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UTMC Achieves 42.77% Surge in Patient Estimates with Experian Health’s Price Openness Solutions
A new partnership with Experian Health enabled UTMC, a leading Level 1 Trauma Center, to not only meet but exceed its goals for delivering patient cost estimates, while together ensuring compliance with evolving federal regulations.
Before 2020, UTMC, serving patients across three states, relied on a cumbersome manual process for providing patients with cost estimates. This system proved unsustainable when the Centers for Medicare & Medicaid Services (CMS) issued the Hospital Price Transparency Rule, demanding greater clarity in healthcare pricing. The existing methods simply couldn’t keep pace with the new regulatory landscape.
UTMC’s financial counselors were burdened with manually extracting charges and Current Procedural Terminology (CPT) codes from historical claims data within an internal reporting system. This inefficiency hindered their ability to serve patients effectively, often leaving them without the required pricing information mandated by the new rule. Facing potential compliance penalties,UTMC urgently needed a streamlined,digitally-driven solution.
To address these challenges, UTMC partnered with Experian Health and implemented Patient Estimates, a solution designed to automate and simplify the estimation process.Unlike the previous manual system, Patient Estimates dynamically pulls data from the hospital’s chargemaster, payer contracts – leveraging Experian Health’s Contract Manager – claims history, and real-time eligibility data.
This integration empowered staff to generate accurate estimates, fostering patient confidence through clear, detailed breakdowns of anticipated costs. The system’s built-in reporting capabilities also provided UTMC with a robust audit trail to demonstrate compliance with the Hospital Price Transparency Rule.Following a successful implementation and fulfillment of all 2021 mandates, UTMC expanded its collaboration with experian Health to develop a comprehensive patient payment strategy.This included the implementation of:
- Self-Service patient Estimates: Allowing patients to generate estimates for both self-pay and insurance-covered services.
- PaymentSafe®: Facilitating secure pre-service and point-of-service transactions.
- Patient Financial Advisor: Delivering estimates via text message with integrated payment options.
The timing of these improvements proved fortuitous. In 2024, UTMC’s Board of Directors established a strategic objective to increase the volume of patient estimates delivered throughout the year. Leveraging the combined power of Patient Estimates, Self-Service Patient Estimates, PaymentSafe, and Patient Financial Advisor, the team not only met this goal but surpassed it by an impressive 42.77%.
The fully integrated system now provides both staff and patients with access to accurate, detailed cost breakdowns, delivered days faster then previously possible. This transparency, coupled with flexible payment options, allows for more compassionate financial conversations and provides patients with the time needed to understand and prepare for their healthcare expenses.
“Estimates and payments are complex to unravel for many of our patients,” stated a senior financial counseling official at UTMC. “And patients are scared and nervous about procedures. It is helpful to have a simple, clear breakdown of costs to help guide these conversations.”
The success at UTMC underscores the importance of strategic technology partnerships in navigating the complexities of healthcare finance.A key takeaway from UTMC’s experience, according to a company release, is the need for hospitals undergoing similar transitions to prioritize investment in their contract data. Experian health’s adaptability and commitment to evolving alongside UTMC’s needs were also cited as critical factors in the project’s success.
“Experian Health evolved with us as our needs progressed and changed to ensure we received the most from the products,” the official added. Furthermore,the association emphasized the need for a cultural shift alongside the system implementation,recognizing that change requires time and patient education.
Learn how price transparency solutions from Experian Health can definitely help healthcare organizations stay compliant with current regulations and help patients better understand their costs.
