Productivity gains over the last few decades resulted from adding more people to meet increased demand.1 This isn’t sustainable as leaders struggle to find people to fill clinical and administrative roles necessary to meet the demands of day-to-day operations.2 Labor costs and churn hurt margins, which are already under significant pressure.
Innovate or perish is a sentiment shared across the healthcare industry. New technology in the hands of skilled providers improves care delivery and outcomes. In the same way, automation and AI are making rev cycle teams across the country more productive. For organizations still burdened by inefficient workflows and cumbersome payer requirements, game-changing tools can empower you and your teams to work smarter, reduce denials and A/R days, and transform the rev cycle to be more efficient and profitable. Now is the time to modernize.
“Overcoming challenges and capitalizing on the next wave of innovation entails investing in the right mindsets, infrastructure, and capabilities throughout the revenue cycle and beyond.” 3
What does modernization look like?
These are the hallmarks of a modern rev cycle:
- Leaders understand how teams work. Process mining and the resulting insights determine how, where, and when work gets done. Opportunities for improvement get identified quickly, and measuring the impact of interventions ensures a positive ROI.
- Streamlined processes cover the cycle from patient registration and insurance verification to claims submission and payment processing.
- Automation and digitization of billing and coding procedures reduce errors and delays, leading to faster reimbursement and improved cash flow.
- Powerful analytics tools show valuable insights and revenue trends to inform decision-making and strategic planning.
- Workers use automations to avoid rote work, allowing them to upskill, contribute more value, and have higher job satisfaction.
Your perspective will dictate your priorities.
Positive change requires a change of mindset. Every rev cycle has its challenges with people, processes, and priorities. The complexity of the health system organization compounds these challenges. There is no silver bullet. However, if solving day-to-day problems is all-consuming, thinking holistically and solving systemic problems will continue to be purely aspirational. As the Chinese proverb says, “The best time to plant a tree was 20 years ago; the second best time is now.” In other words, it’s time to get started.
What follows is guidance to keep you on track for success.
Build a comprehensive view of your operation.
Traditionally, understanding your operation involved over-the-shoulder monitoring by expensive consultants who observed a small sample of employees were on their best behavior with someone watching them. Today, programmatic data capture is unobtrusive and yields a rich data set that accurately shows how individuals and teams work across systems, tools, and applications. This innovation replaces speculation with factual insights that reveal patterns, bottlenecks, and areas ripe for automation or refinement. These insights will also help you quantify the impact of modernizing tools and processes. Unprecedented visibility into your operation will give you the confidence and data that make a compelling argument for ongoing investment.
Think outside the rev cycle.
It may be challenging to garner resources for your modernization journey. A lack of support may be due to competing initiatives, limited IT resources, or skepticism after previous technology trials failed to yield the expected results. Try a different tack:
- Promote interoperability. Your success will require strong partnerships with stakeholders outside of your department. Look for shared opportunities to create value through data and systems interoperability. Interoperability will streamline communications and keep data consistent across systems. It will also make allies of IT and a CDO.
- Align your goals with others across the organization. For example, if innovation, productivity, and revenue growth are shared goals, build a coalition to present a unified vision.
- Get senior leadership on board. Be proactive and prepared to respond to questions from different leaders. You’ll find helpful tips in the blog: Get the C Suite On Board with Automations and AI in the Revenue Cycle.
For a technology partner, choose wisely.
It’s hard to imagine a more important decision than choosing a partner for a long, complicated journey. You want someone with the experience and commitment to support you all along the way. Someone who will help navigate the inevitable roadblocks and detours. Here are some questions you’ll want to ask a potential partner:
- Is there more than one solution? A fit-for-purpose solution with minimal upfront investment will be enticing but, in the long run, will fail to deliver enough value to make a positive impact.
- Do they have revenue cycle expertise? Most vendors know technology, but only some know the revenue cycle well enough to craft solutions considering the unique integration and compliance issues that complicate day-to-day operations..
- Do they have trusted credentials? Getting privacy and security stakeholders on board with proper credentials will be much easier. You want someone familiar with the complex regulatory compliance and data security standards.
- Have they worked with clients with a similar team size, payer mix, and EMR as you? The size and scope of a team will differ from one system to another. Understanding how scale impacts performance will make the solution fit your unique circumstances.
- How do they integrate with your EMR? The EMR is the operating system; any solution must seamlessly integrate. Working within existing EMR workflows will ensure workers will not be distracted by learning and using a new vendor portal to realize any benefit.
- Will they provide ongoing support after the implementation? You’ll need help after deployment. Make sure they’ll be there for you.
Quantify results: measure success.
Data tells the story of your journey and shows progress toward short and long-term goals. How long did it take to see a positive ROI? What is the impact on productivity and revenue? Embrace data, and you will answer these questions with confidence.
You can build a framework for planning improvements by tracking and monitoring key performance indicators (KPIs) like denial rates, clean claim rates, days in accounts receivable, and net revenue per patient. A data mindset gives you a framework to mark progress and plan the next steps.
Modernization will impact workers – in a good way.
Streamlined workflows and automation provide relief from tedious, error-prone tasks. Allocate the found time to upskill workers for the new rev cycle. Bestow on them a mindset of value orientation. Show them the data that points to priorities aligned with the business objectives and KPIs. Optimize staff time and impact, and you can confidently forecast staffing needs. And the workforce will feel empowered and satisfied, directly contributing to the team’s success.
Modernization will look different for you.
Your situation is unique. Learn from the successes and mistakes of others, but the processes, people, and perspectives that challenge you will determine how and when you move forward. The journey may seem daunting, but success is possible with the right partner and mindset. All of the most amazing journeys start with the first step.
Janus is a partner for the long haul — technology and expertise guide every step along the path. We’d love an opportunity to tell you more.
1 The productivity imperative for healthcare delivery in the United States. Mckinsey & Company, February 27, 2019
2 RevCycle Intelligence, May 2022
3 Setting the revenue cycle up for success in automation and AI. Mckinsey & Company, July 25, 2023