Revenue Cycle Management in Healthcare

Revenue Cycle Management in Healthcare
Revenue Cycle Management in Healthcare

Technology Optimization: Boosting Revenue Cycle Management

COVID-19 has changed the business outlook for Healthcare Providers globally. As they revive, innovation and technology will lead the transformation program. Advanced technologies will see greater deployment in hospitals to drive innovation, boost operational efficiency and enable them to focus more on clinical outcomes and patient satisfaction. However, revenue integrity can be challenging for providers due to numerous operational complexities. Deficiencies of one department can adversely affect others performance, as well as the overall integrity of a provider’s Revenue Cycle Management (RCM).

Our recent virtual forum, joined by business leaders and healthcare professionals, focused on impact of COVID 19 on the RCM functions and how digital and technology initiatives have been accelerated as a result. The session deliberated on the current practices when it came to technology usage in the RCM along with strategies to further improve and integrate the RCM functions.

KEY TAKEAWAYS:

  • Technology is going to help in reducing costs for healthcare providers. One such way would be to get various technologies embedded into existing processes via machine learning, robotic process automation (RPA), and cognitive technologies in order to make labor-intensive jobs more efficient.
  • Data analytics and automation tools help healthcare organizations unify and harmonize data pertaining to costing, pricing and margins in order to optimize payor contracting.
  • Given the rapidly evolving landscape and changing customer behavior exacerbated by the COVID 19 crisis, innovation in patient care will be at the forefront of every healthcare stakeholder.
  • Each region is facing challenges when it comes to RCM. Countries like India with an extensive customer base are currently seeing a pragmatic shift at the meta level; however there are challenges existing at the transactional level, which can be managed through leveraging of technology, data analytics, and bringing in participation of emerging startups.
  • Investments in digital healthcare are expected to remain high. At the same time, the efficient use of digitization will reduce costs and increase efficiency, while protecting patient data through robust cyber security frameworks.
  • Automation of processes will optimize backend RCM functions such as claims management and collections.

 

Digital: the Catalyst for Healthcare Transformation?

The moderator set the stage by describing the changing landscape of healthcare, aimed at improving processes that affect various facets such as patient care, access to medical services, ongoing monitoring of patients’ health as well as other key areas like patient billing. While organizations attempt to reduce expenses, investments in digital remain strong to counter gaps in their healthcare systems. However many of them are grappling with challenges through their digital journey.

The Impact of Digital on Organizational Strategy

The key question that often arises is: How ready is my organization in this digital journey? At the heart of this very question is the understanding of what digital health truly means and how it can be embraced to respond to the needs of its patients and the organization as a whole. During the discussion, one of the panelist from one of the leading private healthcare group based in Dubai introduced the interesting concept of “digital quotient” that entails harmonization of digital assets, digitally skilled labor, and the use of data. Due to the pandemic, he explains that his organization’s “digital quotient” has been rapidly accelerated, thus forcing the provider to develop a model that can adopt a digital strategy that engages various facets of healthcare such as cognitive psychology, behavioral economics, continuous patient engagement, all the while leveraging big data, AI, and deep learning. The model addresses two key focus areas; on the one hand - the integration of technologies around the existing system, while on the other hand, the creation of a data model where each patient’s data is made available to the patient and the provider.

Embracing Technology in Revenue Cycle Management – is Automation the Answer?

With downward pressure on investments and the implementation of Diagnosis Related Groups (DRG) in Dubai, challenges around RCM optimization are being felt amongst healthcare providers in the UAE. While traditional tasks of RCM such as eligibility, claims management, and denials, remain intact, automating these processes has taken center stage in the discussion around optimization. Automation will not only reduce costs to collect by utilizing machine learning, it will also provide tools for payors to ease resubmission claims. The latter was expounded upon by challenging the existing system that governs reimbursement: how does an organization use digital and data from various disparate systems that don’t speak to each other for a payor contracting purpose?
A panelist from leading sovereign wealth fund with multiple healthcare assets in in the region offered solution to improve RCM by defining a more collaborative model with payors, based on better and more accurate pricing, which can reflect different scenarios besides the seasonal occurrences and leverage data to develop new contracting schemes. He also highlighted how Protiviti was actively helping them in creating an automation tool for better pricing and improving managed patient care. In the US, the discussion around payor contracting posed different kind of challenge. Another panelist delved into factors that make it difficult to be innovative when there is a requirement to post all the provider’s pricing. Regulations around pricing transparency mandate healthcare providers to share 300 “shoppable” services and post them on a machine readable file on the website for consumers to be able to read and compare with other providers in-network.

Lessons Learned from the Crisis –Regulatory Perspective Thinking 50 years ahead

The rapid spread of COVID 19 also mandated a shift in the healthcare service delivery practices for the government. The panelist from public regulator and healthcare provider in Dubai highlighted how the government demonstrated a readiness to transform existing service offerings to respond to the patient needs emerging from the pandemic. For example, the telemedicine smart service launched in December 2019 titled “Doctor for Every Citizen” was expanded in response to the crisis to cover all residents of Dubai. The service includes telehealth consultations that cover initial diagnosis of Covid 19, e-prescriptions for certain conditions, and lab tests. The regulator is now looking to expand it beyond pandemic related conditions to include telehealth consultations for other common health conditions, and in the future introduce an IoT (Internet of Things) that links the regulator to international entities in order to access more specialties and more doctors worldwide. These kinds of initiatives demonstrate the rapid integration of existing systems to respond to the pandemic while also propelling the development of new ways to integrate these processes for future use.
Further discussion ensued around the adoption of innovative technologies to reduce no show cases and waiting time with the panelist regulator offering a glimpse of initiatives such as the Robot Pharmacist, launched in 2017, where each robot stores up to 35 thousand medicines, and dispenses around 12 prescriptions in less than 1 minute helping them in reducing the waiting time from 20 min to 2 minutes for prescriptions. In addition, smart home care technologies also directly linked to the provider’s Electronic Health Records system in order to ensure that the EHRs are accurately updated in real-time. Another stride towards the future of healthcare in Dubai is the idea of holding the Innovation Lab titled “Health Future Vision 2071 Lab”, which was inspired by the 50 year Charter. It aims to transform Dubai into a future healthcare city by developing ideas and using the latest technologies in order to come up with innovative solutions.

With Change comes Challenges

While insurance-led businesses are at the forefront of healthcare in the Gulf region, India is predominantly cash-led with a system that has faced many challenges around revenue cycle optimization. A panelist from one of the biggest healthcare providers in India presented a meta-level approach to the paradigm shift that the country is currently undergoing. While the government in India used to lay out certain schemes for a class of citizens that includes government employees and armed forces, most providers found themselves bound by this plan;  the government is currently finding new ways to expand its footprint to include other classes of citizens in order to deviate from the primarily cash-based transactions and create a common platform that will ultimately change pricing and the way it will be executed (one such scheme is Ayushman-Bharat-Yojana – this will provide free healthcare for close to 40% of the population in the country). Another innovation that is taking place is the adoption of a digital health ID scheme: the government has launched a digital health ID scheme where every citizen will have a digital health ID that he owns. Insurance companies, healthcare providers and other stakeholders will have limited access to the patient’s information. This not empowers the patient, it also brings about the dilemma that exists between privacy and the ability to provide healthcare. For example, people who are more willing to provide their data are getting access to healthcare while others who are less willing won’t experience the same. Nevertheless, given all the stakeholders involved, it will be interesting to see how these challenges will be superseded.

Parting Thoughts

  • Healthcare organizations should not confuse digital strategy with their IT strategy: the former compliments the latter.
  • Understand operations and then leverage technology accordingly to increase efficiency.
  • Data, analytics, and automation create a more agile process to minimize revenue leakage and create a better financial experience for patients – of course, this starts with cohesive solutions that can be integrated together.
  • Adopt the philosophy that digitization and privacy go hand and hand when it comes to patient data.
  • View the pandemic as an accelerator for innovation rather than a bottleneck.