Sarah Hartwig, patient access officer at Avera Health, discusses how the organization is improving reimbursement and advancing the patient experience through automation.
The complexity of medical reimbursement not only creates a poor patient financial experience, but it also drives up hidden costs for organizations.
Automating certain processes within the revenue cycle can protect patients from surprise medical bills and allow staff to spend more time on meaningful work to improve the patient financial experience, but it’s not a one-size-fits-all endeavor.
Avera Health, an integrated health system based in Sioux Falls, South Dakota, serves patients through 37 hospitals, 215 primary and specialty care clinics, 40 senior living facilities, sports and wellness facilities, and more. In order to improve its revenue cycle processes across its complex system and create a positive patient financial experience, Avera Health realized automation was key.
The patient access officer at Avera Health, Sarah Hartwig MBA, MSHS, focuses on front-end revenue cycle operations and recently shared with HealthLeaders her experience in helping to implement automation solutions in this area of the revenue cycle.
HealthLeaders: Why has automation been essential to your organizations’ revenue cycle?
Hartwig: I think we all know that medical reimbursement is complex. When I started out in healthcare, we would talk about what a dynamic environment it is, and that was 20 years ago. And here we are now—even more dynamic and more complex.
Because of the complexity—from government regulations to payer expectations—it really makes automation even more important and integral to the holistic view of our strategies and revenue cycle. Automation also helps us better leverage our human resources. If we can offload those redundant and elementary tasks, it actually helps make those human efforts more meaningful.
We've noticed the need to unify that approach in the middle and back-end workflows, too. And that automation continuum allows us to have that perspective.
HL: What are key factors organizations should consider in selecting and implementing technology solutions for the revenue cycle?
Hartwig: For us, it's been about maintaining a focus on the patient. During the pandemic, we had to quickly change and shift to adopt new ways and new strategies of doing our work.
But, as we take more of a long-term focus, it really is about maintaining that focus on the patient while considering the needs of multiple stakeholders.
Another factor is interoperability. There are so many potential solutions out there. What we've found is that you need to focus on the core solution for your revenue cycle, build off of that, and then put the focus on interoperability so that it works in the day-to-day. Creating that interoperability will only better reimbursement and the patient experience.
Another consideration for us, again, is evaluating the long-term automation goals.
We feel pretty reactive after dealing with a lot of the changes in the past couple of years. It feels like we've had to quickly change and move. Now that we can breathe a little more, we can take a step back and really look at our long-term goals for these solutions, all while keeping the patient at the center.
One of our long-term goals is maintaining transparency. So, anytime we're selecting a tool for automation, we like to consider what information the patient, care team, and folks supporting the backend process will all see through this tool. This is important to us because we want to make sure there's a level of transparency for everyone.
Also, any automation tool that we're looking for, for example if we're truly leveraging the patient to self-serve, our team needs to consider building quality factors so that it doesn't take any type of rework from our revenue cycle staff.
And lastly, I'll just mention the vendor selection process. For us it is more about building partnerships. I'm building relationships and working more holistically with those partnerships that will take us to and through the long-term solutions that we are looking for.
HL: What are some of the broader trends that have driven adoptions of automation solutions?
Hartwig: We know hospital costs are increasing and reimbursement is not necessarily improving, so our margins are thinning. That’s why it’s so important that adoption of technology truly leverages and positively impacts our costs for operation.
For us, we continue to shift the focus from back-end workflows and try to alleviate and prevent some of those time-consuming tasks (like collections) by utilizing the front end of the revenue cycle. Automation in the front end is much more of a focus for us as it can prevent those errors that would burden the back-end staff.
We are also working to identify potential prior authorization and medical necessity denials early on in order to make sure those prevention factors are put in place. That has also led to more conversations and more inclusion of our care teams. I'm working to automate all of those financial clearance processes upfront so that we're engaging with patients immediately, so they know their out-of-pocket costs and what to expect moving forward. All of these factors will create a positive patient experience and have a positive impact on our bottom line.
“We know hospital costs are increasing and reimbursement is not necessarily improving, so our margins are thinning. That’s why it’s so important that adoption of technology truly leverages and positively impacts our costs for operation.”
Amanda Norris is the Associate Content Manager of Finance, Payer, Revenue Cycle, and Strategy for HealthLeaders.