The road to recovery: How health systems are recapturing lost revenue in 2021

On the back of a $323.1 billion loss to the US hospital system in 2020, healthcare organizations are rethinking strategies to bring back patient volumes, recover margins, and boost market share in 2021.

During an April 7 webinar hosted by Becker's Hospital Review, three industry leaders discussed how healthcare organizations are reengaging patient populations, reconfiguring operations, reducing costs, and growing market share, leveraging lessons learned and innovations developed in response to the COVID-19 pandemic.

Participants were:

  • Parveen Chand, chief operating officer, IU Health Adult Academic Health Center in Indianapolis
  • Simon Curtis, vice president of access services at Duke Health and vice president of ambulatory services at Duke Private Diagnostic Clinic in Durham, N.C.
  • Mukesh Gangwal, co-leader of healthcare performance improvement practice and a managing director of Berkeley Research Group in Emeryville, Calif.

1. Stay true to the organization's mission and values. Both IU Health and Duke Health established guiding principles to direct their response to COVID-19 and care for patients with non-COVID conditions. Adherence to these core values, which emphasize safety for workers, patients, and staff, led to greater trust among stakeholders, stronger relationships with the state and community health services, new supplier partnerships, emphasis on mental healthcare, and a focus on identifying and addressing the systemic issues that create health inequities.

2. Reengage patients. In 2021, many hospitals are seeing reduced discharges but significant increases in length of stay as patients who delay hospital visits require more intensive care. "The last [American Hospital Association] report said gross revenue, as of January 2021, was down by 4.8 percent, outpatient revenue was down by 10.4 percent; patients continue to avoid nonemergent care," Mr. Gangwal said. 

Duke Health is focused on meeting patients where they are to ensure they receive the right care at the right place at the right time, which in many cases now occurs on a digital platform rather than in a facility. The pandemic also has led to renewed focus on managing the health of high-risk and chronically ill patients. Duke has been working with its payer partners to develop quality programs for high-risk chronic condition populations, including diabetes, heart failure, mental health, and colon and breast cancer screenings. 

"Our advanced practice providers have participated in outbound calls to some of our most at-risk patients," Mr. Curtis said. "We've redefined our at-risk, not just by disease, but by education level, ZIP code, and neighborhood … to be sure we're supporting patients everywhere."

3. Innovation in clinical services distribution and delivery. Mr. Chand laid out three examples of how health systems can rework clinical services to better meet community needs and grow market share. First, he recommends organizations take a close look at their distribution of services and partnerships and identify where they can provide a greater level of care through a distributive model. 

Second, providers can leverage solutions and innovations developed in response to COVID. For example, during the early stages of the pandemic, IU Health established a program to provide hospital-level care to patients at home, featuring virtual connection to a home health RN team 24/7; continuous monitoring of vital signs, respiratory status, symptoms, and progress; and a regular check-in schedule throughout the day. 

“We were able to manage the risks of reducing length of stay, lowering the rate of readmission, improving clinical outcomes, and reducing the hospitalizations for our at-risk patients," Mr. Chand said. Building on the program's success, IU Health launched similar initiatives to manage patients with chronic health conditions. 

Third, Mr. Chand recommended organizations review lessons learned from team-based care and analyze if it is a sustainable model for care delivery going forward.

4. Expand remote workforces. Is remote work for support services a long-term, low-cost option? Last year, many hospitals outsourced revenue cycle positions to revamp operations, decrease costs, and improve collections. Shifting certain positions such as compliance, coding, and revenue cycle to work-from-home roles presents an opportunity to cut costs. 

“We have been able to reduce cost in the 10 to 20 percent [range] for specific functions in the revenue cycle,” Mr. Curtis said. “We’re landing on a hybrid model that we think is here to stay.”

5. Telehealth: Transformation or fad? Telehealth has been around since the late 1990s but did not become widely adopted until early 2020 when the pandemic hit. IU Health logged more than 500,000 virtual visits in 2020, compared to7,000 in 2019. The technology is here to stay, but some features need to be addressed, including the lack of available vitals at the point of service, staff training, privacy concerns, and connectivity issues for patients in rural America, according to Mr. Chand. "With a very concerted, mindful approach as to how organizations are approaching telehealth, I think we can get to a point where outcomes can actually be enhanced for those chronic care conditions."

Click here to learn more about Berkeley Research Group and here to view the full webinar.


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