The Rev Cycle Playbook for Technology Investment

In this week’s HealthLeaders’ The Winning Edge series, two revenue cycle leaders shared their tips for successful technology investment strategies.

Investing in new technology is one of the most critical decisions a revenue cycle leader can make. But while the right tools can unlock new efficiencies and boost financial health, failed implementations can be costly and disruptive.

In this week’s HealthLeaders’ The Winning Edge webinar, Jeannine Mages, Vice President of Clinical Revenue Cycle at Kaleida Health, and Christina Slemp, System Vice President of Revenue Cycle – Financial Services at UNC Health, shared their thoughts on building better business cases for technology investments and ensuring smooth implementations.

Put Strategy Before the Software

An important first step is determining whether a specific pain point requires a technology solution or a process change.

For Mages, this begins with a deep look at the data.

“One of the things that I like to do when we're identifying pain points is looking at our KPIs and our metrics,” she said, noting that she looks for trends year-over-year and month-over-month. It is also important to gather input from frontline staff to understand their daily challenges and get their perspectives on potential solutions.

If a technology need exists, building a compelling business case is the next step. This typically involves estimating ROI, but this isn’t always clear.

The value of a new technology can extend beyond cost savings, according to Slemp.  

“Sometimes the value comes from giving a clinician more time to breathe, more time to interact with the patients, giving an associate more time to feel impactful and not continually on the hamster wheel,” she said.

The Human Element of Implementation

Technology often fails because of people, not the product. This places importance on a robust change management strategy to ensure successful adoption. This can include the creation of “champion program,” where peer leaders can help train and support their colleagues.

“I can come in and lead a session all day long,” Slemp said. “But [with] a peer or somebody that's been through it, that knows it, I think there's some respect there and there's some openness there.”

This peer-led approach helps to foster bidirectional communication that is essential for success. It also allows leaders to receive feedback to help them understand what’s working, what isn’t, and where staff may be creating workarounds that undermine the technology’s effectiveness.

Cutting Through the AI Hype

There is incredible potential for AI to improve revenue cycles, but a clear and strategic approach is necessary.

According to Mages, the most practical applications currently for AI are in denial support, particularly for DRG downgrades, and coding and utilization review. In the near future, conversational and predictive AI could help to reduce manual touches and help prioritize high-impact claims, Slemp added.

However, leaders should be cautious of chasing the "shiny new toy." To ensure a strategic approach, both executives said their organizations have implemented AI governance structures.

Kaleida Health, for example, has an "AI review board," which brings together leaders from compliance, IT, and the C-suite to vet new technologies and ensure they align with organizational goals. This disciplined, strategic approach, Mages said, is key to ensuring that technology is not just a shiny object, but an effective tool that helps to gain a winning edge.