Experian Health, a provider of solutions in revenue cycle management, identity management, patient engagement, and care management, plays a pivotal role in transforming the healthcare landscape. By leveraging advanced data analytics and innovative technology, Experian Health aids healthcare organizations in improving operational efficiency and enhancing patient access to care.
The company has just released its annual “State of Patient Access Survey,” which reveals a notable shift from last year’s results. Both providers and patients report increased satisfaction and significant improvements in healthcare services. Nearly a third (28%) of patients and 55% of providers believe that access to healthcare is improving, and an impressive 79% of providers plan to continue investing in patient access services.
Key highlights from the survey reveal that nearly half of the providers (49%) cite patient information errors as a primary cause of denied claims. Patients still face challenges in seeing practitioners quickly, with 27% indicating this as a major issue, consistent with the 2022 results. Contributing factors to the improved patient experience include advancements in telehealth, enhanced automation for speed and accuracy, better staffing, improved insurance identification technology, and the implementation of digital and mobile communications.
These findings underscore the essential role of technology in improving access to patient care. To delve deeper into these insights, we spoke with Clarissa Riggin, Experian Health’s Chief Product Officer, who shared more about these advancements and their impact on the healthcare industry.
The survey indicates a significant improvement in patient access to healthcare services. What specific strategies or technologies have been most effective in driving this positive change, and how has Experian Health contributed to these advancements?
Clarissa Riggin, Chief Product Officer at Experian Health: We see two big factors at play – more receptiveness to doing things differently – the residual effect of the pandemic – and embracing the technology that is available to make change happen. Providers understand that patients aren’t just patients; they are consumers. In today’s world, we’re all accustomed to instant gratification. With a user-friendly app or a click of a button, we have access to the information we’re looking for, like ordering takeout and groceries to our doors, depositing and transferring money to our bank accounts, booking an airline ticket, and buying almost anything we can think of and more. Patients have the same expectations when it comes to their healthcare journey. Patients want the ability to make appointments, pay healthcare bills, and see their health records with ease and efficiency.
The healthcare industry is modernizing and creating an environment where consumers can use their mobile devices and transact in seconds. Whether it’s being able to schedule an appointment quickly or pay a bill online, patients are becoming more satisfied with their healthcare experience as well as better informed.
Based on Experian Health’s 2024 State of Patient Access survey, the operational improvements made by providers have influenced many patient satisfaction levels. In fact, almost a third (28%) of patients and 55% of providers surveyed said that healthcare access and service levels are improving. The implementation of digital tools designed to support more efficient workflows and patient access has greatly improved administrative burdens and patient engagement using technology such as patient portals, online registration and scheduling, and telehealth services. According to the survey, the most significant contributors to happier patients are the improvements in staffing levels, more accurate price estimates, increased use of telehealth, and self-scheduling options.
A significant factor in the improvement of patient access is price transparency and accurate estimates. Patients’ needs and providers’ priorities converge when it comes to the cost of care. In every other industry, consumers know the exact price of what they are purchasing, and they expect the same of their healthcare services. Providers alike want to avoid claim denials. Accurate identification of insurance coverage and generating estimates have the opportunity to make or break the patient access experience for both patients and providers.
The connective tissue among several of these factors is technology and the ability for patients to get online to quickly and easily transact with providers. Through the “digital front door,” patients have access to their information and can take necessary action and make decisions about their healthcare with ease. For providers, technology is helping them be more accurate and efficient in their daily operations which in turn creates a better patient experience.
Our team at Experian Health is constantly evaluating ways we can support providers and innovate to meet their needs. This includes launching new solutions and we are excited about now offering our Patient Access Curator, a new solution that uses artificial intelligence (AI) to retrieve insurance benefits coverage in seconds on the front end. Last year, we launched products that help providers reduce denied claims. Our mission is to simplify healthcare and all of our solutions aim to improve accuracy, efficiency, and the patient experience.
Telehealth and automation serve as key factors to improve the patient experience. Can you elaborate on how Experian Health has integrated these technologies into its services and the tangible benefits they have brought to both providers and patients?
Clarissa Riggin: Before the pandemic, telehealth was a visible trend making its debut as consumers sought out more smartphone-friendly digital healthcare experiences. As we have witnessed, change in healthcare can be a slow process, but the pandemic accelerated the transition to remote care, and many provider organizations struggled to catch up and keep up.
The industry has clearly realized that telehealth is here to stay, and it has immense benefits. According to our latest survey, telehealth has helped patients see physicians faster which remains the top challenge for patients. Telehealth is an effective way for providers to maintain stable service delivery and limit gaps in care. For patients in rural and underserved communities, telehealth has bridged the gap for equitable access to care. Now, telehealth is an expected feature in patients’ healthcare experience.
Experian Health’s data and analytics solutions enable providers to pinpoint gaps in digital strategy delivery, understand and segment patients, and implement a flexible, responsive approach to ensure a seamless patient journey. In addition, with our Coverage Discovery and eligibility verification solutions, providers and patients can confirm coverage eligibility early, which will speed up collections further down the line. We can see that pairing the use of digital channels with telehealth options boosts patient attraction and retention, as well as efficiency and productivity when utilizing telehealth platforms.
Looking at automation—providers can utilize automation technology for pain-staking data entry involved with registration for both telehealth and in-person patient appointments, bettering the patient experience. Automation technology does more than improve workflow efficiency in a complex healthcare ecosystem. Automation technology helps engage patients in every step of the healthcare journey. It personalizes patient encounters and delivers timely, tailored updates to patients for appointment reminders, and provides information related to preventative care. This type of patient access promotes connectivity with the provider and ensures patients know their provider is prioritizing their well-being, as well as helps patients stay informed and adhering to treatment plans.
AI and automation have also proven valuable in lessening claim errors. Experian Health’s AI Advantage solution is designed to first, prevent denials, and if denials happen, perform denial triage. The technology spots claim errors before submission to the payer. AI Advantage is like an early warning system created to reduce denials by red flagging claims errors, as well as flagging claims that fail to meet payer requirements—even if those requirements have recently changed. If denials occur, it identifies denials with the highest potential for reimbursement and automatically segments denials so staff doesn’t spend the manual labor and hours doing it, ultimately increasing revenue and saving providers valuable time.
Taking the guesswork and labor out of claims management also benefits the patient experience by combatting denials in the first place and allowing providers to spend more time with patients discussing patient care instead of claims.
Nearly half of the providers cited patient information errors as a primary cause of denied claims. What innovations are being implemented to reduce these errors and their impact on claim denials?
Clarissa Riggin: Denied claims are incredibly frustrating to navigate and can be financially burdensome for patients. For providers, managing claims effectively, and more specifically preventing denials, is one of their biggest challenges. In our State of Claims 2022 survey, 72% of provider respondents said reducing denials was their top priority, and they cited several reasons denials happen, including payer policy changes, reimbursement delays and a rise in the number of errors and denials.
Experian Health’s new Patient Access Curator makes leaps and bounds in claims management efficiency and accuracy. Most issues in claims management start at the beginning. Problems that lead to denials present themselves early in the revenue cycle, usually when information is missed or captured incorrectly during patient registration. For this exact reason, we focus on denial prevention strategies on the front end.
The patient registration process is overflowing with vital data collection— the patient’s medical history, identification documents, insurance information, etc. Manual collection of this data is guaranteed to have human error on occasion. On the other hand, many digital tools also require healthcare staff to manually check several payer websites and data repositories to verify the patient’s insurance eligibility, as well as check for billable coverage that may have been missed by the patient. At Experian Health, we’ve designed next-level claims management solutions that simplify these processes for both patients and providers. And now, we’ve integrated AI-powered data capture technology that takes it a step further.
With the power of data capture technology, providers can gather and process patients’ insurance data at registration using an “if-then” logic that provides multiple data points from a single inquiry in less than 30 seconds. Allowing providers to access and process this level of information in less than a minute is a game changer for claims management. Paired with the AI-powered data collection technology, this solution allows registration staff to collect and verify much of the information needed to compile an accurate claim, with a single click. In a matter of seconds, staff is provided with a comprehensive readout of eligibility verification, coordination of benefits, medicare beneficiary identifiers, coverage discovery and financial status, as well as the patient’s demographics.
With technology like this at our fingertips, providers and registration staff can greatly decrease inaccurate information and prevent claim denials from the start. In a time where pressure is coming from ever-changing payer rules, labor dynamics, and operational challenges, this type of technology solution is the boost the revenue cycle needs to strengthen reimbursement rates and productivity, as well as alleviate some burden from staff.
With 79% of providers planning to continue investing in patient access services, what are the most promising areas for future investment?
Clarissa Riggin: I believe the providers will continue to invest in all aspects of patient access services. We know from our latest survey that healthcare providers and patients are in rare agreement that healthcare access and service levels are improving, which is a big win considering the industry’s staffing shortage and massive increase in denied claims over the last few years.
Providers included telehealth improving time to see a provider, increased speed and accuracy with automation, better staffing, improved insurance identification technology, and the implementation of digital/mobile communications as the top indicators for why the patient experience is better. Patients’ priorities align with these indicators, and my prediction is that providers will continue to focus on these areas, specifically in relation to price transparency and claims management. Healthcare bills are never going to be a patient’s favorite part of the healthcare experience, but making it seamless and relatively clear and convenient can make it painless and encourage patients to see their physician or schedule a procedure when they need it.
AI and automation are at the forefront of the shift we’re seeing not only in patient access services but also in providers’ operations. AI and other digital tools are revolutionizing registration and claims management, and reshaping the entire revenue cycle management process. As the healthcare landscape evolves, the digital transformation of prior authorization is no longer a distant aspiration. It can be an imminent reality, if we embrace it.
There is still hesitation about AI and modern practices so there are a few hurdles we have to tackle. It’s going to take a 360-degree approach to continue to improve provider stability and the entire patient journey. However, in recent years, providers have seen the immense value in utilizing these tools. They’ve witnessed how proper AI and automation solutions can relieve burdens for staff, as well as improve the patient experience.
The future looks promising if we continue to address pain points and leverage the innovation that exists to solve the issues providers and patients both are fighting in the healthcare system.
The survey identifies seeing a practitioner quickly as the number one challenge for patients, consistent with 2022 findings. What are the main barriers to quick access, and how is Experian Health working with healthcare providers to overcome these challenges and enhance the speed of service delivery?
Clarissa Riggin: It’s encouraging to see that the overall sentiment related to patient access has improved, but the No. 1 challenge for patients still remains— seeing a practitioner quickly. The staffing shortage over the last few years has been one of the barriers. An Experian survey shows that the majority (69%) of the 200 healthcare executives surveyed who are responsible for RCM staffing see challenges continuing for the long term. The biggest hurdles to overcome include finding candidates skilled in RCM, and staff burnout. In fact, 9 out of 10 respondents said the turnover rate for administrative roles related to patient access, RCM and the patient experience is in the double digits, with nearly half (43%) reporting a turnover rate of more than 25 percent. This is much higher than the overall average turnover rate this year in the U.S. of only 3.8 percent.
In addition, many physicians are overloaded with patients. The ideal average patient load for a primary care provider is estimated to be 1,000. However, the reality is around 2,500, and the American Association for Physician Leadership, says the number is closer to 3,000. Not only do providers have an overflowing number of patients, they have messages to respond to once their day of appointments is done.
There are always going to be challenges with staffing levels, which is why leveraging technology is so important. Many tasks can be automated and simplified opening resources that can be applied to patient care and management.
There is still room to continue progressing in the field of digital solutions that make a positive difference, but we’re on the right track. At Experian, we’re definitely aiming to utilize technology to facilitate a better provider and patient relationship. As more solutions surrounding registration, accurate patient data entry, and claims processing continue to advance, our hope is that next year’s survey results will show even more progress in patient access and service.