Where 4 revenue cycle leaders see opportunities for disruption in healthcare

From developing financially unaffiliated partnerships to personalized healthcare, here is where four revenue cycle leaders recently told Becker's they see opportunities for disruption in healthcare:

Christopher Ault. Chief Revenue Officer at Cooper University Health Care (Camden, N.J.):  Development of true, financially unaffiliated, provider/payer partnerships that provide accurate forecasts on yield to the provider (no denials) and reliable utilization guardrails to payers and their members. The only spaces we see this in today are in provider-owned plans. It would be great to see an unaffiliated arrangement come together to write the playbook for the future. Maybe this is occurring outside of our region, but I haven’t seen it. 

While it is true that the consumer approach to healthcare is closer to traditional retail than ever, it is still miles away because of the underlying financial uncertainty for the payer and provider. As we continue to develop more mutually agreeable data sets and share that information in real time, those challenges become easier to solve.

Sheldon Pink. Vice President of Revenue Cycle at Luminis Health (Annapolis, Md.): The midcycle is where we can find a lot of disruption. In clinical documentation improvement … there are a lot of tools out there that people are using. Still, I don't think there's a tool that has touched working with physicians, coders, clinical documentation integrity (CDI), and bringing it all together. And the reason is that there's an EHR involved, and sometimes they don't integrate well with the EHR. There's cultural adoption by the physicians. There are challenges with coding. Many variables serve as barriers to achieving what we would call optimal clinical documentation integrity. CDI technology is disruptive in our industry and can bring all the clinical pieces together with minimal risk.

Another disrupting item would be self-registration. At the Healthcare Financial Management Association conference, someone compared healthcare to the Walmart model at a roundtable. I thought that was very intuitive on his part from seeing it that way because it's the truth. You used to go to a supermarket and can go to a cashier. Correlating that to us, the patient walking into a physician's office or any hospital ancillary department does not exist anymore. You have to check out your groceries, and the direction of healthcare is moving toward a patient checking themselves in, scanning their ID card and registering themselves. So self-service registration will be another disrupting item in healthcare where individuals and patients have to get familiarized with interacting with a computer or a machine to receive healthcare services from the provider.

Then, digital communications are on the back end as we all attempt to optimize and reach our patients in many different ways. There are several generations we must consider, and the challenge we face in healthcare is generational gaps. We want to move toward more digital communications, i.e., whatever we can automate. However, some generations still say, "I want my paper statement, and I want to speak to somebody on the phone." So we're challenged to build a program that supports both populations, because we have a significant amount of both subsets.

Niobis Queiro. Senior Vice President of Revenue Cycle Management at Tufts Medicine (Burlington, Mass.): The best way to be disruptive in healthcare today is to bridge the gap between the clinical and revenue cycles. We have the technology to demystify how the two support each other, so we must provide information so clinical caregivers can understand the why and the how. We have information that gives us what the payer and regulations are accepting why isn't it up front and visible to our clinical providers during the care process — addressing this gap, address clean claims, denial reduction, patient satisfaction and quality measures. Also, we need to exchange data in real time and stop reacting to the payer and regulatory requirements, from the point of request to care and documentation to selecting a treatment plan and medication. We must stop pointing fingers and fighting amongst ourselves and start joining forces to revolutionize our care delivery model to include financial solvency.

Ashley Toney. Director of Revenue Cycle and Chief Compliance and Privacy Officer at Atrium Health's St. Luke's Hospital (Columbus, N.C.):  Personalized healthcare. The current healthcare system is based on a one-size-fits-all type of approach. While standardization is important for quality and safety, there is a large opportunity to make patients feel thought about. When I hear complaints and compliments about patients’ experience, they most often point to the care they received and how they felt considered or not. We must understand how patients want their interactions.

Telehealth has continued to grow, but how can we make the patient’s visit in search for a diagnosis most productive? There seems to be less hours in a day than ever before and an efficient approach is key not only for the provider and staff but for the patient. Many people put off care based on time that has to be put in to attend these appointments. Personalization could look as simple as follow-up with care at home after a visit or the actual visit being based on a patient’s preference. Now we have the ability to use technology to help us with these processes. In the follow-up care post visit instance, a text that connects to the provider and their office monitoring, not only helps a patient feel supported and guided in their healthcare journey but likely would reduce the risk for 30-day readmissions.

For patient preferences, EMRs could have a patient profile that supports what makes a patient feel most comfortable. While realizing the hospital is not a spa, being in the hospital can be a scary time for patients and their family and simple, thoughtful actions can have a big impact on how patients feel about their care.

How can we be intentional with our approach? With healthcare growth being vital to surviving, patient experience and satisfaction is key to any kind of continued growth. Now more than ever, with the ability to monitor consumer behavior we have a large opportunity, especially if companies that have mastered this start penetrating healthcare.

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