Digital Healthcare
Article | November 29, 2023
With consumers’ share of healthcare costs expanding, we need to do a better job making charges more transparent and more predictable
My husband recently stubbed his toe. Badly. Badly enough that I encouraged him to go see a doctor. He was reluctant. While I suspected he’d rather just garner sympathy by complaining to me while limping around the house (just kidding, honey), his stated reason was all too familiar: “I have no idea what we’ll have to pay. They’ll want to do anX-ray,it might need surgery, and I have no idea what it’ll cost.” All true. We have good health insurance; but like most Americans, when we go to the doctor or have a procedure, what we will actuallyhave topay out of pocket remains a mystery.This is something that we can and should change.
As consumers we are shouldering more and more of the cost of healthcare. And the biggest increases are for those of us with employer-sponsored plans. According to an analysis of federal data by the Commonwealth Fund,deductibles in employer plans more than doubled between 2008 and 2017, from $869 to $1,808. Especially troubling, an accompanyingCommonwealth Fund survey revealed that only 62% of adults were very or somewhat confident in their ability to afford healthcare.
This increasing burden is also evident when you look at the crushing levels of medical debt in the United States. According to a new studyby JAMA, medical debt is now the largest contributor to personal debt. And the data for this study was collectedbeforethe COVID-19 pandemic.
Some of this debt is driven by unpredictability—if the heart procedure you needed costs several thousand dollars more out of pocketthan you thought it would, you may not be prepared, emotionally or financially, to pay it. This is a bad outcome, obviously. The risk of nonpayment rises for the provider; and a recuperating patient is burdened with the stress of a large,unexpected bill.
More skin in the game
Soas consumers are paying more out of pocket, some may become reluctant to seek care (like my husband) or seek more information about what they willhaveto pay for the care they receive. Consumers are also armed with incredible levels of price transparency with other products—everything from hotel rooms to clothing to household items. With so much skin in the game, and the internet providing so much information, consumers’ expectations are changing when it comes to healthcare.
State and federal regulators are also beginning to take action, a trend that will likely accelerate. Most hospitals are now required to publicly disclose the prices they charge. This does not, however, solve the issue for consumers. While it provides a measure of visibility into pricing for insurance companies, Medicare, and Medicaid, it doesn’t show what share the patient will ultimately pay.
Making the complicated simple
The complexity of pricing in healthcare is well documented. Niall Brennan, CEO of the Health Care Cost Institute, a nonprofit that analyzes medical costs, suggests that healthcare costs are too high.As a recent Wall Street Journal article reported, a price of a C-section varied from $6,241 to$60,584 at one hospital. This all has to do with the vagaries of the agreements that hospitals sign with multiple insurance companies and government payers. In turn, each insurance company will have its own deductible and out-of-pocket schedules, which providers don’t have access to.
We are seeking to change this at Change Healthcare. We are piloting our Care Cost Estimator with a few innovative providers. With the Care Cost Estimator, weleverage our unique dataset, and the largest eligibility network in the industry, to make the unpredictable, predictable.Because we’ve managed 15 billion healthcare transactions—and our network covers 1 million physicians, 6,000 hospitals, and 2,400 payers—we have an unmatched ability to analyze what real-world patients are paying for practically any procedure, performed at almost any hospital or clinic.
With a cloud-based transaction engine, providers will now be able to tell their patients how much they will have to pay out of pocket for a given procedure.And this analysis takes place in real time.
Removing unpredictability in pricing
This gives providers the opportunity to offer added value for their patients, taking some unpredictability out of whatis often a stressful transaction. In addition, it accelerates patient payment cycles which, as the patient’s share of the cost burden increases, is becoming more and more important. We’re not talking $50 co-pays anymore; it’s thousands of dollars per transaction. If necessary, providers can also help the patient plan for the expense, offering financing options, thus reducing unpaid bills. For the patient, it allows more informed decision-making and peace of mind.
Testing the beta version of our Care Cost Estimator with our partners will allow us to receive real-world feedback and collaborate with customers on how to continuously improve the product as we scale it. We expect the ROI for providers, in addition to the payment-cycle improvements, will include greater patient satisfaction and loyalty. For the patient, it provides information necessary to help make proper decisions and plan emotionally and financially; in other words, giving the consumer the same information for vital healthcare transactions that’s available to them for practically any other purchase.
This kind of win-win solution is at the core of Change Healthcare’s mission to improve the healthcare experience for everyone—including my husband and his broken toe!
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Health Technology, AI
Article | July 18, 2023
Healthcare leaders are embracing the benefits of the cloud and software as a service (SaaS) after the pandemic challenged them to adapt and innovate like never before. 66% of them expect to move their technology infrastructures to the cloud this year – a number that is set to rise to 96% by 2024 [1]. Yet moving to the cloud is more than just a technology transformation. It’s an organizational transformation. Through cloud-based platforms and solutions, healthcare systems can begin to unlock clinical and operational insights at scale while speeding up innovation cycles for continuous value delivery.
Integrating data across the care continuum
In many ways, COVID-19 catapulted healthcare into the future. The pandemic created a new urgency for healthcare leaders to expand their virtual care offerings as a way of connecting with patients beyond the walls of the hospital. At the same time, they wanted the flexibility to scale up or down without large upfront capital expenditures. Effective crisis management also required the rapid exchange of patient information across systems and care settings. Thanks to the flexibility of pay-as-you-go cloud-based services and solutions, healthcare providers were able to quickly scale up digital health technologies to meet new demands. As a result, the acceptance of cloud has increased remarkably [2].
Keeping patient data secure and compliant
As healthcare leaders embark on this journey to the cloud, data protection is a critical consideration. Data processing in healthcare must comply with rigorous standards, whether it is HIPAA in the US or GDPR in the EU. Unfortunately, healthcare organizations also remain a top target for data breaches, calling for additional data security protection measures [3].
While the need for data security and regulatory compliance has historically motivated healthcare organizations to keep data on premises, today there is a growing awareness that moving to the cloud can in fact be the better road to travel. In fact, 60% of healthcare leaders now cite security as one of the top benefits of the cloud [4]. When healthcare organizations rely on their own data centers, they are responsible for security from end to end, which can become prohibitively complex and time-consuming as IT infrastructures expand over time. Cloud-based services and solutions can reduce dependency on local hardware to store sensitive data while automated software updates keep systems current.
Turning data into insights at scale at the point of care
Working from these foundations, the next big opportunity in healthcare is to capture the insights in the data that we are beginning to connect and integrate. This is where the cloud is also turning into a vital enabler, with its powerful computing resources and advanced machine learning capabilities, offered as microservices. These microservices provide the building blocks to develop new digital solutions that, once validated and approved, can be deployed at scale to help improve clinical outcomes and operational efficiency.
Enabling rapid experimentation and continuous value delivery
Embracing the cloud also changes the very nature of innovation in healthcare.
Healthcare-compliant cloud platforms offer a flexible foundation for rapid development and testing of digital applications. Cross-functional teams working in short and agile cycles can put new digital applications into the hands of physicians or patients more quickly, and then add new or improved features and functionalities as they gather additional user feedback. That means healthcare organizations get to innovate faster. And in smaller, more digestible increments.
Moving to the cloud is not all or nothing
Of course, none of this is to suggest that moving to the cloud is like switching a button. It’s a complex and multi-year journey for most of our customers. And it’s quite a journey for Philips, too. Any organization that has accumulated a large number of legacy systems and infrastructures over the years will have to manage a hybrid architecture during their journey to the cloud [5].
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Health Technology, Digital Healthcare
Article | July 14, 2023
Momentum in digital healthcare transformation… it’s massive, and much needed.
As organizations adapt to new modes of care, demands on resources, and consumer expectations, payors and providers are eyeing opportunities to reduce costs, improve care, build awareness, and expand relationships.Here are 8 trends we’re currently tracking into 2021:
TREND 1
The evolution of healthcare will be characterized by a reengineering of clinical care and operations around digital health and pervasive real-time use of data and advanced analytics. Gartner
TREND 2
The current landscape has underscored the importance of improving workflows, achieving greater clinical efficiencies and better integrating data across organizations through tools like natural language processing, remote process automation, and cloud-based technologies. Becker’s Hospital Review
TREND 3
Now more than ever, healthcare organizations must build a multi-channel digital experience portfolio to deliver personalized consumer-centric experiences that drive engagement and reduce costs. Becker’s Hospital Review
TREND 4
With increasing emphasis on cross-platform (EHR, CRM, CMS, virtual health, etc.) and cross-organizational data portability, advanced APIs and interoperability should ensure secure and efficient data exchanges between EHR systems, devices, and various channels of care. Forbes
TREND 5
COVID-19 has pushed telehealth into the mainstream, and adoption has gained impressive traction. Expect expansions of asynchronous virtual care leveraging integrated wearable technologies. Business Insider Intelligence / Research and Markets
TREND 6
With more healthcare data available, artificial intelligence and machine learning technologies will provide greater speed and insights to analyze and predict outcomes that drive change in patient care. Gartner / Forrester
TREND 7
Organizations will continue looking to Social Determinant of Health strategies to help understand health disparities – including those highlighted through COVID-19 infections – and alleviate some of the financial strains while delivering high quality care. Fierce Healthcare / Healthify
TREND 8
Successfully making the transition to offering greater price transparency will not only put healthcare organizations in compliance, but help satisfy patient demand, increasing patient engagement and even point-of-service payments. Health Leaders Media
The strategy imperative
With so much call for transformation, it’s vital to resist the pull of “shiny object” point solutions and to, instead, build a fully-considered digital strategy. Need help getting started? Our healthcare experts help the nation’s largest providers and payers navigate and execute their north star strategy, tackling specific challenges through assessments, best-practice advice, strategy, and roadmaps. Explore our thought leadership and connect with us to learn more today.
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Health Technology
Article | February 19, 2022
Dialysis providers face many of the same financial and operational pressures that affect other provider organizations, including flat or reduced reimbursements, chronic staffing shortages, and increasingly complex insurance requirements. Dialysis centers, nephrologists, and renal pharmacies also grapple with the impact of a growing shift in dialysis care to the home setting.
End-to-End Automation Can Reduce Denials, Improve Cash Flow
The good news is that despite these challenges, dialysis providers can sustain strong cash flow, reduce costs, and mitigate denials by applying advanced technology to the revenue cycle.
Here are six ways technology can help strengthen the dialysis center revenue cycle in the today’s difficult operating environment:
Identify undisclosed insurance coverage
Because patients often present as self-pay even though coverage exists, determining their true insurance status can be challenging. Yet failure to identify existing insurance can result in significant write-offs.
That’s why renal providers need technology solutions that can uncover patient coverage information before care is provided. Change Healthcare’s Coverage InsightTMsolution provides an expansive network and search-and-matching capabilities necessary to identify and confirm patient coverages at the outset of care.
The solution uses machine learning algorithms—coupled with access to vast stores of available third-party-data—to develop robust patient profiles, which can then be linked to potential funding sources. Notably, it identifies a variety of indicators, including high probability of disability, income levels and financial status, insurance sources, and other actionable information to help you verify coverage and recover revenue.
We can help identify undisclosed coverage for end-stage renal disease (ESRD) patients through Medicare/Medicaid, Disability/SSI, third-party liability, commercial insurance, state and county programs, social programs, and charity.
Expedite seamless prior authorizations
Streamlining the prior authorization process is essential to help ensure optimal reimbursement for renal care rendered, particularly with commercial insurance and Medicare. But traditional prior authorization processes are frequently time-consuming and labor-intensive and can delay necessary care.
Our Clearance Authorization software addresses the chronic problem of prior authorizations with automated functionality that can determine if prior authorization is required and on file with the payer. The solution also will automatically check medical necessity requirements at the time of registration and electronically submit requests to integrated payers.
Change Healthcare’s Connected Authorization Services go a step further by deploying pre-authorization experts to handle routine authorizations quickly using intelligent technology while working complex cases by exception to improve authorization efficiency and accuracy.
Speed adjudication with electronic attachments
As claims management processes have grown more numerous and complex, providers have struggled to ensure that the correct information is provided to the payer at the appropriate time. The result can be delayed, denied, or rejected claims.
Assurance Attach AssistTMcontributes to faster reimbursement and reductions in denials, organizational expense, and administrative burden by automating the attachments process to meet payers’ increased demands for additional documentation. Attachments are automatically delivered and matched to the appropriate claim, and once the claim is released, claim and attachment status can be easily tracked.
Expedite claims workflow for recurring services
Creating claims for ongoing ESRD care requires repeatedly documenting the same details on each claim. Revenue Performance Advisor, an end-to-end medical billing platform, provides automation that allows dialysis staff to save time by quickly replicating unchanged data from prior visits while updating date-of-service and other information to expedite claims processing.
Revenue Performance Advisor also includes eligibility and benefits verification and automated claims scrubbing that flags incomplete or incorrect claims prior to submission, resulting in a first-pass clean claim rate of 98%.
Accelerate your Medicare claim cash flow
Medicare is one of the largest payers of dialysis services, so ensuring a problem-free and expedited Medicare claims submission process is essential to strong cash flow.
Our Assurance Medicare Direct EntryTMsolution provides a single system for the real-time submission and processing of Medicare claims. It can help expedite reimbursement, reduce AR days, and speed your Medicare primary claim cash flow by at least one full business day.
Assurance Medicare Direct Entry also checks your Medicare claims for eligibility errors using the CMS eligibility transaction system (HETS). Claims needing attention are flagged and posted in Assurance Reimbursement Management for editing. You can quickly correct errors within the system before transmitting the claim directly to Medicare for validation and payment processing.
Optimize patient liability
Making it easy for patients to receive, understand, and pay their portion of the medical bill is key to ensuring a healthy revenue cycle, mitigating the need for collection services, and improving patient goodwill.
With our Patient Billing and Statements solution, Change Healthcare serves as your strategic communications partner, delivering multi-channel, personalized print and digital statements to help expedite patient payment collection.
The solution is designed to provide fast, effective statement and invoice processing, printing, and mailing—cutting your costs and getting you paid sooner. Our advanced statement printing allows you to bypass conventional and time-consuming folding, stuffing, and stamping.
SmartPayTMconsolidates each step of the billing and payment process into one place, enabling you to collect more patient payments, get paid faster, reduce your collection costs, and lower patient write-offs. With multiple payment channels, including online, mobile, telephone and via mail, SmartPay helps expedite patient payments before, during, and after the encounter.
A single, trusted partner
Change Healthcare’s deep knowledge of the renal care landscape and our development of disruptive technologies to overcome traditional revenue cycle barriers can help dialysis centers achieve unprecedented revenue cycle excellence.
And unlike many point solutions that only address a specific revenue cycle issue, Change Healthcare’s technologies are part of a comprehensive approach delivered through a single, trusted vendor. That translates into improved process integration and continuity, as well as simpler overall accountability.
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