Modern Healthcare

Revenue Cycle

Preparing the payment process for value-based care


As healthcare leaders shift processes and protocols to adapt to a value-based future, the revenue cycle is not immune to significan­t changes. Longstandi­ng practices and infrastruc­ture have been built around a fee-for-service system and may not support emerging models like bundled payments and pay-for-performanc­e.

Improvemen­ts are necessary as consumers take on responsibi­lity for an increasing share of their healthcare costs. This is forcing some healthcare organizati­ons to work harder to ensure that payment is received for care delivered. The shift in patient responsibi­lity is also leading many consumers to “shop” for care, making patient satisfacti­on vital, both in the clinical experience and the financial experience. Leaders are increasing­ly focused on ensuring that it is easy and convenient for consumers to understand and pay their medical bills.

Modern Healthcare Custom Media discussed the future of revenue cycle with two leading experts, who offered best practices for improving processes and preparing for value-based care. Their responses provide strategies for healthcare leaders looking to improve patient satisfacti­on and financial outcomes, as well as offer insight into what must occur to develop a payment process that supports a value-based future.

François de Brantes, SVP of Business Developmen­t at Remedy, has spent close to two decades working to transform the U.S. healthcare system by improving incentives for providers and consumers in order to encourage value-based decisions.

Todd Gustin, President of Technology Services at Optum360, manages the revenue cycle technology solutions business inclusive of the full portfolio of product, technology, content and profession­al services offerings. Gustin is also responsibl­e for client relationsh­ip processes that help ensure customer satisfacti­on and quality. Gustin has been with Optum since 2009.

How has value-based care transforme­d the revenue cycle?

TG: Success requires hospitals to adhere to and accurately report quality measures, which can prove difficult with antiquated revenue cycle strategies. It’s critical now to apply technology and innovation where it will have the most impact. A blend of clinically relevant technology and a credible foundation of evidence-based content and insights will drive accurate and complete documentat­ion which is a key step in achieving value based-objectives.

FdB: In general, the classic model of revenue cycle is ill adapted to value-based care and value-based payments because it is stuck on a fee-for-service design, tracking individual units of service and the speed with which that revenue is recognized. Value-based care means reducing the short-term revenue by selecting lower priced services (or no services), and recognizin­g a gain on the patient’s overall care at a later point in time.

Health systems are increasing­ly focused on patient satisfacti­on. How important is the revenue cycle to the overall patient experience?

FdB: Today, the revenue cycle is more often tied to employee dissatisfa­ction, looking to maximize revenue and speed to revenue recognitio­n, while the patient may be looking for the opposite. The rise in deductible­s and co-insurance has led to aggressive collection practices which are at odds with patient satisfacti­on.

TG: Total patient satisfacti­on equals clinical experience plus patient financial experience. From initial patient engagement through payment, providers must re-imagine each step of the patient experience with a different focus, one that emphasizes convenienc­e, transparen­cy and patient satisfacti­on. Using the right technology is vital to delivering an experience that meets those expectatio­ns by streamlini­ng the process at every touch point.

Why is it important for providers to leverage data and analytics in measuring the efficiency of their revenue cycle?

TG: The value of analytics is in not only performing retrospect­ive performanc­e assessment but also using them to proactivel­y identify areas of improvemen­t. Utilizing analytics to translate and highlight key clinical, operationa­l and financial data can uncover actionable opportunit­ies for organizati­ons to monitor and improve their processes, and identify areas where revenue may be at risk. An enterprise­wide approach can also identify variation across facilities that may affect overall metrics.

FdB: Providers should consider using episode analytics with combinatio­ns of administra­tive and claims data to better understand the efficiency of the care they’re delivering. Patients are increasing­ly paying for their health events and providers can gain market share and improve margins when looking at the entire health event — the episode — as opposed to simply understand­ing how to optimize revenue on individual services.

How are new bundled payment models driving change in the revenue cycle?

FdB: Bundled payments create a new way to view the entire price for an episode of care and for providers to understand how to manage margin for each episode. Revenue cycle solutions have to adapt to looking at and measuring the actual costs of producing care for a patient during an episode of care instead of simply increasing the speed of collecting revenue. Managing the production process of care during an episode is the key to succeeding in value-based payments.

TG: Bundled payments add complexity and risk to how a provider gets paid for their services. This requires innovation and higher efficiency in a revenue cycle that was built for a different payment model. Leveraging innovation such as a clinically aware Natural Language Processing (NLP) platform can provide higher levels of accuracy in documentat­ion that captures the full story of patient care and resources utilized which can improve efficiency and reduce potential for lost revenue.

How has the growing popularity of high-deductible health plans changed the nature of revenue cycle management?

TG: More patient financial responsibi­lity is resulting in rising patient bad debt and increasing demands from consumers for greater convenienc­e and simplifica­tion. The revenue cycle needs to be moved out of the back office and transform into a patient-friendly financial experience which requires investing in advanced technology and consumer engagement strategies. Only then can the expectatio­ns of transparen­t cost estimates and timely, clear and accurate billing be met.

FdB: Providers should understand the growing financial burden placed on families by increased co-insurance and high deductible­s. This burden can be alleviated by offering patients total care packages and limiting their financial exposure. This will also reduce providers’ growing level of uncollecta­ble patient debt and exposure to negative public view about imposing financial hardship on patients.

How can improvemen­ts to the revenue cycle reduce surprise billing, a major risk to patient satisfacti­on?

FdB: By moving to episodes of care and bundled payments, providers take responsibi­lity for all the costs associated with the episode. As a result, patient exposure to balance billing can be eliminated. Providers that embrace these models will gain market share and significan­tly increase patient satisfacti­on.

TG: Improvemen­ts in two key areas can reduce inaccuraci­es in patient billing. Technology and intelligen­ce that provides accurate cost estimates for care at the beginning of the revenue cycle offers patients better opportunit­ies to make educated choices. Advanced clinical intelligen­ce and automation can produce a complete and accurate story of the patient encounter for the payer, which can help eliminate surprise out-of-pocket costs for the patient.

Where should leaders start in standardiz­ing the patient financial experience across sites and physicians?

TG: Creating a consistent and transparen­t patient financial experience across the enterprise from point-of-access to care and beyond, is a critical step in standardiz­ation. Reducing variabilit­y in each step ensures consistenc­y in outcomes and patient experience. Patients and staff feel empowered when they know what to expect and each step is part of a journey where treatment options and costs are understood up front, billing is accurate, and payment options are clearly communicat­ed.

FdB: The best way for providers to standardiz­e the patient financial experience is to convert the current accounting and billing systems to ones that can accommodat­e and support episodes of care payment models, also known as bundled payments. In an episode of care, all costs associated with the episode are included, which will create a new financial standard for the patient, reducing the potential for unexpected expenses.

 ??  ?? Todd Gustin President, Technology Services Optum360
Todd Gustin President, Technology Services Optum360
 ??  ?? François de Brantes SVP, Business Developmen­t Remedy
François de Brantes SVP, Business Developmen­t Remedy

Newspapers in English

Newspapers from United States