be possible unless the entire telehealth journey is as
seamless as possible. From scheduling to payment, Experian Health can help you create
a virtual patient experience that’s convenient, secure and reliable. Contact us to find out

The post 4 Tips for Launching Telehealth Services appeared first on Healthcare Blog.

5 Ways to Make Patient Scheduling Easy Through Your Call Center

Consumers today expect fast and convenient access to almost everything, healthcare included. While still only offered by a fraction of healthcare providers out there, online scheduling is catching on throughout the market – especially as more providers turn to telehealth solutions during COVID-19.

Still, despite the uptick in online self-scheduling, there are patients who prefer to call to schedule an appointment and call centers may be overwhelmed as a large number of patients rush to reschedule appointments that were cancelled or postponed due to COVID-19. To best prepare, providers will want to ensure the best possible patient experience for those calling to schedule an appointment. This can be done by enabling online scheduling throughout the call center.

Here are five ways to make patient scheduling easy through your
call center:

Save time
With a manual scheduling process, patients often have to sit on the phone – sometimes for upwards of twenty minutes – while also being put on hold or having to wait to be called back to confirm an appointment. It’s not only an awful patient experience but imagine what all that time adds up with the number of scheduling calls providers receive every single day? By reducing call times you’re making the process more efficient for more routine scheduling calls while also opening up call center agents to focus on those patients who need more attention.

Automate the rules
The key to reducing time spent scheduling an appointment is automating the scheduling protocols and business rules of the providers in the scheduling platform. Call center agents traditionally have to manually navigate expansive spreadsheets or three-ring binders of business rules with the scheduling criteria for each provider. Experian automates all those rules in our system and translates them to easy Q&A prompts for the scheduler while on the phone with a patient. In short, rules automation equals quicker scheduling (while maintaining accuracy).

Improve training
Because the rules are automated, the training process for call center agents is made much more efficient. Where agents would have had to learn the various nuances of scheduling complex specialty care for a variety of providers, they now just need to learn how to use the scheduling platform. The scheduling protocols are automated and help dialogues will pop-up to explain and guide agents through the scheduling process for every provider and care type. Where it may have taken 60 to 90 days to master scheduling for a new specialty, schedulers can now be experts for that specialty in as little as one hour.

In order to get the most out of any scheduling solution it needs to integrate into the provider’s practice management system. Leveraging APIs or HL7 bi-directional connectivity, all bookings occur in real-time. This prevents any double-bookings and also removes any calendar maintenance by staff to block and recheck time for providers. With the integration, bookings from the call center transact the same as if a staff member was logged in at the providers office and scheduling on the spot.

Automated outreach
Providers can use automated outreach to augment their call center capabilities. With it they can send text message and IVR campaigns to patients with the ability for patients to schedule an appointment in real-time on the phone.

Check out Patient Schedule to learn more or download our free guide about how scheduling can be made easier for your patients through all of your access channels.

The post 5 Ways to Make Patient Scheduling Easy Through Your Call Center appeared first on Healthcare Blog.

7 must haves for your patient scheduling system

COVID-19 has changed the way millions of Americans access care during COVID-19, leading to the widespread adoption of virtual health and other consumer-centric technologies. Without online self-scheduling however, technologies like telehealth may not reach their full potential. Incorporating a self-scheduling solution that reaps long-term success takes a specific strategy, and with the number self-scheduling vendors growing every day, it can be hard to know what to look for in a self-scheduling solution.

How can you be sure that you are choosing the
best solution for your organization? Here is a snapshot of what to look for:

  • Automated Business Rules.Online self-scheduling that automates scheduling protocols with customized business rules drives efficiency while ensuring bookings are accurate. Providers can maintain control of their calendars while filling existing gaps, designating which days and times are available for which specific type of patient or appointment. This is particularly vital during a pandemic like COVID-19 where to avoid further exposure and spread of the virus providers may only want to see patients experiencing those symptoms at certain times of day. The benefits are three-fold: schedulers, including call center agents and patients, see only appropriate appointment availability for a provider in real-time allowing them to book on the spot, providers can experience a more predictable schedule as they know their rules are being maintained, and patients can be assured that their health and safety is a top priority for in-office visits.
  • Integration. Direct integration with any EMR/PM system is a key component for any successful scheduling solution as it provides everyone (patients, providers, health plans, and call center agents) with a continually up-to-date, real-time view of appointment availability. These integrations improve workflows and behind the scene while enabling the patient-centered aspect of the technology, which is the ability to book an appointment from a computer, phone, or tablet. Additionally, being able to provide a non-integrated scheduling experience for affiliated providers and other services is a vital additional offering that needs to be available outside the integration so that systems can open scheduling to all services. Having a solution that can do both is ideal.
  • White-Labeled Experience.Customers remember and go back to brands they love, and that couldn’t be truer in healthcare. That is why it is important for organizations to deliver a consistent brand experience across the board—even with a self-scheduling solution hosted by an outside vendor. Leveraging a white-labeled scheduling solution promotes a strong brand experience and builds trust while saving patients the hassle and confusion of leaving the organization’s website to schedule via another. Moreover, many scheduling vendors require logins to their system in order to schedule, this is an unnecessary barrier to access – it’s best to find a solution that needs no additional logins.
  • Real-Time Scheduling (Not Just Request an Appointment).Unfortunately, what you see with self-scheduling isn’t always what you get. So many times, patients go through the entire online scheduling process only to find out that they’ve only requested an appointment, and still have to wait for the provider to confirm and book – often with a phone call which is what they were trying to avoid. Real-time scheduling means patients have the ability to view and actually choose their preferred appointment day and time and book right there on the spot. This also means that patients can book an appointment at all times of the day (or night), not just during the provider’s business hours. This is particularly helpful during times of social distancing and stay at home orders when schedules are completely thrown out of whack and patients may not even have the opportunity to schedule an appointment until odd hours of the night or morning when a provider office is closed.
  • Calendar Reminders.The act of booking an appointment isn’t always enough to make a patient show up for scheduled care. Automated calendar reminders sent to patients immediately after the booking process, however, increase the chances that patients will show for their scheduled appointments and dramatically reduce patient no-shows. Specifically, ones that include .ics calendar files that can be added to smartphone calendars have been proven to be effective.
  • Automated Outreach. Many health systems send automated phone and text campaigns to patients about their healthcare needs, but all of them still require a patient to call in to schedule an actual appointment. Healthcare organizations looking to effectively close more gaps in care while also simplifying the outreach process should look to a solution that provides patients the ability to book appointments in real time via IVR and text.
  • Analytics. Do you know where your patients came from before they arrived at your website? What did they do after arriving? Are they dropping off and when? And maybe the most important question, what is your conversion rate? The answers to each of these questions can refine and improve the scheduling process, and a sophisticated self-scheduling solution will come with real-time analytics dashboards and data science capabilities to help determine opportunities for improvement.

The rise of consumerism in the healthcare
industry is no doubt influencing the creation and adoption of self-scheduling
solutions, among other digital technologies that improve patient access. As
these technologies are more seriously considered, providers need to be aware of
what to look for in a self-scheduling solution. Smart technology that
incorporates the components above will stand out from the crowd, ready to fit
the unique needs of any provider organization.

Download our free guide to learn more about and how it fits within an omni-channel access strategy.

The post 7 must haves for your patient scheduling system appeared first on Healthcare Blog.

Telehealth Benefits Expansion: Helping Providers Maximize Reimbursement

today expect digital capabilities from their provider and will
increasingly choose
those who offer digital capabilities. Knowing this,
many providers have been working to shift more of the patient journey online,
through telehealth and virtual care. Not all care needs to be delivered face to
face, and technological advances allow patients to access more services from
the comfort of their own homes, at a time that suits them.

This trend
has been visible for a few years now, as consumers sought out more smartphone-friendly
digital healthcare experiences. But change in the healthcare industry often
comes at a lumbering pace, so when the coronavirus pandemic hit and accelerated
the transition to remote care, many organizations found themselves on the back
foot. Now, it’s a case of catch-up, keep up or get left behind.

As demand
for telehealth services grows, so too does the regulatory framework around it.
A big part of staying competitive will be the ability to keep track of new
telehealth regulations and changing payer rules. Those that don’t will find
their collections straining under the added pressure of missed reimbursement
opportunities. How can providers stay on top of the changes and maximize

Keeping track of telehealth
reimbursement regulations

Since early March 2020, the federal government has moved to make telehealth
more accessible to patients with Medicare coverage. Limitations on the types of
clinicians that can provide telehealth services under Medicare have been
waived, while Medicare beneficiaries in rural areas and those with audio-only
phones can now access care remotely. New telehealth services will be added to
the reimbursable list under a quicker process, which is a huge benefit to both
patients and providers, but will mean the rules around reimbursement could
change more frequently.

Speaking in March, CMS Administrator Seema Verma said:

“These changes allow seniors to communicate
with their doctors without having to travel to a healthcare facility so that
they can limit risk of exposure and spread of this virus. Clinicians on the
frontlines will now have greater flexibility to safely treat our beneficiaries.”

Flexibility is always welcome – but what do looser rules mean for reimbursement workflows? Three challenges stand out:

  • Payer variation. Telehealth and telemedicine data can be presented
    differently by different payers, causing a headache for providers during
    eligibility verification.
  • Coding variation. Each type of telehealth visit is coded and billed
    differently. Regardless of where appointments are carried out, clinicians must
    still follow the same billing workflow, so keeping track of the differences is
  • Geographical variation. Providers now have to track billing and coding changes
    for telehealth services from different payers across multiple states.

What can providers do to bill telehealth services as accurately
as possible?

Billing for telehealth services more frequently calls
for a solution that’s flexible enough to keep pace with changing payer rules,
and sufficiently scalable to provide real-time reimbursement information when
it’s needed. Automation can help achieve both of these goals.

Two use cases for automation:

  • Quicker Medicare checks: Run quick and accurate checks to confirm patients are eligible for Medicare coverage for the services in question. A tool such as Coverage Discovery can comb for available coverage, even as patients are switching plans or payer rules are changing. In addition, eligibility verification automations can sweep for coverage information on telehealth services, using reliable and secure third-party data and analytics to check for updates.
  • Cleaner claims submissions: Tighten up billing workflows so that claims can be submitted as soon as possible. Claims management software can run automatic checks so that every claim is submitted clean and error-free. Any missing or incorrect codes can be flagged up, eliminating costly and time-consuming rework. Telehealth alerts can be included as customized edits to confirm whether virtual care is a benefit included in the patient’s current plan.

While these actions can help protect your
bottom line during the immediate crisis, they’ll also help you build a solid
foundation as your telehealth offering inevitably continues to grow. Whether
you’re looking to verify coverage, check eligibility or protect patient
identities as they log in and use telehealth services, reliable data is key.

a free consultation
to discover how Experian Health can help you leverage
accurate and real-time data insights to optimize your billing workflow and
maximize telehealth reimbursements.

The post Telehealth Benefits Expansion: Helping Providers Maximize Reimbursement appeared first on Healthcare Blog.

The rise of digital healthcare solutions: optimizing the patient journey in a post-COVID world

From airlines to cafés to car manufacturers, businesses across
America are scrambling to respond to the challenge of COVID-19. In healthcare, services are
being put on pause
to protect staff and patients on the pandemic’s front line,
leaving health systems to contend with gaps in reimbursements and exhausted
cash flows

The problem lies in the sheer number of human touchpoints involved
in the typical patient experience: scheduling, paperwork, waiting rooms, treatment, payment…all
that in-person interaction just isn’t realistic in the current climate.

Digital and mobile
technology could be the answer. While digital communication platforms have been growing steadily
over the last decade, they’re now a life raft for many providers as COVID-19
forces much of the patient journey online.

director of research and marketing at Rock Health, says investments in virtual
care have already exceeded $3 billion this year:

“Without COVID, the story would have continued from last year
as this was a healthy, growing space with a lot of momentum behind it. That
momentum has turned into incredible urgency and demand for communication,
testing, monitoring, care– all of those things done at a distance.”

This trajectory will likely continue beyond the immediate crisis,
as providers prepare for a possible second wave later in the year and patients
become accustomed to remote and mobile options. Providers that take advantage
of these digital solutions now will be better positioned to optimize the
patient journey in a post-COVID world.

What could the digital patient
journey look like beyond COVID-19?

A digital healthcare experience can offer patients more
convenience and flexibility while protecting revenue for providers, in the
following ways:

  • Scheduling appointments when it

The first bump in the road for many patients is scheduling their
appointment. With many in lockdown juggling home-schooling and home-working,
it’s not always convenient to call during office hours.

A patient
scheduling platform
lets the patient book
their appointment whenever suits, using the channel they prefer. Before the
pandemic, Benefis
Health System
found 50% of patients
chose to book after hours, including for urgent care. We can expect this to
increase as even more patients are nudged online.

As the threat of COVID subsides, a massive influx of
patients will also want to reschedule postponed visits. Automated patient
scheduling will reduce the pressure on call centers and offer a more efficient
consumer experience.

  • Reducing registration gridlock
    with automation

Patient access is often rife with avoidable stress – queues,
unnecessary forms and manual data entry, resulting in costly errors and
repeated work.

Instead, providers can streamline the process by allowing
pre-registration tasks to be completed online, and automating
patient access
with a mobile intake
experience. Completing as many tasks as possible outside of the provider’s
office will help minimize face-to-face contact, keeping everyone safe.

  • Opening up access to telehealth

There’s no getting around the fact that most care needs to be
delivered in person. Telemedicine offers an effective way for patients to seek
care from the safety of their own home. Video calls can be used for general consultations,
remote monitoring of patients with respiratory conditions, and even supporting
patients with chronic conditions to adhere to care plans.

As the government allocates $20 million to support access to telemedicine in response to COVID-19, up to 54% of
patient encounters
are expected to take
place remotely in the near future.
Many of these patients will choose to stick with telemedicine, even when
in-person options return.

[Remember to check out our free COVID-19
Resource Center
, where you can get free access to telehealth payer
policy alerts to help avoid payment denials and delays.]

  • Making
    contactless payment the easy option

payment through apps such as Apple Pay and Venmo are gaining popularity as
consumers try to avoid exchanging cash and cards. But can it be used in
hospitals? In short, yes.

only does Experian Health’s Patient Financial Advisor offer patients a way to
make secure – and socially distanced – payments, it allows providers to give a
breakdown of estimated costs using real-time information. Patients get updates on
their mobile or through their patient portal. These digital alternatives not
only offer a more convenient patient experience, they can also allow providers
to collect payments faster and in full.

Contact us
to find out how digital health solutions can help your organization adapt to
the new normal, and provide a better patient experience now and beyond COVID-19.

The post The rise of digital healthcare solutions: optimizing the patient journey in a post-COVID world appeared first on Healthcare Blog.