An Overview on the Shift to Value-Based Care
What are some of the widely prevalent challenges you notice in the Revenue Cycle Management landscape?
The biggest challenges we face in revenue cycle management are the changing competitive landscapes. A large part of that is due to the ongoing changes with the private and public payment side. Hospitals are facing a considerable impact on their reimbursement due to the impacts of consumerism in health care such as operating margins, declining reimbursement rates and overall changes in the reimbursement models. In general, there is an uncertainty that’s developed around what will occur regarding the ACA (Affordable Care Act). As value-based care management models continue to change and evolve, the landscape for the revenue cycle will also change.
What are the current market trends you see shaping the Revenue Cycle Management landscape?
To efficiently run the hospital’s revenue cycle management process, we, as well many healthcare organizations turn to data analytics. Data has the potential to swiftly and accurately measure the performance. This helps the revenue cycle and organization to track our performance in real time. Data analytics helps to drive changes or counter the changes happening with the reimbursement model.
Could you shed some light on the approach that you follow while choosing the right solution provider?
I reach out to companies that are acclimated to our EMR system, as it is essential to select a vendor who has vast experience with our system. Having a company that has already created interfaces and relationships with other organizations on the same EMR is very important. A great relationship with the vendor it is important, but their understanding, background and knowledge of our system is what truly matters. We want to select a company that has experience working with the systems to ensure they can offer us the insight into what has and has not worked previously with other clients.
What are the strategic points that you go by to steer the company forward?
Traditionally, when we begin strategic planning, we all meet to review our mission, vision, metrics and initiatives to ensure success. We strategize to devise plans to manage our areas of focus. As healthcare moves into this value-based care environment, we are focusing on what produces the best outcomes and devising plans to tackle efficiencies in the process, including our reimbursement models. Our strategy is to evaluate, analyze, and execute all steps in the process. This includes our internal process and the reimbursement derived from our internal and external processes.
How would you see the evolution a few years from now with regard to disruptions and transformations within the arena?
I believe there’s a need to dedicate more of our focus on gathering the data elements and doing the basic groundwork to pull together the information, with the goal of ensuring that we’re collecting it in the most efficient way possible. Also, having data is important, but knowing how, when, and where to use it is just as crucial. Hence, data analytics is the component that we have to focus on to analyze what is happening on a daily basis.
What would be the single piece of advice that you could impart to your colleagues to excel in this space?
We will need a plan to facilitate a transition away from the fee for service reimbursement structures. There is a need to focus on assessments around the major levels of patient care, patient engagement and billing methods. Focusing on the key areas of patient care, engagement, and reimbursement will allow organizations to make the successful transition to the value-based care and effectively navigate the current financial landscape. This is why data analytics is necessary, as it allows organizations to measure the quality metrics and learn whether the organization is pulling in financial metrics to allow the RCM (Revenue Cycle Management) team to track progress and provide transparency into those capabilities.
In recent years, healthcare organizations have seen a shift in healthcare revenue resources and patient financial responsibility. Currently, there is an increased estimated out-of-pocket cost for patients, and it is steadily rising. As a result, leaders have to provide more visibility into the billing practices and processes. With the new pricing transparency rules that have been put into place, patients are able to search the market and decide what organizations can offer the best care at the most affordable cost. Organizations have to ensure that the overall process for patients receiving and paying for services are more personalized and consumer-centric than ever before.
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