Three ways to improve patient access

Clarissa Riggins: ©Experian Health

We’re at a critical juncture in health care: patients increasingly expect seamless, digital-first access, yet operational gaps impact one in five patients before they even receive care. These issues range from insurance verification problems to errors in patient medical records or billing information.

Addressing these foundational breakdowns is no longer optional; it is imperative. Here are three ways providers can improve patient access:

1. Focus on collecting accurate data on the front end
2. Streamline manual workflows with AI and automation
3. Map, prioritize and scale solutions to replace outdated technology

Confusion in patient access

Most patients have never heard of Revenue Cycle Management, but providers understand all too well that RCM encompasses one of patients’ biggest barriers to care and one of providers’ biggest headaches: patient access.

For patients, access generally means not just being allowed to get care, but being able to get it easily, affordably, and in a timely way. This includes being able to easily book an appointment, view medical records and test results, and communicate with their doctor’s office or via digital portal. Access to patients is synonymous with transparency and convenience.

Providers, however, think more logistically and operationally. They often consider patient access to mean the ability for a patient to be seen by the right provider in a timely manner with no logistical hiccups. This includes appointment availability, scheduling plus insurance coverage and verification. Even more granular for providers, patient access is about efficient workflows and compliance with all the necessary and ever-changing rules and requirements associated with insurance eligibility, authorization and claims.

Bridging the patient access gap means addressing both sides of the equation: operational efficiency and a transparent patient experience, all powered by better data.

Focus on collecting accurate data on the front end

The ripple effect of inaccurate data collected at registration is profound, extending far beyond initial inconvenience. Patient information errors contribute to a host of RCM pain points, including delayed reimbursements, increased accounts receivable days, cash flow issues, and denied claims. The accuracy of cost estimates, crucial for patient financial transparency, is also declining, largely driven by the complexity of insurance coverage, evolving payer rules, and the difficulty of capturing comprehensive patient information upfront.

To combat this, providers must focus on automating registration and check-in processes. They can leverage technology and AI-powered solutions for real-time insurance verification, coordination of benefits, and insurance discovery which directly contributes to more accurate estimates by improving the accuracy of underlying data at the point of registration.

Technology can verify insurance and eligibility, predict errors before claim submission, and automatically identify secondary and tertiary coverage, preventing gaps and ensuring cleaner claims.

Streamline manual workflows with AI and automation

Inefficiencies are major roadblocks to increasing patient access. Manual workflows place a heavy burden on staff, consume critical time, and increase the risk of human error. These avoidable obstacles can lead to data inaccuracies and claim denials that can disrupt the entire care delivery cycle.

Front-end health care staff, such as registrars who interact with patients to collect personal and insurance information, are experiencing a high turnover rate largely due to factors such as low wages, demanding manual workloads, and the important role these positions play in the patient experience. The influx of new staff creates a cycle of constant training, which subsequently adds to the workload of experienced personnel.

In addition, tasks like manually checking for multiple insurance coverage become burdensome and can lead to data entry errors which frequently result in claim denials. While denials are often viewed as a financial problem for providers, they also negatively impact the patient journey, potentially leading to unexpected out-of-pocket costs, delayed medical care, or even entirely skipped treatments.

Map, prioritize and scale solutions to replace outdated technology

For providers that need to modernize patient access, it’s hard to know where to start. They can begin by comprehensively mapping the end-to-end patient journey. This involves gathering direct feedback from both staff and patients to precisely pinpoint specific friction points and the biggest challenges hindering a streamlined workflow. Understanding these critical breakdowns from both administrative and patient perspectives is foundational for effective improvement.

Next, prioritize for maximum impact. It’s unrealistic for providers to overhaul the entire revenue cycle process at one time. Organizations must strategically prioritize their efforts, determining which areas or "quick wins" will yield the greatest impact on both the financial bottom line and overall patient access. This ensures resources are allocated to achieve the most significant and immediate benefits.

Finally, invest in scalable technology solutions. These innovations can effectively automate core processes like eligibility verification, prior authorization, and scheduling, thereby creating a seamless workflow and significantly reducing staff effort and process delays.

By strategically embracing technology, healthcare organizations can not only significantly improve the patient experience but also realize substantial gains in administrative efficiency and financial health, paving the way for a truly seamless and patient-centric healthcare ecosystem.

Providers best positioned for progress are those that prioritize investing in technology that supports and streamlines patient access.

Clarissa Riggins is the chief product officer at Experian Health