Health Data Man­age­ment – Rev­enue Cy­cle Q&A with Marty Cal­la­han, RevSpring

Health Data Management - - SUCCESS STORIES + STRATEGIES - Marty Cal­la­han, Pres­i­dent of Health­care Mar­kets

RevSpring is a leader in pa­tient com­mu­ni­ca­tion and pay­ment sys­tems that tai­lor en­gage­ment touch points to max­i­mize rev­enue op­por­tu­ni­ties in acute and am­bu­la­tory set­tings. Since 1981, RevSpring has built the in­dus­try’s most com­pre­hen­sive and im­pact­ful suite of pa­tient en­gage­ment, com­mu­ni­ca­tions and pay­ment path­ways backed by be­hav­ior anal­y­sis, propen­sity-to-pay scor­ing, in­tel­li­gent de­sign and user ex­pe­ri­ence best prac­tices.

How can health­care or­ga­ni­za­tions best bal­ance the need to move to­ward value-based mod­els – while still ad­dress­ing long-es­tab­lished rev­enue cy­cle con­cerns such as days in A/R and col­lec­tions?

Bal­anc­ing mov­ing to new value-based re­im­burse­ment mod­els while man­ag­ing self-pay re­ceiv­ables is es­sen­tial to main­tain the financial health of any health sys­tem or provider. This is es­pe­cially true as con­sumer financial re­spon­si­bil­ity for health­care ex­pense con­tin­ues to rise and the pres­sures of lower re­im­burse­ments in­creases. We see savvy health­care providers re­ly­ing on ven­dor part­ners that can pro­vide re­lief for A/R man­age­ment in the form of an­a­lyt­ics, ad­vanced tech­nol­ogy, and em­ployee ef­fi­ciency that im­proves pay­ment per­for­mance. By us­ing th­ese ven­dor part­ner tech­nolo­gies and solutions, health­care providers can al­lo­cate more re­sources to de­ter­mine how to best com­ply with new re­im­burse­ment mod­els.

What tech­nolo­gies can health­care or­ga­ni­za­tions use to more ef­fec­tively deal with emerg­ing riskbased con­tracts?

For Health­care providers to ef­fec­tively man­age val­ue­based con­tracts and re­im­burse­ments they need to have vi­able data and an­a­lytic tech­nolo­gies to store and track data per­tain­ing to pa­tient di­ag­noses, treat­ment modal­i­ties and out­comes, and an­a­lyze the data at an ag­gre­gate and in­di­vid­ual per­spec­tive. The chal­lenge for providers is not only in the tech­nol­ogy to sup­port value-based pric­ing and re­im­burse­ments but also the ex­per­tise to an­a­lyze and sup­port th­ese new strate­gies and re­im­burse­ments.

What strate­gies and tech­nolo­gies can health­care or­ga­ni­za­tions adopt to im­prove pric­ing trans­parency?

Most es­ti­ma­tion mod­els that are used to pro­vide cost trans­parency to pa­tients are based upon the payer con­tract with this hos­pi­tal. This method­ol­ogy typ­i­cally doesn’t con­sider a pa­tient’s con­tri­bu­tion to­wards their an­nual de­ductible or co-pay. It can also be in­ac­cu­rate if the model is us­ing the prior year’s con­tract in­for­ma­tion with that payer (in other words, not up­dated based on cur­rent con­tract). A best case sce­nario would al­low the pa­tient to make a de­posit against the es­ti­mate and then the tech­nol­ogy would au­to­mat­i­cally ad­ju­di­cate the bal­ance with the credit card in­for­ma­tion on file.

Do you ex­pect the fed­eral gov­ern­ment’s fo­cus on re­duc­ing ad­min­is­tra­tive bur­dens to have an im­pact on rev­enue cy­cle prac­tices? If so, how?

As the fed­eral gov­ern­ment gains ad­min­is­tra­tive stan­dard­iza­tion around elec­tronic health­care records and billing pro­cesses it seems that health­care providers will have fewer ad­min­is­tra­tive bur­dens and lower op­er­a­tional costs re­gard­ing com­pli­ance with th­ese rev­enue cy­cle pro­grams. Over­all, ef­fi­cien­cies should be gained that will af­fect rev­enue cy­cle op­er­a­tions across the coun­try.

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