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Getting Identity Right: The Foundation for a Stronger Revenue Cycle and Safer Patient Experience · Becker’s Healthcare Digital Health + Health IT

• 0:00
  - Hello, and welcome to the Becker's Healthcare Podcast.
• 0:03
  - My name is Chanel Banger recording live at
• 0:05
  - the Becker's eleventh annual Health IT, Digital Health
• 0:08
  - and RCM conference in Chicago, and currently sitting
• 0:11
  - down with Christina Berg,
• 0:13
  - the Senior Director of Product Management at Improvada.
• 0:16
  - Today, we'll be talking about Getting Identity Right,
• 0:19
  - the Foundation for a Stronger Revenue Cycle and
• 0:22
  - Safer Patient Experience.
• 0:24
  - Christina, thank you so much for joining me
• 0:26
  - today. Thank you for having me.
• 0:28
  - Now before we dive in, can you please
• 0:30
  - introduce yourself and share a bit about your
• 0:32
  - background?
• 0:33
  - Sure. I'm thrilled to be here. I am
• 0:35
  - Christina Berg. As you mentioned, I work in
• 0:37
  - the product management organization at Improvada.
• 0:40
  - Been doing this work for about seven years.
• 0:42
  - I have background as an ICU nurse, and
• 0:44
  - so patient care is really near and dear
• 0:46
  - to my heart. I've spent the last many
• 0:49
  - years working in health IT,
• 0:51
  - implementing different EHR solutions, and now on the
• 0:54
  - vendor side with Improvada for the last seven
• 0:57
  - years.
• 0:58
  - Great. And now that we have that experience
• 0:59
  - in mind, to get us started out, what
• 1:01
  - does a good identity experience look like for
• 1:04
  - health system?
• 1:05
  - Yeah. This is a really great question. When
• 1:07
  - I think about what a good identity experience
• 1:10
  - means for health system, it expands
• 1:12
  - really beyond the patient. It is the entire
• 1:15
  - enterprise. You wanna have a trusted
• 1:18
  - single platform
• 1:19
  - that can be used for anybody interacting with
• 1:22
  - your health system.
• 1:23
  - From the patient side, that means ensuring that
• 1:25
  - that identity is correct if they're calling into
• 1:27
  - the service desk, if they're trying to access
• 1:29
  - their patient portal account,
• 1:31
  - recover that account. But then, of course, across
• 1:33
  - the enterprise too, we have a lot of
• 1:35
  - people coming into our organization. We have clinicians
• 1:38
  - coming in, whether that's through an application process,
• 1:41
  - their onboarding,
• 1:42
  - if they have to call the service desk
• 1:44
  - or reset their password. And so a single
• 1:46
  - platform
• 1:46
  - to really secure your identities across the entire
• 1:49
  - ecosystem
• 1:50
  - is incredibly important.
• 1:52
  - You know, at Improvada, we've been trusted in
• 1:54
  - health care for a very long time. In
• 1:56
  - fact, I'm sitting with you here in Chicago.
• 1:58
  - Chicago has some of the strictest biometric laws,
• 2:02
  - in the whole country, and we work with
• 2:03
  - health systems closely here to ensure that that
• 2:06
  - data
• 2:07
  - is secured and that the health systems that
• 2:09
  - we serve have full control
• 2:11
  - of that data.
• 2:13
  - And part of what you asked me too
• 2:15
  - that I wanna make sure I hit on
• 2:16
  - is the experience.
• 2:18
  - We've been so focused on ensuring security
• 2:21
  - while also improving the experience. And whether that's
• 2:24
  - with the clinician or the patient, we want
• 2:26
  - them to have a great experience when they're
• 2:28
  - interacting with our health
• 2:30
  - system. And so when we think about identity
• 2:32
  - and assigning identity,
• 2:33
  - we wanna ensure that that's a non transactional
• 2:36
  - thing. We assign that identity with high assurance
• 2:39
  - once, and then they can use it across
• 2:41
  - the entire journey.
• 2:43
  - Yeah. Thank you so much for walking us
• 2:44
  - through that. And when an identity experience breaks
• 2:47
  - down, that impact can extend well beyond access.
• 2:51
  - Patient misidentification
• 2:52
  - can create significant downstream challenges for the revenue
• 2:55
  - cycle.
• 2:56
  - What impact can getting identity right have on
• 2:59
  - revenue cycle performance?
• 3:01
  - It's significant and expands across multiple different teams.
• 3:05
  - And so we know and there's been studies
• 3:07
  - that about 35%
• 3:09
  - of denied claims are just due to misidentification.
• 3:13
  - So there is a true rev cycle impact
• 3:16
  - just from denied claims.
• 3:17
  - I have the opportunity to talk to a
• 3:19
  - lot of different health systems, and there's hundreds
• 3:22
  - of disputes that happen annually. For some mid
• 3:24
  - sized organizations, that's over 500
• 3:27
  - disputes that occur.
• 3:28
  - And a lot of those are not just
• 3:30
  - the dispute,
• 3:31
  - but it takes more than seven business days
• 3:33
  - to actually come to a conclusion.
• 3:35
  - So a lot of times, health systems are
• 3:37
  - saying,
• 3:38
  - this one, it's just
• 3:40
  - not worth the chase, and they just let
• 3:42
  - it slide. And so there's a lot of
• 3:43
  - revenue that sits on the table that way.
• 3:46
  - But, also, just duplicate record creation as well.
• 3:49
  - Not only does it cause patient safety concerns,
• 3:52
  - which is something that I'm very focused on,
• 3:54
  - but there's a lot of manual rework that
• 3:56
  - has to happen when you have duplicate records,
• 3:59
  - and this happens so easily.
• 4:01
  - Many organizations
• 4:02
  - are having to merge
• 4:04
  - 200,000
• 4:05
  - records a year. This is significant amount of
• 4:08
  - time. We're talking tens of thousands of hours
• 4:10
  - and full time individuals
• 4:12
  - that are just spending time trying to merge
• 4:14
  - duplicate records and ensuring that they're correct.
• 4:17
  - Got it. And health care has some unique
• 4:20
  - identity challenges,
• 4:21
  - especially when somebody needs emergency or urgent care
• 4:25
  - and may not have identification
• 4:26
  - or be able to complete a traditional verification
• 4:29
  - process.
• 4:30
  - How can health systems handle those situations without
• 4:33
  - creating more work downstream?
• 4:35
  - Woo hoo. What a question. There are a
• 4:38
  - lot of unique identity challenges in health care.
• 4:41
  - Different health systems serve different patient populations that
• 4:44
  - look very different, and the privacy of that
• 4:47
  - patient data and the way that we protect
• 4:49
  - that unique ID is incredibly important. So it's
• 4:52
  - incredibly important. So it's not just about misidentifying
• 4:55
  - the ID, which we talked a little bit
• 4:56
  - about earlier,
• 4:57
  - but it's also for patients who are unable
• 5:00
  - to tell you who they are. I think
• 5:01
  - about someone who might be out on a
• 5:03
  - run and they passed out and they're not
• 5:05
  - carrying ID on them. How do we care
• 5:07
  - for them when they show up in emergency
• 5:10
  - situations?
• 5:11
  - If we have the opportunity
• 5:13
  - to know who that patient is and then
• 5:16
  - reuse that identity in an emergency situation to
• 5:18
  - surface their correct chart from the get go,
• 5:21
  - not create a Jane John Doe chart, that
• 5:23
  - has significant patient safety implications that improves the
• 5:26
  - patient safety. But also from a clinician side,
• 5:29
  - if I have visibility into their medications and
• 5:32
  - their allergies from the get go and I'm
• 5:34
  - not having to create a Jane John Doe
• 5:35
  - chart, it's incredibly meaningful to their care.
• 5:39
  - And in cases where, you know, these Jane
• 5:41
  - John Doe charts do have to be created,
• 5:44
  - a lot of times, it's been best practice
• 5:45
  - to have that carry with the patient through
• 5:48
  - their entire encounter, through their entire stay, which
• 5:50
  - has a lot of implications. That has implications
• 5:53
  - that I'm ordering labs or I'm having to
• 5:55
  - work with the blood bank. And, also, from
• 5:57
  - a clinician perspective, if I'm having to open
• 5:59
  - up their actual chart alongside this anonymous chart,
• 6:03
  - it leads to opportunity
• 6:05
  - for
• 6:06
  - error to occur at that point.
• 6:09
  - One of the things that we've purposely done
• 6:11
  - is we allow for patients to really be
• 6:13
  - enrolled in this platform with that high security
• 6:15
  - identity at first, and then it can be
• 6:18
  - reused in things like emergency care. And so
• 6:20
  - if they do show up unable to tell
• 6:22
  - you who they are, a simple scan of
• 6:24
  - their face can surface the right chart for
• 6:26
  - that clinician.
• 6:28
  - One of the other unique pieces too is
• 6:30
  - that
• 6:31
  - solutions when I think about an enterprise approach
• 6:34
  - to identity,
• 6:35
  - they have to work beyond just US based
• 6:37
  - ID as well. We serve these diverse populations.
• 6:40
  - We're talking about unique identity challenges. We have
• 6:42
  - folks that do not have a US based
• 6:45
  - ID. They are coming from other locations. And
• 6:47
  - so that is something that was really important
• 6:50
  - to Imprivata as we're building out this identity
• 6:52
  - solution is to ensure
• 6:54
  - that we can use IDs broadly from other
• 6:56
  - locations all across the world.
• 6:59
  - And then lastly, when I think about health
• 7:01
  - care and unique identity challenges,
• 7:03
  - we're not all coming into our health care
• 7:06
  - looking great and looking the same.
• 7:09
  - There's a lot of accommodation of physical attributes
• 7:11
  - in health care. We come in with masks,
• 7:13
  - or we come in with wigs, or we
• 7:15
  - come in with glasses,
• 7:17
  - or we come in with a facial laceration.
• 7:19
  - The technology
• 7:20
  - has to be good enough to work across
• 7:22
  - all of those things. It's a patient dissatisfier
• 7:25
  - to ask them to remove their mask. And
• 7:26
  - so when you're building out an identity solution,
• 7:29
  - you wanna ensure that it is meeting the
• 7:31
  - patient where they're at at that point of
• 7:33
  - care.
• 7:35
  - Absolutely. And there's also an important security component
• 7:38
  - to getting identity right. Can you share an
• 7:40
  - example of a situation where biometric authentication
• 7:44
  - uncovered potential fraud or prevented the wrong identity
• 7:47
  - from being used, and what could have happened
• 7:49
  - if it hadn't been caught?
• 7:51
  - Yeah. And you mentioned biometric identity. So that's
• 7:53
  - really the way that Improvada is approaching this
• 7:56
  - from a patient identity perspective. We do
• 7:59
  - a, high assurance identity verification
• 8:01
  - upfront, and then we enroll this space to
• 8:04
  - be used at all of these other places
• 8:06
  - because
• 8:07
  - fraud, complicit, or noncomplicit, or just a simple
• 8:10
  - unintentional error happen all of the time in
• 8:13
  - health care. And I think about these unintentional
• 8:15
  - errors happening just simply at the registration desk.
• 8:18
  - I've had the opportunity at this conference to
• 8:20
  - listen in on a lot of sessions and
• 8:22
  - have conversations around
• 8:24
  - folks really having a hard time keeping registrars
• 8:26
  - in the seats. There's a lot of turnover.
• 8:29
  - Training can be spotty. A lot of time,
• 8:30
  - you're doing elbow to elbow training, and that
• 8:32
  - can look differently. And at that registration desk,
• 8:35
  - there can be unintentional consequences when they're trying
• 8:37
  - to select the right patient. A biometric can
• 8:40
  - really prevent that from occurring.
• 8:42
  - Even if I'm just a chatty registrar, a
• 8:44
  - lot of the best registrars are the chatty
• 8:45
  - ones, and I accidentally click the wrong patient
• 8:47
  - off of the schedule.
• 8:49
  - Putting a biometric in front of that can
• 8:51
  - ensure that we are opening the right chart
• 8:53
  - at the right time.
• 8:54
  - The other thing that I am seeing a
• 8:55
  - whole lot at registration desks and getting back
• 8:58
  - to this idea of duplicate medical charts happening
• 9:01
  - is we're starting to ask for more identifiers,
• 9:03
  - which is not great from a patient perspective.
• 9:06
  - Last name, first name, date of birth, Social
• 9:09
  - Security number. Talk about trying to build trust
• 9:11
  - with your patients when you're asking them out
• 9:12
  - loud their Social Security number. So, again,
• 9:15
  - preventing that unintentional
• 9:17
  - grabbing of the wrong chart using that facial
• 9:19
  - biometric can be incredible.
• 9:22
  - But then we have this whole concept of
• 9:24
  - fraud, complicit fraud, noncomplicit
• 9:26
  - fraud.
• 9:27
  - I've got a great example from one of
• 9:29
  - the health systems that we work very closely
• 9:31
  - with. And right after we had initially went
• 9:34
  - live, they actually had this case with twin
• 9:36
  - brothers that had come in, and twin a
• 9:38
  - had been admitted. He had been seen at
• 9:40
  - one facility. He was admitted to that facility,
• 9:43
  - and he was using his brother's identity because
• 9:46
  - they looked close enough. Brother b, unfortunately,
• 9:49
  - ended up in the ED a day later
• 9:51
  - while his brother was admitted.
• 9:53
  - And the system very quickly flagged based on
• 9:56
  - that biometric what had occurred there. And so
• 9:58
  - using biometrics can certainly catch, in this case,
• 10:01
  - unfortunately,
• 10:02
  - uncomplicit fraud, but also the complicit fraud aspect
• 10:05
  - of that.
• 10:07
  - And then when I think about fraud too
• 10:08
  - outside of the four walls, we are seeing
• 10:10
  - a ton come out in the press in
• 10:13
  - different areas around bad actors really using patient
• 10:16
  - portals as an attack factor. In fact, I
• 10:18
  - read an article recently where over 40 different
• 10:21
  - health systems, and it's growing,
• 10:23
  - have sent warnings to their patients about these
• 10:25
  - phishing campaigns that are occurring for the patient
• 10:27
  - portal. And so if you have the opportunity
• 10:30
  - to put a modern identity verification
• 10:33
  - in front of that portal, to create that
• 10:35
  - account, to secure that account, to recover that
• 10:38
  - account using just that biometric after the identity
• 10:41
  - verification has been done, it's an incredible opportunity.
• 10:44
  - You don't want to have to ask patients
• 10:46
  - to come into their provider to get credentials
• 10:50
  - reset.
• 10:51
  - And like I mentioned earlier, this is all
• 10:52
  - about building patient trust too. You wanna protect
• 10:55
  - their identity. When we're having to reach out
• 10:57
  - to our patients about potential scams or we're
• 10:59
  - having to ask them Social Security numbers at
• 11:01
  - the point of care, This doesn't help build
• 11:04
  - trust. And a lot of health systems are
• 11:06
  - in this very competitive situation today where building
• 11:09
  - trust and making efficient workflows is imperative to
• 11:12
  - the health system and their success.
• 11:14
  - Yeah. And ultimately, identity needs to work across
• 11:17
  - the entire organization.
• 11:18
  - As health systems think beyond solving identity challenges
• 11:22
  - at a single registration desk or point of
• 11:24
  - care, what would you say an enterprise approach
• 11:26
  - to patient identity looks like?
• 11:29
  - Yeah. That's a great question. You know, at
• 11:31
  - Improvada, we've been focused for so long on
• 11:33
  - the enterprise and the
• 11:35
  - and the identity and now really expanding that
• 11:38
  - over to the patient side too. This cannot
• 11:41
  - be a onetime
• 11:42
  - transactional
• 11:43
  - point in time interaction that you're having with
• 11:46
  - that patient because then each time that they're
• 11:49
  - having to recover an account, you're having to
• 11:51
  - put them through this owner's IDV perspective, right,
• 11:54
  - this whole process. And so if we have
• 11:56
  - the ability again to just do and enroll
• 11:59
  - once of this identity and use it everywhere,
• 12:03
  - that is incredible to their safety, to their
• 12:05
  - experience, and, ultimately, the revenue cycle impact that
• 12:08
  - it has to having that identity be correct
• 12:11
  - from the beginning.
• 12:12
  - We also want consistency.
• 12:14
  - Imprivata has been trusted for a very long
• 12:16
  - time standardizing
• 12:17
  - the clinician experience, and we wanna bring the
• 12:19
  - same over to the patient. We wanna meet
• 12:22
  - them no matter where they're at. So I
• 12:23
  - mentioned the patient portal quite a bit, but
• 12:26
  - that also means the service desk too. If
• 12:28
  - I'm a patient and I need to update
• 12:30
  - my demographics or my email or my allergies,
• 12:33
  - having that same experience. And then when I
• 12:35
  - show up at the point of care, whether
• 12:37
  - that's a registration desk or a kiosk or
• 12:40
  - if I'm in an unfortunate emergent situation
• 12:43
  - or even during a procedural time out, a
• 12:45
  - pre procedure, that should all look the same
• 12:47
  - and feel the same to that patient to
• 12:49
  - improve their experience.
• 12:51
  - And, again, we don't wanna make them come
• 12:53
  - in. I talked to so many health systems
• 12:55
  - who really struggle with service desk having high
• 12:58
  - confidence that the person on the other end
• 13:00
  - of the line is who they have pulled
• 13:02
  - up on their computer.
• 13:04
  - And so if we can have a high
• 13:05
  - assurance way of identifying that patient that doesn't
• 13:08
  - require them to answer security questions that social
• 13:11
  - engineering is doing such a good job at
• 13:13
  - spoofing anyway or forcing them to come into
• 13:17
  - their provider. A lot of times, these folks
• 13:19
  - have moved and they're just trying to get
• 13:20
  - access to the records coming into the provider.
• 13:23
  - It's a very difficult thing for them. So
• 13:25
  - improving that experience, we wanna be able to
• 13:27
  - enable
• 13:28
  - service desk, self-service points of access for those
• 13:31
  - patients. And then again, like I said, use
• 13:33
  - it at any point of care. Really, this
• 13:36
  - concept of enrolling a secure identity, a high
• 13:39
  - assurance identity once and allowing it to be
• 13:41
  - used everywhere is a big win for an
• 13:43
  - organization and for the patients that they serve.
• 13:45
  - That's really helpful context. Well, Christina, I wanna
• 13:48
  - thank you for your time today. I've definitely
• 13:50
  - learned a lot. But before I let you
• 13:51
  - go, is there anything else that listeners should
• 13:53
  - know?
• 13:54
  - Absolutely.
• 13:55
  - So first, I really appreciate the time today
• 13:58
  - as well. This conference has been fantastic. I
• 14:01
  - just want listeners
• 14:02
  - to really walk away with the idea that
• 14:05
  - we can secure identities
• 14:07
  - while creating efficiencies within the health system. And
• 14:10
  - we all know there are more security vulnerabilities
• 14:12
  - coming up all of the time. A lot
• 14:14
  - of this conference is about AI as well.
• 14:16
  - And so the quicker that we can secure
• 14:18
  - those tools that our patients rely on while
• 14:20
  - creating a better experience, the better. That's a
• 14:23
  - great note to end on, Christina. I wanna
• 14:25
  - thank you once again for your time today.
• 14:27
  - We also wanna thank our podcast sponsor, Improvada.
• 14:30
  - You can tune into more podcasts from Becker's
• 14:32
  - Healthcare by visiting our podcast page at beckershospitalreview.com.
• 14:36
  - Thank you. Thank you.