Healing revenue cycle management

May 25, 2017
By Jack Brock, Executive Vice President, Information Technology, R1 RCM

Over the past decade, there has been significant progress improving performance in the acute revenue cycle for hospitals and health systems. Leading performers have standardized their approach, invested in technology, and strengthened talent. However, the revenue cycle could evolve to better serve current needs. The traditional approach has focused on financially driven process improvement and workforce efficiencies without prioritizing the needs of patients and physicians. As a result, today’s revenue cycle management is suffering in several ways. First, the patient experience is poor.  Patients are often confused, inconvenienced, and dissatisfied.

According to recent studies, more than 60% of patients don’t understand their bill, 88% of scheduling is still done by phone (vs. online), and 96% of patient complaints relate to customer service.

Redundant paperwork

Despite available technology, patients are stuck filling out paperwork and providing the same information multiple times. In addition, health systems could achieve improved economics as studies have shown that more than 30% of referrals don’t turn into visits.  Physicians are also challenged with care coordination, scheduling issues, and too much administrative burden. Lastly, existing processes are too costly and resource intensive. Clerk-led workflow for patient access and registration requiring repetitive data entry drives up cost and worsens the patient experience. Looking ahead, a new approach is needed to improve the patient experience, better support physicians, and achieve a revenue cycle infrastructure for the future.

Courtesy of R1

RCM with consumer in mind

A significant opportunity exists to transform the revenue cycle from the patient and physician perspective. Emerging solutions could make it easier for provider and patient collaboration to improve the experience and outcomes. This would be a shift from today’s disjointed contacts and onerous scheduling options for the patient (and physician) to a simplified process enabled by technology. In addition, the revenue cycle could empower patients through online self-service options and deliver a more personalized experience leveraging information at the right time.

Consumer-facing technologies could be better utilized, integrated, built using modern design methods, and scaled in healthcare to enable patients to engage the way they do in day-to-day life. Omni-channel communications and easy-to-use digital solutions could be part of a seamless and engaging experience for patients. It would be supported by a technology infrastructure that’s secure, reliable, and scalable—and increasingly cloud-based. The experience and supporting technology would be rooted in a sophisticated operating model incorporating efficient workflow, intelligent-routing, automation, analytics, and talented professionals.  The new revenue cycle could extend to give health systems a more comprehensive financial infrastructure that spans payment models and settings of care.

With a new approach, the patient experience can be transformed from one that’s frustrating, confusing, and burdensome to a future that keeps patients healthy and happy—where patients are engaged, supported, and well served. Imagine a simple experience that’s easy to navigate—a workflow where a physician places an order through an app that invites and enables the patient to schedule an appointment at his/her convenience. This moves administrative work out the physician’s office, so they can focus on providing care. In response to a notification (e.g., text message), the patient can easily schedule an appointment from his/her smartphone at a convenient time. After scheduling, the patient preregisters online from a tablet at home to get financially cleared and chat or speak live with a counselor to understand coverage options before arriving for the visit.

By making it convenient for the patient, providers are more likely to get accurate and complete registration information. When the patient arrives for care, he/she quickly checks in via a kiosk (without a barrage of questions and paper forms). The concierge (transformed from registration clerk) is expecting him/her and prepared to provide personalized guidance if helpful. The concierge is able to concentrate on patients who have unique issues or just need extra support. Throughout the experience, the patient—whether at home, on the go, or at check-in—is at the center.

Blockchain opportunity

Over time, new opportunities will arise through more advanced predictive analytics and cognitive computing in the revenue cycle. In addition, new models, such as blockchain technology, could someday be adapted to healthcare to improve how we maintain health records, complete transactions, or engage with stakeholders.

Right now, patients simply want a better experience, and providers need a commercial infrastructure that yields better performance, so they can focus on what matters most. By beginning to look at the back office from the front, there’s an opportunity to create value for patients, physicians, and health systems alike.  Patients could understand and navigate the system in a way that’s easy for them.  Physicians could focus on delivering outstanding care.  Health systems could improve cash yield, revenue, and market share with higher patient and clinician satisfaction. Through technology, intelligent design, and greater focus on the patient and physician, the revenue cycle could soon be on the road to recovery.

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