In revenue cycle management, strategic priorities are continually evolving; however, the overarching goal to improve yield remains constant. Recent surveys conducted by HFMA and FinThrive, as well as the American College of Healthcare Executives (ACHE), unveil how healthcare organizations strategically approach technology investments to address key performance indicators, especially amidst rising denials and potential cash flow slowdowns.
According to the HFMA survey results1, 70% of respondents prioritize revenue increase, 60% focus on enhancing the patient experience, and 55% aim to reduce costs. Additionally, workforce challenges topped the list of hospital CEOs’ concerns in 2023, according to the annual ACHE survey of top issues confronting hospitals2. Recognizing the interconnected nature of these goals is pivotal for maintaining financial sustainability. Healthcare organizations are homing in on crucial initiatives like reducing denials and enhancing prior authorization processes—leveraging technology, third-party solutions, and process mining to do so.
This is the third, in a series of blogs, that delve into three critical areas where technology solutions directly impact priorities: accelerating the prior authorization workflow to improve the patient experience, utilizing claim status and denial analytics to boost revenue, and prioritizing process mining to enhance workflows and reduce costs.
Unlocking Operational Efficiency through Process and Task Mining
For executives navigating the complex terrain of healthcare, challenges abound. The recent ACHE survey sheds light on the daily struggles faced by hospital CEOs, with workforce issues consistently topping the list for the second consecutive year. While workforce shortages tend to focus on clinical roles, it is important to note that 79% of respondents were concerned with non-physician burnout and 27% cited the management of remote staff as an issue. Financial challenges weighed heavily on CEOs noted as the second issue of great concern with reducing operating costs and revenue cycle management both cited as significant barriers to achieving financial health2.
The interplay of opportunities and challenges from the C-Suite perspective is evident, as highlighted in the annual C-Suite Agenda report by Sage Growth Partners. Notably, workforce resilience is intricately linked to cost-cutting measures, with 64% of respondents emphasizing the need to reduce the use of agency employees, and 63% stressing the importance of efficient staff utilization to mitigate expenses related to overtime, turnover, and redundant positions3. This raises the question: How can AI contribute to enhancing the workforce and where can it be leveraged for maximum gains?
Enter process and task mining, emerging as a transformative force for organizations by equipping leaders with crucial insights into the workflows across their dispersed and remote workforce. This empowers them to leverage data to explore opportunities for process refinement and optimization.
So, what exactly is process and task mining, and how can it benefit your revenue cycle?
Task Mining involves capturing and analyzing real-time user interactions with systems including EHRs, and payer portals to understand the user experience by identifying how individuals navigate software applications and perform specific actions.
Process Mining delves into the analysis of event logs generated during business process execution, producing visual representations of the actual workflow. It uncovers process sequences, variations, and inefficiencies, thus enabling organizations to optimize workflows and bolster operational performance.
Power is in combining process and task mining
For revenue cycle leaders, achieving a comprehensive, bird’s-eye perspective on work across systems, applications, and teams is crucial. With Janus this is made possible through our Workforce Management solution which features a user-friendly software application, providing leaders with the ability to delve into the specifics of their team’s operations and identify potential barriers to efficiency and effectiveness. Detailed dashboards furnish managers with a nuanced view that allows them to discern productivity differences among employees, particularly as tasks are directly linked to claim outcomes. In the current era of remote work, the capability to access transparent data on activities and seamlessly tie them back to claim resolution is invaluable.
Moreover, our Process Intelligence solution illuminates work performance and uncovers opportunities for improvement at the workflow level. By pinpointing and addressing bottlenecks that hinder efficiency, leaders can streamline processes through automation. Moreover, extracting key insights empowers leaders to rethink the roles and responsibilities of revenue cycle workers, including retraining underperforming employees and identifying impactful roles for high performers. With Janus, process mining is taken to the next level through intuitive process maps and optimal path solutions, allowing leaders to zero in on specific parameters such as user, claim type, and payer. This empowers them to determine the most effective approach to resolving each claim.
These tools not only enhance the effectiveness and efficiency of revenue cycle management but also elevate the role of revenue cycle workers by liberating them from mundane tasks. Instead, they are directed toward more specialized, high-impact work. In essence, process intelligence emerges as a key element for leaders dedicated to advancing the overall performance of revenue cycle management.
The challenges faced by healthcare leaders, from workforce shortages to financial complexities, necessitate innovative solutions rooted in data-driven insights. Workforce Management and Process Intelligence offer a transformative approach, enabling executives to unravel the intricacies of their operational landscape, optimize workflows, and empower their teams to excel in specialized, high-impact work. As revenue cycle leaders harness the power of process and task mining, they pave the way for a more agile, efficient, and resilient revenue cycle workforce.
Read the rest of the blog series:
1. HFMA, While increasing revenue is a top goal for 2024, improving the patient experience is a close second – specially for large health systems, HFMA Poll
2. CAQH, 2022, Index Report, A Decade of Progress
3. Sage Growth Partners, The New Healthcare C-Suite Agenda: 2024-2025