Transforming healthcare with data and technology

Healthcare is the second-largest expense for a U.S. household after the cost of housing. Given the high cost, using technology and innovation to find solutions to modernize healthcare and improve the patient experience is now more critical than ever.

Jason Considine, Chief Commercial Officer at Experian Health, says data and analytics have been helping businesses and consumers around the world make better decisions for years—and there is now an opportunity to use the same approach in the U.S. healthcare market.

“We help healthcare providers leverage data and technology to improve patient experience—as well as the efficiency and effectiveness of revenue cycle management process—and get paid most efficiently and effectively, both by patients and insurance companies,” he says. “Patients are paying more and more of the cost of healthcare every year. Leveraging data to determine the optimal financial pathway for a patient, at or before the time of service, is critical to improve operational efficiency, reimbursement, and patient satisfaction.”

Over the past five to 10 years, a digital and data revolution has led to significant changes in the way consumers buy products online and schedule daily appointments. But healthcare has lagged behind other industries and sectors at offering those digital capabilities to patients.

“The digital front door trend is driving a lot of activity around how patients access care,” Considine says. “Experian and other companies have the opportunity to help bridge that gap and offer more of that consumer experience to patients and their interactions with providers.

“Patients want to schedule an appointment without picking up the phone and calling a provider. They want to know what my cost is going to be for a service before they go see the provider. When they leave, they want to be connected with flexible options on how to pay. That might look like a payment plan or maybe even financial assistance that some healthcare organizations provide to patients who may not be able to pay their bill.”

The expanding use of AI could also transform the industry, particularly for improving operational efficiency and preventing claim denials. Experian recently acquired WaveHDC, an AI-enhanced healthcare data curation service that provides solutions to identify unknown insurance benefits coverage and critical patient demographics at the start of a patient’s healthcare journey.

“The acquisition will enhance Experian Health’s leading patient access products to offer an advanced solution that captures all important registration data in real time from the start, as the patient checks in for an appointment.” Considine says. “No longer will data need to be chased and updated post-registration. A single inquiry can search for all the essential insurance and patient demographics instantly, avoiding costly rework and delayed reimbursements.”

“There are some really exciting things emerging with machine learning and AI,” he says. “A good example is how AI is being used with claim denials. It creates a very negative patient experience when a claim gets denied—for a number of different reasons—and they end up getting stuck with an unexpected bill from their doctor.   

“We’re using AI and machine learning to learn from the patterns in the data that we see from our customers across the country. And we’re able to use those insights to predict when a claim is going to get denied before it’s even billed to the insurance company.”

“If we can predict that,” Considine says, “the provider can address the issues in advance. It means that the claim gets paid more efficiently and we can avoid the patient having that negative experience with a surprise bill.”

To find out more about the Experian Exchange series, go to Experian.com/exchange.

https://www.experian.com/blogs/news/exchange/