Why 4 health systems are outsourcing RCM to Optum

Becker's has reported on four health systems that have outsourced revenue cycle and other services to Optum since January 2023. Here is why leaders of those systems have said they outsourced these services. 

1. Minneapolis-based Allina Health said Feb. 1 that it is transitioning roughly 2,000 revenue cycle and IT employees to Optum. 

Allina Health CIO Dave Ingham told Becker's the increasing complexity of patient billing was a big driver of the decision. 

"Revenue cycle is so dependent on technology these days," he said. "And there's such an emerging area of opportunity around interfacing with payers, delivering real-time financial information to patients in terms of estimates that are accurate, that actually tell you how much something will cost, understanding your copays, where you are in your deductibles. And then having an actual digital experience when you're making your payments.

"Healthcare has lived in the dark ages of paper-bill-every-30 days for so long. We're really digging in hard and investing in that digital financial experience. So sending both teams over, we think, does bring synergy and will enable a lot of new capabilities."

2. Optum announced Oct. 4 that it was hiring more than 800 employees from Waukesha, Wis.-based ProHealth Care and will begin managing the health system's revenue cycle management, information technology, informatics, analytics and inpatient care management. The 835 revenue cycle management, information technology, informatics, analytics and inpatient care management officially transitioned to Optum on Jan. 27. 

ProHealth Care CEO Susan Edwards told the Milwaukee Business Journal the shift will allow the health system to remain independent at a time of increasing mergers and acquisitions.

"As one of the smaller [health] systems in the market, we certainly don't have the ability to leverage scale," Ms. Edwards told the news outlet. "So by working with Optum, we can basically leverage their scale and expertise to really enhance the efficiency and effectiveness of our administrative operations and also free up resources that will allow us to invest in improving the care in our communities."

3. Owensboro (Ky.) Health selected Optum on Jan. 10, 2023, to manage its revenue cycle operations and IT services. Optum hired 575 employees from the health system. 

Owensboro Health CFO Russ Ranallo said in a news release the partnership with Optum will allow the health system to "build on the innovative work we've already done, recruit and retain the loyalty of the best physicians and clinicians, invest in new technologies to enhance patient care, and expand our services to underserved areas." 

The health system also said the partnership will simplify revenue cycle workflows so team members can spend more time communicating with patients and less time dealing with repetitive tasks. It will also drive digital healthcare transformation by enhancing infrastructure across Owensboro Health's care delivery networks.  

4. Brewer, Maine-based Northern Light Health tapped Optum on Jan. 5, 2023, to manage its revenue cycle management, information systems, inpatient care management, analytics, project management office and supply chain functions. In March, 1,400 of the system's employees became Optum employees.

Tim Dentry, Northern Light's president and CEO, told the Portland Press Herald the deal is expected to save $1 billion over 10 years by outsourcing billing and support operations to Optum.

"Nobody was going to save the day for us in healthcare," he told the newspaper. "This decision by Northern Light is going to take a huge amount of pressure off of individual entities like [Eastern Maine Medical Center, a hospital parented by the health system]."

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