It’s Time for Healthcare to Adopt Modern KYC (Know Your Customer) Data Practices

By Mike Bechtel

As the world acclimates more and more with doing business virtually, the healthcare industry is grappling with how to embrace virtual care and telehealth tools to maintain patient care in a safe and modern way. Although some of the public health emergency-loosened standards may retighten after pandemic subsides, it is safe to say that telehealth and virtual care tools utilization will remain a significant proportion of the care delivered moving forward. 

HIPAA is well-known privacy standards protecting consumers’ health information. However, the protection of this sensitive information from bad actors has become an increasingly larger problem for healthcare organizations. The industry saw 41.4 million patient records breached in 2019 according to the Protenus Breach Barometer. These breaches can cost healthcare organizations millions of dollars in fines, damage to their reputation, and healthcare consumer trust. Already, healthcare organizations have contended with increased data breaches and an increased average cost per breach. According to IBM, the average data breach was up to $7.15 million from $6.45 million last year.

With the uptake in 2020 of consumer-facing digital health tools including telehealth services, the industry is certain to experience increased attempts at breaching valuable protected health data this year and in the future. A recent report noted a decrease in healthcare breach reports in the first half of 2020 due to the pandemic, but cautioned that this is likely due to a lack of detection or reporting, not an actual decline. It warns that an increase is highly likely in the second half of this year.

Learning From the Experts

‘Know Your Customer’ is a critical part of today’s financial regulatory environment to verify the identity of its consumers to prevent banks from being used by criminal elements for money laundering activities. This usually incorporates policies and procedures to cover four elements:

• Customer acceptance policies
• Customer identification procedures
• Monitoring of transactions
• Risk management

This concept is not well known in the healthcare industry, yet, given that until recently, less than 1% of care was performed virtually. However, moving forward virtual visits could potentially account for $250B or about 20% of what Medicare, Medicaid and commercial insurers spend on outpatient, office and home health visits according to a new report.  Despite a temporary lull in reported healthcare fraud as a result of Covid-19 in the first half, there has actually been an alarming increase in healthcare data breaches. Once fraud reporting catches up in 2H 2020 along with the dramatic increase in digital health utilization, it will be very clear that healthcare organizations need to implement KYC technology services. 

There are a number of use cases across the various channels when healthcare consumers engage with their healthcare providers, health plans and other healthcare organizations. These channels are ripe for modernized technology, automation to increase operational efficiencies, risk reduction and improved consumer experience. 

Digital account onboarding

Healthcare organizations are not unlike other consumer-facing organizations in that they need to build loyalty to their brand. However, loyalty is not the only thing they have to think about. Patient and member engagement is critical in the age of value-based care. To engage at scale, healthcare organizations must leverage digital tools. Even with how important engaging healthcare consumers in these tools, healthcare organizations often make initiating a digital account such as a portal or electronic healthcare cumbersome for even the savviest of consumers. Whether it’s activation codes or requiring a dozen fields of highly personal information to be entered, the industry is still a laggard in adopting tools that streamline the experience for consumers. Today, healthcare consumers can simply use their phone numbers to pre-fill digital forms with verified demographic information from authoritative sources that both ID proof and improve the digital experience.

Digital account servicing

Usernames and passwords are still primary ways in which digital accounts are “protected”. However, forgotten usernames and passwords also act as a barrier to adoption, especially when accounts are accessed infrequently. Today there are better ways. Multi-factor authentication is commonplace today. However, within healthcare it’s still relatively unused when it comes to ongoing digital services such as returning portal users or when a higher risk interaction, such as a telehealth visit, is initiated. A patient’s bank most likely authenticates them each and every time they log on to their banking app. Healthcare organizations need to begin treating patient information with the same care that the financial services industry protects their customers’ money.

Call Center engagement

Verbal communication remains a critical modality of communication in healthcare. As such, call centers continue to proliferate throughout the industry. First, there’s outbound communication whereby the healthcare organization performs outreach to engage with and manage the care of the patient or member. With a good ‘Know Your Customer’ process in place, healthcare organizations should have up-to-date contact information on file for them. However, this is usually not the case. Phone contact information for healthcare consumers is notoriously unreliable. The result is increased staff time trying to make contact and ultimately lower engagement rates, which costs the system money and diminishes health outcomes. Knowing the phone numbers associated with healthcare consumers creates frictionless, passive authentication for inbound callers. By implementing services which look at the possession of the device the consumer is calling from, the reputation of that phone number and the ownership of the phone number itself, it’s possible to improve the consumer and agent experience, and create a much more secure interaction.

The healthcare industry is a dynamic and mission-driven industry. There are innovative and groundbreaking medical breakthroughs that occur each and every day and lives are saved because of it. However, the system still has a long way to go in its transformation. Leveraging technology to scale resources to adequately care for and engage the consumer is a requirement. 2020 has taught us that this is possible. It’s now time to rapidly optimize the digital tools that have been thrust to the forefront of healthcare. Healthcare organizations must prioritize secure consumer access to protected health information at all times, and make it easier for consumers to engage with their healthcare organizations. And they must quickly learn how to meet healthcare consumers expectations as we all progress with our “new normal”. 

Mike Bechtel is VP of Healthcare for Prove.