How Banner Health modernized its revenue cycle

Brad Tinnermon joined Phoenix-based Banner Health as vice president of revenue cycle management and revenue integrity in late 2017, before the organization launched its revenue cycle modernization and the COVID-19 pandemic began.  

His job has consisted of leading the 29-hospital health system to balance labor and technology use, prepare for a standard host system platform and improve the patient financial experience. 

Mr. Tinnermon told Becker's these efforts have allowed Banner to be more efficient in the revenue cycle and offset financial damage from the public health crisis. He shared his top priorities for 2021, discussed the modernization project and offered some advice for his peers.

Editor's note: Responses have been lightly edited for clarity. 

Question: What is the biggest challenge you're facing as a revenue cycle leader?

Brad Tinnermon: The pandemic gave us some new challenges. Protecting our staff and pushing things to work from home was a big focus and continues to be a refining focus in 2021. Banner continues to grow and acquire, so that keeps us busy. The patient financial experience, particularly with the new price transparency regulations that went live in January  — that's another area. We're not sure how that challenge is going to play out, but it's something we're continuing to stay in front of.

Q: How are you addressing that challenge? 

BT: We have a team we tap into that's aligned with revenue cycle, but it's a core competency of Banner, where we have a change management, continuous improvement and project management team, and it aligns with a different division. We use those teams to push initiatives and keep our road map full, so we have intakes of new opportunities and items that need to be addressed, and we manage our way through those. Sometimes a new topic will surface, and it trumps or reprioritizes what we're doing, but we have a road map we're working on. Now it's grown or moved into refinement. But in general, we use that internal change management, continuous improvement, project management team to manage any item that comes our way.

Q: Banner recently completed 95 percent of our revenue cycle modernization efforts. What does this entail and how has it affected cash flow during the pandemic? 

BT: Modernization started before the pandemic and kicked off in 2018. We were looking for a few things to accomplish, and one was balancing the use of labor and technology. We underinvested in technology and overinvested in labor, which led to a fragile environment that was volatile from a staffing perspective, so we needed to address that. We're also moving to a standard host system platform across our enterprise, so we wanted to be prepared for that and have the plans in place to ensure we reduce risk and have a stable environment as we transition. We also wanted to improve the patient financial experience. 

We utilized teams to accomplish these things, starting with getting the funding for that project. We asked for over $20 million for the modernization bridge plan and had operational expense for subscriptions for products. Over the course of that modernization, we generated a net amount of about $690 million in net benefit after the capital expense and the operating expense over about 28 months. Some of that — $208 million — was cash acceleration, and the balance from net revenue lift that considered volume changes, rate changes, acuity changes. Going into 2020 with the volatility we had in our business, our ability to be more effective and efficient in the revenue cycle had a great effect for our organization. It made the financial strain much less in 2020 than it could have been during that time. 

Q: What other revenue cycle goals do you have for 2021?

BT: There's still a lot of refinement to do with the work we've done, so optimizing some of those solutions are things we're looking at. But now that we've created some refined solutions and designed our operations, we need to look at where we can cut some cost out. Can we centralize more? Do we have duplication of vendors we can move out? We're working on the cost takeout component of our program. Now that we have this in place, we've moved forward with the host system conversion, which is going to take us about 24 months. Also, patient financial experience still has room for innovation and analyzing how price transparency regulations will play out competitively and publicly for us.

Q: Health systems across the U.S. have experienced financial damage because of the public health crisis. What is your advice to other revenue cycle leaders to sustain revenue cycle operations as patient volume fluctuates?

BT: We focus on our core competency and operate accounting for "normal" operations. We utilize strong strategic vendor partners to help us react to unforeseen shifts in volume, regulations, transitions or growth. We consistently scrutinize if we have the best expertise in-house, or if partners are the best solutions for patient experience, cost or recovery of revenue. Setting those relationship up before they are needed and having flexibility to utilize them quickly would be my recommendation. 

 

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