Why IT must play a role in rev cycle management evolution

Provider organizations need to innovate to make necessary progress that keeps pace with changing reimbursement mechanisms.

For healthcare organizations to succeed and position themselves for the rapidly evolving healthcare environment, they must address three critical imperatives: innovation, investment and integration.

Successfully addressing these imperatives will demand a revenue cycle that is fundamentally different from the ones that organizations have in place today, and it will require increased use of information technology to make the transition.

Results achieved within the revenue cycle operations group are inherently constrained by their alignment and integration with other “upstream” drivers.

Technology is an obvious enabler for this broad-based perspective, and prioritizing a technology strategy is a key way to execute on the three critical imperatives mentioned above. Ensuring that the right technology platform is in place can result in seamless integration of process, drive enhanced performance analytics, and ultimately enable an integrated view of drivers of revenue performance.

To maximize enterprise results, healthcare providers will need to better use information systems to establish an integrated view of the organization’s entire revenue ecosystem and assess the organization’s alignment across all drivers. Responding to these drivers will require successful organizations to have robust information systems in place.
  • Strategic drivers. While revenue cycle performance has not traditionally been directly tied to strategic indicators, it is, at the highest level, the result of strategic decisions made by the organization, both intentionally and unintentionally. By understanding and addressing strategic drivers, a more enduring solution can be developed and implemented to drive revenue cycle improvement.
  • Payer contracting drivers. Payer contracting can have an enormous effect on top-line revenue potential. For example, responding to regulatory requirements can negatively affect commercial payer performance if contracts are not realigned.
  • Clinical operations drivers. Many organizations regularly assess their clinical operations as an area of potential cost savings, but they also have material revenue growth potential. Providers should consistently and systemically evaluate the effectiveness of the clinical operation to identify opportunities to increase revenue generation from existing clinical assets, rather than solely looking to reduce expenses for clinical operations, during the annual budget process.
  • Revenue cycle drivers. It is essential that the revenue cycle operate as more of a value-add business enterprise and intelligence agent. It should drive and enable ing: hybrid reimbursement model operations; process redesign supporting new clinical models; technology integration across all domains; and business intelligence guiding real-time decision support via feedback loops.

The increasingly critical interconnectedness of strategic, contracting, clinical and revenue cycle agendas requires these areas work in harmony with one another, enabling continual improvement and alignment between theoretical objectives and actual performance. Thus, information systems will grow in importance in helping organizations react to these drivers.

The revenue cycle has always played a critical role in a health system’s financial health, but as providers prepare for the changes that lie ahead with value-based care and more, adopting this new, broader orientation around the entire revenue ecosystem is an essential step.

Note: Todd M. Bankhead, Principal and Catharine Wilder, Revenue Cycle Practice Manager also contributed to this article.

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