Mid rev cycle automation tools and platforms to drive innovation — 5 learnings

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The healthcare revenue cycle landscape is complex. Investment in EHR tools and other technologies has accelerated, yet clinicians remain burned out, operations teams are working on razor-thin margins and patients aren't loyal. 

During a roundtable discussion sponsored by DeliverHealth as part of Becker's Sixth Annual Health IT + RCM Virtual Conference, session participants shared the challenges and opportunities associated with improving revenue cycle performance through AI and automation. Michael Clark, DeliverHealth's CEO, and Jason Martin, DeliverHealth's chief product officer, moderated the conversation.

Five key learnings: 

  1. It can be helpful to use a maturity model to structure technology projects. DeliverHealth has developed a five-level RCM Automation Maturity Model, starting at Level 0 and going to Level 4. 
      • Level 0 involves organizations using consultants with RCM automation domain knowledge to evaluate their needs. 
      • Level 1 is when organizations leverage managed services in areas where automation will impact demand for human resources. 
      • Level 2 focuses on analytics to measure performance and return on investments in technology.
      • Level 3 includes implementing new technology that is flexible and caters to employees' workflows. 
      • Level 4 is optimizing technology performance.
  1. When investing in automation to streamline coding, transparent systems and robust analytics are essential. One participant noted that "black box" autonomous coding was a concern from a compliance perspective. The most successful automation initiatives rely on explainable AI. Analytics are also critical for measuring project performance. "Analytics can benchmark your evolution after you adopt a new technology," Mr. Martin said.
  2. Staffing is a major barrier to improving the revenue cycle. Constantly changing payer rules require a different level of revenue cycle employee. Utilization management in today's work-from-home environment is also difficult. "Payers are doing everything remotely, so they don't have staff at the case manager's elbow putting eyes on the patients," a participant from an Arizona-based community hospital said.
  3. EHR system limitations also create obstacles for revenue cycle teams. Many organizations don't require information to be standardized before it's entered into the EHR system. Unstructured data with no consistency makes it more difficult to automate processes. In addition, EHR customization is a double-edged sword. "We have customized everything within Epic, and we're handcuffed now," a participant from a Minnesota safety net hospital said. "It's almost like we have to get back to foundation to implement new tools and technology as they evolve."
  4. Before selecting a technology vendor, thorough due diligence is a must. "Don't be lulled into the idea that an existing vendor who is good at 'A' will automatically be good at 'B,'" a participant cautioned. "Conduct due diligence to identify who is good at both automation and the revenue cycle. Just understanding one side but not the other will be detrimental." Another attendee suggested that health systems want strategic partnerships with vendors that include innovative approaches to cost-sharing. "We can't do $3 million upfront," she said. "I could sell technology projects more effectively to internal decision-makers if I could say we're all in this together." 

While automation in the RCM space has significant promise, the path to successful implementation isn't always easy. "Healthcare organizations are constantly on the lookout for ways to improve care delivery and also capture appropriate reimbursement for those services," Mr. Clark said. "The RCM systems that organizations use must reflect the wonderful care that they provide."

To learn more about the event, click here

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