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Reduce healthcare costs to identify leading drivers of claim denials, rebilling, self-pay errors, and more with innovative technology like AI and machine learning.

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Authenticx | Customer Experience Solution

Authenticx analyzes customer conversations to surface recurring trends.

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Emerging insights from chat-driven conversations

A pharmacy benefit manager (PBM) wanted insights from chat conversations to review performance of them. Authenticx uncovered themes and insights that the PBM used to take action on friction strategically.

Strategies To Reduce Healthcare Costs

Did you know that America has one of the highest healthcare costs per person in the world? A recent Peter G. Peterson study reported that the United States spends nearly $13,000 on healthcare per person. In 2021, healthcare spending reached $4.3 trillion in total. The COVID-19 pandemic also had a strong impact on healthcare costs, exacerbating an already inflated market. Many healthcare organizations recognize the need to find ways to control the rising cost of healthcare with strategies to reduce healthcare costs.

Many hospitals operate as nonprofits, meaning that they gain nothing from the high cost of healthcare. The American Health Association’s Fast Facts on U.S. Hospitals in 2023 reported that almost 60% of hospitals are non-government nonprofit hospitals. 19% of hospitals are owned by the state and local government, and 24% are investor-owned for-profit hospitals. 

While nearly a quarter of hospitals are for-profit (and therefore actually benefit from high healthcare costs) the vast majority of hospitals are nonprofit. Hospitals are also not the only kind of healthcare organization – family practices, specialists, pharmacies, and more are also healthcare organizations that have their own unique economies. However, they all share one thing in common: they are likely out of reach for the average American. 

According to a study by West Health and Gallup, 44% of American adults are struggling to pay for healthcare. 93% of Americans reported feeling that the quality of the care is not worth the cost that they paid. There are several reasons that it is in the best interest of healthcare organizations to find ways to reduce healthcare costs. 

Lowering healthcare costs is crucial to the long-term success and sustainability of healthcare organizations, not to mention the American people. Healthcare organizations that utilize strategies to reduce healthcare costs also have a competitive advantage over healthcare providers that do not. Cost-efficient organizations can attract more patients, insurers, and contracts by offering competitive pricing and focusing on value-based care. 

Here are a few hospital cost reduction strategies that may help healthcare organizations optimize their prices and reduce costs while effectively increasing quality.

  1. Value-based care
    Healthcare organizations should shift towards value-based models to focus on delivering high-quality care while controlling costs. Organizations that implement care protocols, clinical pathways, and evidence-based practices can optimize outcomes and reduce unnecessary interventions, thereby lowering costs.
  2.  Focusing on preventative care and wellness programs
    Investing in preventative care can make a big difference in healthcare costs. If preventative care is easily accessible, patients of many kinds may come to see healthcare providers. Their issues may be diagnosed sooner when they are easier to treat, instead of later on in the disease or injury’s progression. 
  3. Health Information Technology
    Health information technology solutions such as electronic health records, computerized provider order entry, and qualitative solutions such as Authenticx can automate and provide insight into many healthcare processes in order to increase efficiency. 

Reducing Costs And Improving The Quality Of Healthcare

Many healthcare organizations have the opportunity to find innovative ways to reduce healthcare costs without a government mandate or intervention. Rather than ask, “How can the government lower health care costs?” Many healthcare organizations can take matters into their own hands and align quality improvement initiatives with cost-saving measures. In fact, reducing costs and improving the quality of healthcare can often go hand in hand. This is because many methods of cost-reduction require healthcare staff to be more collaborative, increasing communication and teamwork. This in turn can improve patient outcomes, providing a higher quality of care. Many individuals seek to answer the question “How can the government reduce healthcare costs?” with policy reform and government mandates. However, there are ways to lower healthcare costs that hospitals and other healthcare organizations can put in place without a government mandate.  

Some methods of cost reduction in healthcare that hospitals and other organizations can practice right now are:

  1. Data analysis and cost identification
    Organizations should continuously be auditing and analyzing their healthcare expenditures to identify cost drivers and areas for potential savings. This can be done by examining claim data, utilization patterns, and cost variations across different services and providers. 
  2. Care coordination and transitions
    Improving care coordination and transitions between healthcare settings (like from hospital to hospice, for example) can enhance efficiency and reduce costs. Organizations can implement care management programs, employ care coordinators, and ensure effective communication to prevent fragmented care and avoidable readmissions. 
  3. Automating tasks and streamlining workflows
    Healthcare leaders wondering how to reduce healthcare costs in hospitals can also look at administrative processes and find ways to automate repetitive tasks and streamline workflows, allowing for higher productivity and efficiency. Healthcare organizations can also use health information technology to identify customer disruptions in their patient journeys and use those insights to make meaningful changes in their processes, lowering healthcare costs over time as a result.

Benefits Of Reducing Healthcare Costs

The benefits of reducing healthcare costs are many for both patients and healthcare providers. As we mentioned briefly before, healthcare providers are incentivized to provide high-quality care at low costs. This is because healthcare organizations that offer lower costs without sacrificing quality have a competitive advantage over other healthcare providers. In addition, stabilizing healthcare costs leads to financial sustainability for healthcare organizations as well. Some government intervention already exists to provide healthcare organizations with motivation to lower their costs. Regulatory bodies and government agencies often encourage or impose requirements on healthcare organizations to reduce costs. These requirements can be tied to eligibility for specific reimbursements or participation in government-funded healthcare programs. Compliance with these regulations can incentivize healthcare organizations to lower healthcare costs so that they can continue to participate in these government programs. 

Lowering healthcare costs can also help to mitigate the burden placed on healthcare systems in times of crisis, such as natural disasters or pandemics. Low and controlled healthcare costs contribute to the overall sustainability and resilience of the entire healthcare system.

Lowering healthcare costs for patients means improved affordability and increased access to care. When healthcare costs are reduced, it makes it easier for individuals to afford necessary medical care, treatments, and medications. This includes traditionally underrepresented groups, people who are facing extreme financial hardship, and uninsured populations. This can result in reduced financial stress for patients and their families. Medical expenses can be a significant burden, especially for individuals without adequate insurance or limited financial resources. 

What are some of the most prevalent cost-reduction strategies in healthcare organizations? Many healthcare organizations focus on streamlining administrative processes, strategic sourcing and supply chain management, and utilization management. 

Cost reduction strategies for healthcare organizations can also lead to a healthier population as a whole. Lower costs can encourage patients to engage in preventative care. Operational efficiency as a result of lowering costs can increase to more effective use of time and resources, leading to a higher quality of care and better-served populations. 

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Reducing Healthcare Costs Through Technology

One of the most popular methods of reducing healthcare costs through technology involves data analysis and performance management. How can healthcare organizations use clinical data to increase quality while reducing costs? Healthcare organizations leverage data analytics to identify areas of inefficiency, monitor performance, and drive evidence-based decision-making. Evidence-based decision-making is one of the best ways to reduce the cost of healthcare without compromising patients’ health and safety. 

Authenticx is a qualitative analysis tool that helps provide healthcare organizations with the insights they need to make evidence-based decisions. Through listening to their customers’ voices and stories, they can identify sticking points in the patient journey and resolve them, creating more efficient processes and lowering costs as a result. 

Other healthcare technology tools such as electronic health records and computerized provider order entry systems can also help to lower costs by making healthcare communication and charting more efficient. Some of these same methods are used in other strategies for reducing healthcare costs, such as universal healthcare. 

How will universal health care reduce medical costs? The idea of universal health care is to simplify and standardize access to healthcare. Universal healthcare is thought to have supreme administrative efficiency, bulk purchasing power, improved access to primary care, and more. Universal healthcare also places a focus on prevention and early intervention, tackling healthcare issues when they are less costly to treat. Universal healthcare may also eliminate the issue of uninsured or underinsured individuals, instead providing everyone with access to equal healthcare coverage, regardless of insurance

How Can Nurses Reduce Healthcare Costs

Every aspect of a healthcare organization has a part to play when it comes to reducing healthcare costs, including nurses. Nurses play a vital role in patient care and can have a large impact on the overall cost of patient care. A few cost-effective care in nursing examples include care coordination, medication management, health promotion, patient education, and much more.

Effective care coordination can play a large role in healthcare costs, as can patient education. Care coordination, patient education, and patient empowerment are major tools against healthcare accidents and unnecessary readmissions. Other cost-effective care examples include the use of electronic health records, which can enhance efficiency, minimize errors, and reduce unnecessary duplication of tests and procedures. 

How can nurses reduce healthcare costs? Cost effectiveness in nursing can have a big impact on reducing healthcare costs overall. Nurses collaborate with many other healthcare professionals such as physicians, pharmacists, and social workers to coordinate care and optimize resource utilization. This interdisciplinary approach ensures comprehensive care while avoiding redundancy and minimizing costs. 

Some healthcare policies give improved authority to nurses, such as the ACA. How does the affordable healthcare act affect nurse practitioners? The ACA led to an increased demand for nurse practitioners because more individuals and uninsured individuals could be seen for care. The ACA also recognized nurse practitioners as essential healthcare providers and allowed them to practice to the full extent of their education and training. Some states have given nurse practitioners full practice authority, allowing them to see and treat patients without physician oversight. How does healthcare reform affect nurses now? This is dependent on the type of policy, however, healthcare reform may have several impacts on nursing, such as expanded access to care, role expansion and scope of practice, payment and reimbursement changes, and more. 

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