Latest / Off the Chart: A Business of Medicine Podcast / S1 Ep173: The patient access blind spot, with Mindy Fortson of Experian Health
Transcript
- Speaker 1 0:00 That was actually the most unsettling stat for me personally that I saw in the survey because both over 70% on the provider side and almost half on the patient side that said they will forego or delay care. That's not a revenue problem. That's a public health problem. Austin Littrell 0:26 Welcome to Off the Chart, a business of medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders, and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Latrell, and the associate editor of Medical Economics, and I'd like to thank you for joining us today. In today's episode, Medical Economics Managing Editor Todd Shryock sat down with Mindy Fortson, Chief Operating Officer of Experian Health, to talk through the findings of the company's 2026 State of Patient Access Survey. The headline finding is a perception gap. 46% of the healthcare organizations surveyed say patient access has improved over the past year, but among patients, that number is just 18% Todd and Mindy get into what's driving that split and why 73% of respondents on the practice side say patients delay or forego care when they can't get a cost estimate up front. A fine the Mindy calls a public health problem rather than a revenue problem. They also cover how much of the prior authorization burden the practice can realistically fix on its own versus what'll take payer and policy reform. Why training deficits keep surfacing in front office roles and where automation and artificial intelligence are most likely to take pressure off short-staffed teams over the next couple years. With that said, Mindy, thank you for joining us. Let's get into the episode. Speaker 2 1:39 I'm here with Mindy Fortson, Chief Operations Officer at Experian Health, to talk about Experian's 2026 State of Patient Access Survey. Mindy, thanks for joining me. Speaker 1 1:50 Absolutely, thank you for having me. Speaker 2 1:53 So, Mindy, there's a striking gap between providers, 46% and patients, 18% who think access has improved? What's driving that disconnect? Speaker 1 2:06 You know, I think the the the disconnect is really caused by the way that patients and providers are measuring outcomes. I think the provider is looking at their ability to staff, how they're adopting digital tools, how quickly they're able to train staff, and they're looking at some of those outcomes of adoption across their facilities, where our patients are looking for how am I going to be able to afford this bill? You know, what is my cost estimate up front? How quickly can I access my provider? And so, while both are very valuable and important metrics to be looking at, I just think that they're looking at two different kind of sides of the ball when they're measuring success. So I think that is what's causing some of the growing gap between the two. So I think focusing on the pain points to bring those together is where we start to see the patient sentiment change. Speaker 2 3:04 36% of patients reported authorization difficulties. How much of this burden is realistically fixable at the practice level versus requiring payer or policy reform? Speaker 1 3:18 I think a lot of this still falls within the payer and the policy reform. I mean, there are we're seeing advancements in the digital tools that providers are able to use to help kind of automate some of that. But it's just a difficult problem to solve. It's very payer specific, plan specific, and it's just not an easy thing to solve from a digital perspective, because there's so much clinical work that has to go in within the authorization as well. So it's a challenge that's still trying to to get solved. But so much of the change that happens within regulations and payer policies is also what causes that complexity. So I think there's going to have to be more of a meet in the middle between digital and the payer and regulatory side before we see a big swing on the authorizations front. Speaker 2 4:07 Nearly three in 10 patients experience delays due to insurance verification. Are there operational changes that practices can implement now to help reduce those delays? Speaker 1 4:19 Absolutely. A lot of the administrative complexities that you see that I think are surfacing in this report are not clinical workflows. They're administrative burdens that are happening up front. So there's a lot of automation that can be you know applied in those areas, and we see a lot of hospitals are adopting those. Experian, for example, has our patient access curator solution that helps to identify coverage upfront. It also has insurance eligibility. It goes out and looks at MBI lookups, and it helps define unidentified coverage as well as goes out and checks for eligibility that the patient. Provides and delivers that back into the hospital of providers' hands, and that helps kind of reduce errors upfront. And so there are a lot of digital tools that can be adopted, especially when you're seeing the number of staff shortages that are happening. I think it's important for providers to be able to really look at tools and AI and automation to to help to optimize the staff experience, because if you see the numbers in the survey, that's still the number one frustration on the provider side is staffing shortages. It just continues to go up, and so I think the automation and being able to adopt these tools to help with these administrative burdens upfront are just going to become more important. Speaker 2 5:43 Your survey found that 73% of providers say patients delay or forfeit care when they can't get a cost estimate. Are there some practical ways that practices can provide accurate estimates, considering they might have limited resources? Speaker 1 6:00 That was actually the most unsettling stat for me personally that I saw in the survey because both over 70% on the provider side and almost half on the patient side that said they will forego or delay care. That's not a revenue problem. That's a public health problem, and so I think it's very important for providers to find ways and find tools to deliver accurate, as close to accurate as estimates as possible, so that the patient understands what that cost is going to look like, especially if they are delayed care. So there are tools out there, patient estimate tools that help to take the eligibility, the payer contracts, and combine that information to make sure that you are delivering and understanding that the service that the patient is coming in for, combining that and being able to to give that estimate up front. There was a second metric that came up that also kind of shows the bright side of this. You're you are seeing that in surprise billing that that number has actually gone down considerably. So you we are seeing an impact of these patient estimate tools for the providers that are adopting them are able to give these cost estimates up front so that the patient has a clear view on what's going to be charged to them and they're not getting that surprise bill on the end. So while it is, I think, very concerning to see that patients are foregoing care for the providers that are adopting these tools, and we are seeing it start to scale across the industry by providing those estimates up front, the patient is gaining more trust in the provider and understanding what that out-of-pocket cost is going to be. Speaker 2 7:42 The survey notes that 39% of providers see training deficits as impacting access. Do you have any insight into what specific skills or roles are lacking, and what could be done about that? Speaker 1 7:54 So, healthcare is just complex, right? It's it's when you're hiring and staffing some of these upfront registration areas, for example, there's just a lot of things the staff needs to know. So again, if you can look at tools and automation and how AI, I think, is going to have an impact in this space, it helps deliver the information directly to those registrars hands, so that you can start to reduce the amount of training because it is complex. Every payer is different. Every patient experience is going to be different. What they're being seen for. So it's just a hard. It's hard to navigate if you're doing a lot of manual processes up front because there's just a lot of boxes that need to be checked to make sure that the provider is protected and can ensure payment throughout the revenue cycle process. Keith A. Reynolds 8:55 Hey there, Keith Reynolds here, and welcome to the P2 Management Minute. In just 60 seconds, we deliver proven real-world tactics you can plug into your practice today. Whether that means speeding up check-in, lifting staff morale, or nudging patient satisfaction north, no theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before lunch. But the best ideas don't all come from our newsroom. They come from you. Got a clever workflow hack, an employee engagement win or a lesson learned the hard way? I want to be true. Shoot me an email at kreynolds@mjhlifesciences.com with your topic, a quick outline, or even a smartphone clip. We'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching, and I'll see you in the next P2 Management minute. The Speaker 2 9:46 survey highlights automation and AI as non-negotiable. Where do you see future gains happening for practices? Where is it going to have the biggest impact? Speaker 1 9:56 So I think it will be addressing this upfront administrative burden that. Seeing, I think it will help providers so that they can get access to schedules easily, to patient portals, to payment plans, so that a patient can understand not only what their out-of-pocket cost is going to be up front, but also how they're going to be able to pay it. And so, one of the frustrations that you saw in the survey was just not only understanding the bill, but wanting a tailored plan to help them pay that. So again, the these automated tools up front are are going to be a non-negotiable. And I think as you saw in the survey, I think it was 28% of providers that were starting to see adopting AI, which is actually an encouraging kind of metric to me because last year we didn't even measure it, and so I think over the next year to two years, you're going to see AI moving out of a pilot phase into kind of the general infrastructure of health, and people adopting it, being able to get information more readily. So I think as these tools start gaining traction. You're going to see that process start to improve. Healthcare, of course, as we all know, is much more regulated than a number of areas. So our providers have to be, you know, cautious and careful on on how and where they're adopting it. But the ones that are adopting it and adopting it safely, I think, are be the ones that are going to be able to advance in that experience and and be able to continue to gain that trust with their patients. Speaker 2 11:28 The data shows that 93% of providers say patients struggle to pay. How does that compare to prior years? And does that number surprise you? Speaker 1 11:38 It does surprise me. You know, I think just with healthcare cost and affordability continuing to shift, I think with the, you know, the big beautiful bill and kind of some of the financial anxieties that are happening around how Medicaid is going to continue to to be in flux and change and and what that regulatory clarity is going to look like. I think there's anxiety on both the provider side and the patient side because the providers are trying to figure this out to be able to make sure that they understand enrollment requirements and what that's going to mean for their patients, and then the patients are trying to figure out what does this mean to me. You know, there's a lot of cost shifting that's continuing to happen, and I think will continue to happen with employers shifting costs, you know, to the employees, and so that's going to have a direct effect. And so I do think the affordability and the healthcare cost is is going up. It's going in the other direction, and so I think these, you know, what you're seeing surfacing here is different than we've seen in the past, and I'm not sure that those headwinds are going to go away. Speaker 2 12:46 For the fourth consecutive year, access to practitioners remains the top patient-reported challenge at 27. Is there anything physicians can do about this, or is this more of a systemic problem that needs to be solved at the government level? Speaker 1 13:01 I think it's I think it's a little bit of both. I think you know making sure that you have scheduling tools. You know, I mean, we're we're moving more towards a mobile society, and while that's a little bit twofold, you can see that come out in the survey. You know, people want the you know healthcare to be just like access to other areas of life, right? So you want to be able to easily go in and access and schedule, and not have to do repetitive paperwork and all of the things that happen in your in your physician's office and going into your providers. I think the scheduling component, the digital tool adoption for patients to be able to easily schedule their appointments, do their paperwork up front, be able to kind of expedite that process. That's what I feel like they are speaking of in the survey when they say you know being able to access the physician. the The patient portal adoption, I don't think, is happening as fast as we want it to, and I think there's a little bit of the you know economics there that are coming into play. I think we have a large majority of our population that have the smartphones and that are able to go in and access this easily. But we still have a large piece of our population who maybe not doesn't have a smartphone or is not comfortable navigating a patient portal and having to figure out how to log in and go in and you know schedule and view information and so I think we're just at an interesting time with how people still want to access their care. Speaker 2 14:33 Were there any other data points that jumped out of you in the survey results? Speaker 1 14:39 I one of that was interesting to me is the is paper billing and some of the the snail mail metrics that came up. That was actually you know that actually jumped up this year, which is interesting because that kind of goes against the the whole mobile healthcare experience. But when you look at it and you think about you know all of the regular. And legal notices and HIPAA notifications and all of the things those typically default to paper mail, and I also think it's interesting because there's so many, so much concern around you know cybercrime and you know people that are reaching out to you that may not be the actual you know provider and concern about putting your personal information in some of these portals, so I think there may be a component where people are starting to to go back to wanting to see paper invoices and making sure that they understand exactly where they're putting in their information and how they're paying their bills. So I think that may be having some effect on that. But that was an interesting metric to me. Speaker 2 15:41 Is there anything else that you would like to point out that we haven't talked about? Speaker 1 15:45 You know, I think it's just interesting over the next year to two. I think that AI metric is is one that we need to watch and just see how that adoption continues to play. When you look at the financial. So let's look at the speed to access, for example. Since we were just talking about that, when you look at the metrics, it's one of the biggest frustrations, but it's also one of the biggest successes because the ones that can't have access to their position and they are getting their cost estimates, and they do have tailored payment plans. Those are the ones that you see in the survey that are saying that they're having a better experience. But the ones that are not, it's the same problem. So it's a little bit of a nuanced metric there. And so I think we still have a gap with providers on who is, you know, really being kind of forward thinking and adopting these tools and the ones that might be a little bit slower. So I think that providers are going to need to continue to invest. They're going to need to continue to look for automated ways, especially when you look at the staff shortage and training numbers, and figure out ways to help automate that experience. Speaker 2 16:59 Very good, Mindy. Interesting stuff. Thanks for joining me. Speaker 1 17:02 Absolutely. Thank you so much, Todd. Austin Littrell 17:17 Once again, that was a conversation between medical economics managing editor Todd Shryock and Mindy Forsen, Chief Operating Officer of Experian Health. You can find the link to Experian Health's 2026 State of Patient Access Survey in the show notes below. But with that said, my name is Austin Latrell, and on behalf of the whole Medical Economics and Physicians Practice teams, I'd like to thank you for listening to the show and ask that you subscribe so you don't miss the next episode. As always, be sure to check back on Monday and Thursday mornings for the latest conversations with experts sharing strategies, stories, and solutions for your practice. You can find us by searching Off the Chart wherever you get your podcasts. Also, if you like the best stories that Medical Economics and Physicians Practice publish, delivered straight to your email six days of the week, subscribe to our newsletters at medicaleconomics.com and physicianspractice.com. Off the Chart, a business of medicine podcast, is executive produced by Chris Masolini and Keith Reynolds, and produced by Austin Latrell. Medical economics and physicians practice are both members of the MJH Life Sciences family. Thank you. Transcribed by https://otter.ai