To confront disappointing performance in its revenue cycle, leadership at Bon Secours Mercy Health made the decision to outsource. The deep, collaborative partnership has led to a significant turnaround.
Billie Jean Mounts arrived at Bon Secours Mercy Health (BSMH) shortly after the health system partnered with Ensemble Health Partners.
“Things were pretty well on fire at the time,” said Mounts, the health system’s current chief revenue officer, referring to the state of the revenue cycle prior to the partnership.
Aware that a change was necessary, BSMH leadership made the strategic decision to bring in a full-service revenue cycle partner.
That partnership not only quenched the fire but has since propelled BSMH to achieve top-tier performance, demonstrating how a deep, collaborative outsourcing relationship can drive significant and sustainable financial results.
First Step: Tackling System Complexity
An initial assessment by Ensemble revealed multiple broken processes, but the most significant challenge was a lack of standardization. BSMH was operating on more than 50 different instances of its Epic EHR system, creating a disparate and inefficient environment for data flow and claims management.
Consolidating these systems into a single instance was one of the first initiatives for the health system and its new partner. This undertaking standardized workflows and data infrastructure, creating the foundation for a more efficient and effective revenue cycle. With a foundation laid, the team could then begin to address the root causes of issues like claim denials.
Driving Measurable Results
The results of the turnaround were both rapid and dramatic. Before the partnership, cash collections as a percentage of net patient service revenue was only about 97%. Process improvements boosted that figure to above 100%.
The initial denial rate, which was around 3.6%, was another key focus. By leveraging data-driven insights and working to fix the root cause of denials, BSMH has driven that metric down to industry-leading performance, earning multiple HFMA MAP awards in the process.
A Partnership for Payer Accountability
A key element of BSMH’s success is the nature of its relationship with Ensemble, which extends beyond a simple transactional vendor agreement. It is, instead, a deep, shoulder-to-shoulder partnership focused on holding payers accountable.
As payers become more aggressive in their tactics for delaying payment, like excessive requests for medical records, it puts pressure on internal revenue cycle resources. To improve understanding between payers and the health system, sometimes it takes “sitting down side-by-side with the payer and going through claim by claim by claim,” according to Mounts. “It is painful.”
With a revenue cycle partner by their side, Mounts doesn’t need to do that grunt work. Instead, the partner provides the scale, technology, and analytical resources to identify payer issues and arm BSMH’s leadership with the information needed for high-level contract negotiations.
Many health systems may have their reasons to keep revenue cycle operations inhouse. However, for BSMH, the lesson is clear: in an increasingly complex healthcare landscape marred by payer pressure, a deep strategic partnership can provide the resources and expertise needed to not only fix a revenue cycle that is "on fire," but to transform it into one that is best in class.
Luke Gale is the revenue cycle editor for HealthLeaders.
KEY TAKEAWAYS
Bon Secours Mercy Health's partnership with a revenue cycle vendor has allowed the health system to drive significant and sustainable financial results.
The health system has increased its cash collections from about 97% of net patient service revenue to more than 100% and now boasts an industry-leading initial denial rate.
Outsourcing components of the revenue cycle to a vendor can help health systems to benefit from scale and specialized expertise.