REV­ENUE CY­CLE MAN­AGE­MENT

MEET­ING CHAL­LENGES – OLD AND NEW

Health Data Management - - SUCCESS STORIES + STRATEGIES -

cy­cles to sup­port the move to value-based care. Un­for­tu­nately, many or­ga­ni­za­tions are strug­gling to han­dle this tran­si­tion. A sur­vey of 117 hos­pi­tal financial ex­ec­u­tives, con­ducted by the Health­care Financial Man­age­ment As­so­ci­a­tion (HFMA), shows that re­spon­dents do not view their or­ga­ni­za­tions as highly ca­pa­ble in most ar­eas that sup­port value-based pay­ment.

“Many health­care or­ga­ni­za­tions do not cur­rently have the in­fra­struc­ture that is needed to be suc­cess­ful un­der the var­i­ous value-based pay­ment and care de­liv­ery mod­els. In­vest­ments in build­ing the in­fra­struc­ture such as tech­nol­ogy and per­son­nel is crit­i­cal, in ad­di­tion to or­ga­ni­za­tional align­ment and clin­i­cal re­design. Strong part­ner­ships with health plans and physi­cian buy-in is key,” said Su­san Hor­ras, di­rec­tor, Health­care Fi­nance Pol­icy, Health Plan and Pop­u­la­tion Health, HFMA. “Health­care or­ga­ni­za­tions need to an­a­lyze, iden­tify and man­age the trends im­pact­ing the qual­ity and to­tal cost of care. Some or­ga­ni­za­tions are still faced with the chal­lenges of hav­ing timely, ac­tion­able in­for­ma­tion that im­pact cost and qual­ity out­comes.”

One of the most dif­fi­cult – and press­ing – chal­lenges for health­care or­ga­ni­za­tion is to im­ple­ment the in­te­grated in­for­ma­tion sys­tems that are needed to sup­port value-based mod­els. In­deed, ac­cord­ing to the HFMA study, 24% of re­spon­dents said their or­ga­ni­za­tions are “not ca­pa­ble” of sup­port­ing ex­ter­nal in­ter­op­er­abil­ity and 59% said their or­ga­ni­za­tions are only some­what ca­pa­ble of han­dling ex­ter­nal in­ter­op­er­abil­ity while 2% said they are “not ca­pa­ble” of sup­port­ing in­ter­op­er­abil­ity and 57% said they are only “some­what ca­pa­ble.”

“There are chal­lenges with both in­ter­nal and ex­ter­nal in­ter­op­er­abil­ity. In­ter­nally, some or­ga­ni­za­tions have dis­parate sys­tems across the or­ga­ni­za­tion that presents chal­lenges in ex­chang­ing mean­ing­ful clin­i­cal and financial data. For ex­am­ple, all physi­cians may not be on the same EHR and an in­terim so­lu­tion may need to be im­ple­mented in or­der to ex­change and share in­for­ma­tion across pri­mary care, spe­cial­ists, phar­macy, etc.,” Hor­ras said. “Ex­ter­nally, the in­dus­try still lacks na­tional data def­i­ni­tions and stan­dards that en­sure con­sis­tency across soft­ware func­tion­al­ity. Pa­tient match­ing is a sig­nif­i­cant chal­lenge with no room for er­ror when ex­chang­ing med­i­cal record in­for­ma­tion. In­for­ma­tion needs to be in a con­sis­tent mean­ing­ful for­mat that can be used across the con­tin­uum to im­prove pa­tient safety, man­age cost and build ef­fi­cien­cies.”

While many or­ga­ni­za­tions do not yet have this in­ter­op­er­abil­ity in place, health­care lead­ers rec­og­nize its value – as more than 70% an­tic­i­pate an ex­tremely im­por­tant need for capabilities around in­ter­op­er­abil­ity and 50% around ex­ter­nal in­ter­op­er­abil­ity in the next three years (see Project Needs Chart).

With all of th­ese pro­jected needs, health­care or­ga­ni­za­tions are ex­pected to in­vest more heav­ily in rev­enue cy­cle man­age­ment sys­tems. In fact, the health­care rev­enue cy­cle man­age­ment mar­ket is ex­pected to hit $100 bil­lion by 2024, ac­cord­ing to a re­port from Global Mar­ket In­sights Inc. This growth is ex­pected to em­anate from not only the gov­ern­ment and pri­vate in­sur­ance shift from vol­ume to value-based health­care but also form the de­mand to re­duce billing er­rors, the im­ple­men­ta­tion of big data an­a­lyt­ics, the need to ad­dress gov­ern­ment com­pli­ance re­quire­ments such as ICD-10 and HIPAA v5010 and in­creased fraud­u­lence screen­ing, ac­cord­ing to the re­port.

Health­care Financial Man­age­ment As­so­ci­a­tion, HMFA’s Ex­ec­u­tive Sur­vey Value Based Pay­ment Readi­ness, Spon­sored by Hu­mana

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