Executives Explore Trends, Insights and Approaches Driving Revenue Cycle Innovations

A captive audience of hospital and healthcare system executives got a rare view into industry trends and innovations impacting the revenue cycle at an Executive Roundtable, held at the 2016 Healthcare Business Summit in April. The session opened with an opportunity to share top organizational and business challenges. Internally, managing change topped the list, followed by recruiting and training issues exacerbated by talent shortages. Top of mind external industry pressures included changing payor requirements, more focus on managed care and consumerism.

Reacting to industry changes

The opening dialogue was a perfect segue for guest speaker Bill Woodson, senior vice president at Sg2, whose organization is recognized as a forward-thinking voice in the healthcare industry. Woodson gave the audience a non-traditional interpretation of where industry growth is headed based on converging market forces. While traditional projections show inpatient acute-care demand growing based on volume from aging Baby Boomers, Sg2's analysis projects higher growth in outpatient, non-acute care due to changing care models and cost constraints driven by population health and value-based care.

Woodson explained that this market shift, combined with unprecedented margin pressures, is driving a dramatic rate of industry consolidation and giving rise to consumerism as individuals assume greater financial burden for care due to rising deductibles. He noted that payors also are feeling the squeeze as greater numbers of insured individual's access the healthcare system through the Affordable Care Act (ACA), citing financial losses reported at $475M by United Healthcare on 2015 exchange plans.

Given these factors and more, Woodson challenged the audience to consider a shift in thinking, acknowledging that patients are consumers first, with an ever growing number of options. In a post-ACA world, these consumers will continue to demand higher levels of service along with competitive pricing.

Revenue cycle is integral to meet changing demands

Because innovating the revenue cycle is integral to cost-effectively solve complex, cumbersome challenges, the discussion next focused on how the combined MedAssets-Precyse organization can help facilitate enterprise-wide, end-to-end industry solutions.

Addressing root causes versus pursuing a fragmented, point-solution approach was emphasized, as revenue cycle problems are integrated and comprehensive in nature, with many dependencies. Bringing together technology, process and education can be a game-changer, helping organizations create a long-term, sustainable leadership position in their market.

Attendees gained a view into how this works through case study snap shots on three partnering approaches. In the first scenario, technology and consulting expertise helped a Southwest-based health system leverage analytics to uncover new performance opportunities and solve root causes triggering denials in patient access, resulting in an increased net patient revenue of $17.5M.

A second scenario illustrated the power of combining technology, people, process and education to implement a robust health information management (HIM) solution, bridging revenue cycle functions and solving problems across the board. In this scenario, the organization realized increased net patient revenue of $48M through performance improvements.

A final full-outsourcing scenario demonstrated how a customized solution enabled a three-hospital network to increase their point-of-sale (POS) collections by 50 percent, along with overturning and winning denial appeals an average 68 percent of the time.

The session wrapped up with group breakout sessions focused on key questions healthcare executives should be asking as they consider next steps to innovate their revenue cycle, including:

• What steps are you taking in your revenue cycle today to mitigate internal and external challenges?
• Which revenue cycle component or areas do you see growing the most in importance over the next three years? Which are decreasing in importance?
• Has your organization experienced any effects of increased patient consumerism? What role do you see your revenue cycle playing in addressing this trend?
• How is your revenue cycle structured today across professional and technical components?
• Are you utilizing data analytics different than five years ago?

If you are looking for answers to these questions and more to help shape the future of your enterprise, contact us to speak with a specialist at solutions@medassets.com, or call 678.323.2500.

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