Why analysis has become so complex and how tech is delivering deeper insights
Amidst an evolving landscape, hospitals and health systems grapple with a myriad of escalating business challenges, including surging denials, diminishing patient volumes, reduced payments, the pursuit of revenue recovery and the quest for sustained profitability. For healthcare finance leaders, the task at hand is not just about navigating these choppy waters but also interpreting essential revenue cycle metrics to get better visibility into performance across the revenue cycle. John Yount, chief innovation officer for FinThrive, points out that the complexity of healthcare operations is exacerbated by intricate processes, a multitude of stakeholders and the existence of data silos that keep essential information just out of reach. “Data typically originates from a single source, a best-of-breed solution, preventing a comprehensive view of the revenue cycle and the ability to stay on top of critical areas such as payer performance.”
Yount advocates for the adoption of a unified system that creates a 'platform effect,' streamlining data sharing across the organization to drive enhanced revenue cycle outcomes. Here, he examines the benefits of end-to-end (E2E) platforms, revealing strategies that have effectively bridged revenue cycle management gaps and boosted reimbursement rates.
Q: What are the primary challenges faced by healthcare revenue cycle management (RCM) leaders when analyzing revenue cycle metrics?
Yount: There are three key areas where roadblocks are most prevalent in revenue cycle performance evaluation. The first lies in leaders having difficulty efficiently monitoring their performance, primarily due to data silos. Currently, the RCM landscape is quite fragmented, with data scattered across multiple niche systems. Most health systems rely on 30 to 40 different RCM vendors. There's an increasing need for consolidation through a unified platform. The second challenge is figuring out ways to increase net revenue. With so much dispersed data, leaders often grapple with evaluating data from multiple sources in one view to get a complete understanding of an issue. As a result, they are challenged to identify effective steps required to impact revenue growth positively. Another significant problem is the slow access to data, which restricts the ability to act swiftly on corrective measures. It’s not uncommon for revenue cycle departments to spend days or weeks compiling essential data, which delays interventions and affects desired results.
Q: Which one of the challenges mentioned stands out most and why?
Yount: The most significant challenge is undoubtedly the data silos. The core issue is that data often comes from a variety of niche solutions that aren't naturally aligned. This means there's a need for additional tools to consolidate this data, which is a complex task for providers. In practice, organizations have traditionally monitored key performance indicators (KPIs) across distinct categories, such as patient access, pre-billing, claims, account resolution, financial management and productivity. These categories have been quite compartmentalized, which makes it difficult to compile a comprehensive data view. In many cases, a leader only has a picture of the KPI that's specific to the work they're doing. To illustrate, consider pre-billing, where the KPI 'discharged, not final bill' (DNFB) is typically monitored. But what we want is to enable an executive to look at DNFB in conjunction with other critical metrics, such as denial write-off percentage, all in one place. Ultimately, this provides insights specific to pre-billing but also encompasses broader financial management metrics.
Q: What are the advantages of using an E2E platform for KPIs or metrics over point solutions?
Yount: An end-to-end platform excels by centralizing scattered data, which allows for a comprehensive and contextual analysis of both payer and provider performance. For example, with denials increasing, it’s critical to accurately assess your top payers by examining collections, denials, underpayments and the payer mix together for a comprehensive understanding of trends. This unified view extends to provider performance, bringing together productivity and revenue data into one platform. With the ability to compile diverse data into one unified interface, we can overlay different data sets for a more complete analysis. This not only enhances our understanding of performance but also informs the actions needed for improvement.
Q: Have any of your customers successfully overcome these challenges, and can you share the outcomes?
Yount: The concept we have championed, known as the 'platform effect,’ is all about leveraging a shared data environment to drive efficiency and action across a health system. It is the effect that has enabled our clients to realize substantial improvements in key areas. Specifically, in overall reimbursements, there's been an uptick of about 5% in revenue. Additionally, having access to benchmark data has empowered them to identify and close gaps in revenue cycle management outcomes, leading to boosts in performance by 10% to 15%. This all circles back to our core objective: transitioning from metrics derived from single data sources to a more integrated approach where data from multiple streams converges and brings end-to-end intelligence. This approach doesn't just pool data—it adds a layer of context, enabling comprehensive analysis across the entire revenue cycle for more predictive and proactive revenue management.
In conclusion, Yount emphasizes the urgency of resolving fragmentation within healthcare finance systems. "Unresolved, we're going to continue to see organizations struggle from a margin perspective," he states. He foresees a market shift towards comprehensive, end-to-end solutions that cover the entire revenue cycle, from patient access to revenue recovery. "Opt for a partner that can deliver these essential capabilities to truly harness the platform effect," Yount advises.
For more information on FinThrive’s Analyze solution which delivers actionable insights to customers across the revenue cycle, visit Transform | Analytics and Intelligent Automation | FinThrive