Shifting from Denial Management to Denial Prevention with Jason Considine, President of Experian Health

[00:00:00] Hello everyone and welcome back to the Outcomes Rocket. I am so excited to be joined by Jason Considine today. He is the President of Experian Health. Jason took the helm as President of Experian Health, a unit of Experian in April of 2025. He had served as Chief Commercial Officer for more than three years leading sales, marketing, mergers and acquisitions and business development.

[00:00:35] Experian Health specifically serves more than 60% of U.S. hospitals and more than 7,500 medical practices, labs, pharmacies and other healthcare providers with leading data, analytics and software solutions that ultimately simplify healthcare. Jason, really excited that you were able to join us today. Yeah, I'm excited to be here. Thank you for having me, Saul.

[00:01:01] Of course. You guys are up to some really interesting things in the space, Jason. Talk to us about really Experian Health. Like, tell us about that and then we could start getting into some of the questions. Yeah, absolutely. You said it at the beginning, Experian Health exists to simplify healthcare and we're really focused on helping our customers, large healthcare providers,

[00:01:25] be more drive efficiency and how the process of getting reimbursed from both patients and payers works inside of their organization. And if we can make that very complicated process easier for our customers, it helps them do a lot of different things. It helps them free up the resources to deliver a better patient experience.

[00:01:51] And if we can reduce this quite massive amount of administrative costs in healthcare, those funds can be redeployed into parts of the care delivery system to deliver patient care. And so it's all about simplifying healthcare and driving efficiency in these administrative areas inside of healthcare providers. Well, that's definitely welcomed, Jason. This is a big pain point for a lot of providers.

[00:02:18] Talk to us about how Experian Health is using digital health and technology to drive meaningful change in healthcare. Yeah, so I travel all over the country talking to our clients, Saul, and there is so much enthusiasm and interest in how these digital tools and technology can transform processes.

[00:02:44] And they've kind of been done the same way for a long time in our industry. And one of the things that I've seen, I've been doing this for close to 20 years now, is that we've built processes around denials. And whole teams of people exist inside of healthcare organizations to manage denials.

[00:03:06] There are companies like Experian and EHR and billing platforms that have even modules inside of them. Lots of revenue cycle companies have tools called denial management, right? And so we've got this, you got to get paid, we got to send a claim. And if it gets denied, we have to manage it. We have to appeal it. That takes workflow. It takes people. It takes technology. And it's very expensive.

[00:03:34] And it's expensive to manage these denials. The labor force that we have to deploy to manage the denials is expensive. And it takes time and it delays the reimbursement. And there is so much that we're doing at Experian to shift our thinking and the industry's thinking away from denial management to denial prevention. And that's a big part of where our investment is going as an organization.

[00:04:03] As so many of the denials that end up today getting managed on the back end, they could be prevented. And the information that led to the denial was knowable at the point of registration. And either due to bad data coming into a system, human error, there's many different things that are the root cause of this. But that ends up causing a denial that needs to get managed.

[00:04:32] So by leveraging new technology, leveraging AI way up front at the beginning of these processes, sometimes even before the patient comes into the healthcare providers organization, we can fix this data, get the right information into the system at the beginning of the process and prevent denials from happening altogether.

[00:04:55] And so that's a big part of our focus of this organization is how do we get that information right up front, drive a much more efficient process that results in a clean claim getting paid the first time that it's submitted to the insurance company. Love it, Jason. Yeah. At the end of the day, if you get ahead of it, prevention is the name of the game instead of trying to get back and getting money that you should have gotten. Start from the start.

[00:05:21] What would you say the most important innovation your team is focused on right now is and what specific problem is it designed to solve? Yeah, it's the most important innovation we're working on right now is something called Patient Access Curator. And it's a product that we've already released into the market, but we're in the process of continuing to enhance its capabilities and the innovation.

[00:05:47] And it's specifically geared towards the solving the problem we just talked about. And so today, what this piece of technology is doing is I've described it this way for 20 years plus, the industry has been doing a series of point to point communications between a provider and a payer. A provider requests an eligibility response from a payer.

[00:06:14] A payer responds back and tells you, yes, that patient's eligible and here are their benefits, right? And oftentimes, the answer back is no, that patient's not covered with this insurance. And if the patient's not standing right in front of you, you got to call the patient, get them on the phone, try to see if they have different insurance. A lot of times, patients have multiple insurances and they may not know that they have multiple insurances.

[00:06:42] Maybe they're covered under a spouse's insurance and they don't have that other insurance card. There's lots of reasons why this information is not captured up front correctly 100% of the time. And so this capability that we've built, it's sending out the information to the insurance company and it's interpreting the response.

[00:07:02] And we've got intelligence now built into this process that knows based off the response I'm getting, what do I need to do to go either further curate additional information about this patient? Do I need to go find and validate other insurance coverage?

[00:07:20] If I find multiple insurance coverages, I can determine what the order of billing should be and then automatically update all that information back into the registration system without a human touching it in seconds. And so this technology has done tremendous things for our customers. We've seen denials go down by over 30% with the customers that have adopted this tool.

[00:07:49] We've seen some of the backend processes where companies go through and try to discover insurance on patients that are in the self-pay accounts receivable. We've seen those contingency fees drop by over 40% in organizations that have adopted this capability. And so it's performing very well, but we believe we can make it even better and further reduce even more denials.

[00:08:18] And then the other thing that we're working on is stitching this capability and this intelligence layer, this AI intelligence layer more broadly through our revenue cycle management platforms so that we can help prevent additional denials and additional steps in the revenue cycle management process. Well, the results sound like they're speaking for themselves. And now it's getting even better.

[00:08:44] So kudos to you and the team for building that out and incorporating some of the most modern technology into it. And as you look ahead, where do you see the biggest opportunity for your company to make an impact over the next year or two? Yeah, I think it's in the area we're talking about. Denials is something I hear all of our customers continuing to be frustrated about.

[00:09:10] It's a big challenge for the industry because it adds to a tremendous amount of costs into the equation. Right. And so health care providers are struggling with increased labor costs in all different areas of their business. And these organizations operate on very skinny margins today already.

[00:09:35] Right. So added costs to the labor pool and then the cost of managing these denied planes just makes that problem even harder for health care providers. So I think we're focused on the right area and continuing to leverage technology to improve the automation and getting the data right so that we can prevent denials in the first place. That's the first goal. But then you're never going to get all of them prevented.

[00:10:03] And so the ones that do happen, how can we help our customers automate the things that are relatively easy and then leverage the human expertise that exists in their organization? To focus on those more complicated denied claims and processes.

[00:10:22] That's really where we're focused is leveraging this technology to complement the teams that exist inside of our customers and help them scale those teams more effectively so that they can manage that cost pressure in the organization.

[00:10:37] And that's really where we're going to stay focused over the next couple of years is helping our providers operate as efficiently and effectively as possible and reduce their cost to collect from both patients and payers. Well, and it's certainly something that we're leaning into technology to help solve. AI is one of those technologies that continues to accelerate. The adoption continues to accelerate.

[00:11:07] What obstacles are providers encountering right now, Jason? And how's Experian Health helping them adapt to this new normal? Yeah, I think there's several obstacles that I think the provider community and the industry is wrestling with right now. One of them is trust. And I think there's this fear, I think, of what's happening inside of this black box in some capabilities of AI.

[00:11:34] And that's one of the things that I think companies, vendors like Experian and others have a responsibility to unlock that black box and be transparent about the type of AI, how it's arriving its decision making. The data elements that are going into the decision making can help develop that trust. The promise of these capabilities is immense, but I think that trust has to be there.

[00:12:04] We're dealing in a highly regulated environment in healthcare. There's protected health information. And there's a lot of concern that these tools are going to be treating that data with the privacy, the respect, and adhering to the regulations. And so I think that transparency is something that is a concern.

[00:12:24] It's a valid concern, and it's all of our responsibility to make sure that we're being transparent about how these algorithms are working and arriving at the decisions that they're making. Another issue that I think the industry is wrestling with, and we see this, Saul, every time some new technology comes to market, there is so much noise and talk about AI in the industry right now.

[00:12:51] And everybody is racing to see how they can apply these technologies to drive benefit. And there's a lot of discussion that doesn't really have a linkage to real value, and I think that's causing some confusion in the market. It's really hard if you're a buyer right now, you're a healthcare provider looking to access some of this technology to drive benefit in your organization.

[00:13:17] Everybody seems to be doing massively great things with this technology, and it's really hard to pick. Like, what am I going to do? Which partner, which vendor, which technology am I going to choose? And so I think that providers need to really lean into linking the outcomes that are being produced by whatever technology or vendor partner they're going to work with. You need to ask those questions.

[00:13:43] Give me some examples of customers that have adopted this capability and the outcomes they're generating from the use of those tools. Because I think the risk is pretty high right now that a bad decision can be made. And we've seen a little bit of that, and you always see that when you see big transformations happening in the industry.

[00:14:03] And so that's another area that I see some confusion that I think the industry is going to have to work through in the months and years ahead as this technology gets more prominent in the industry. Yeah, that's overwhelming. There's way too many choices. The trust, the validation, the ROI, I think those are all really great proof points to ask for. And so 100% agree with you there.

[00:14:29] We spent a lot of the time at the beginning of our talk really focused around the denial prevention. And there's a lot of uncertainty. OB-3, the One Big Beautiful Bill Act, there's so many pressures on providers right now. How's Experian Health helping them prepare for what's coming? Yeah, good question.

[00:14:54] And there is a lot of uncertainty and concern about the impact of the OBBA regulation that's going to be going into effect here really soon. Experian's doing a number of things.

[00:15:08] We're educating our customers in the market on what this means, the changes that are coming, and how that is going to apply and impact the organization and the processes that they need to implement to prepare for this.

[00:15:27] And then we're also looking at ways that Experian can help our customers and the industry as a whole meet the needs of this new regulation. And I think we're uniquely positioned because we are a part of the bigger Experian to help here. Experian has a number of very rich data assets that we already leverage to help our customers make better decisions.

[00:15:56] Our healthcare customers make better decisions. And we're looking at taking some additional data, like we have employment data. We know how many, for example, hours people have worked, and we have access to some of that information. And these new regulations are going to require not just what somebody's income is, but you're also going to know how many hours they work in a given pay period or month

[00:16:21] to understand if they're going to qualify for these Medicaid programs. And so we're in the process of seeing how we can link that data into our healthcare providers' workflows and help them use additional information and bring additional data to bear to help drive better decision-making and automate some of these important decisions that customers are going to have to make here in the next few months.

[00:16:48] Yeah, that's great to know you guys are focused on this. And, you know, why would you say providers can't solve the claims denial problem? And how's this dilemma going to accelerate AI adoption? Yeah, I think the reason you can't solve the problem is the problem keeps changing, right? It's one of the fascinating things about the industry that we're in is that

[00:17:12] the rules are constantly changing and those rules are being changed by the insurance companies. Sometimes the rules are being changed by the contracts that are being negotiated between a payer and a provider. And when those rules change and the systems don't change as quickly as the new contracts are being negotiated, those can lead to denial problems.

[00:17:37] But it's this constant change and rules changing that lead to these issues. And the systems haven't always been able to keep up with the changes. And so I think the other challenge that we're seeing is that both sides, the payers and the providers, are both implementing AI at the same time. And I actually think that may accelerate the challenge that we have in the industry.

[00:18:03] Because if payers are getting smarter about how they're applying AI tools to understand if claims are being submitted and paid correctly, providers need to be implementing the same types of technology to keep the pace with what the payers are doing. And we're going to be in a bit of this kind of race to keep up both sides. And so I think this dilemma is actually going to accelerate the need that the provider world

[00:18:30] and then segment of the industry continues to invest in AI because we're seeing the same types of tools being invested in on the payer side. And the simple fact is back to the cost pressures and all those things. I just don't think organizations are going to be able to thrive and survive without adopting this type of technology. And so it's going to be interesting to see how it continues to evolve.

[00:19:00] We're seeing tremendous promise in these tools that they can help drive this efficiency, help prevent a lot of denials from happening. And in the ones that do happen, we're also seeing that the appeal and management process and how that process works between payers and providers getting more efficient on both sides.

[00:19:22] And so I am optimistic that this technology is showing a lot of promise to reduce the administrative costs all across the continuum here. The same administrative burden exists on the payer side. We're really focused on the provider side at Experian Health, but I think the technology is showing real material gains and reducing administrative costs both for payers and providers.

[00:19:48] Well, it is definitely the AI arms race. And for better or for worse, it's something that everybody needs to prepare for. And partners like Experian are investing heavily into this. So you don't have to do it alone. You could check them out. Jason, if people wanted to get in touch with you and the team over there at Experian Health, what's the best place they could do that?

[00:20:15] www.experian.com slash health is the best place to understand what Experian's working on and reach out to us. We'd be very interested in talking to you about how we can help you with your AI adoption and revenue cycle management. That's great, Jason. Well, look, thank you so much for the time today. We've really enjoyed just speaking with you about the latest that you and the crew are up to over there.

[00:20:44] Folks, check out the show notes for all the ways to get in touch with Jason Considine at Experian Health. And we look forward to seeing the future of a healthcare that works better for you as well as your constituents. Jason, thanks for spending time with us. Thank you, Saul.