What are the odds of patients recommending your services if they went out of your facility smiling and contented? Maximum, one would say. On a flipside, what if a patient goes out of network midway through their care journey? It not only means one patient lost but in fact, a setback to the organization’s strategies to improve the potential pool of patients─ either through positive word-of-mouth or through outcome-focused marketing.
Evaluating care quality and patient satisfaction to close revenue gaps
Imparting care the way patients desire begins with oiling the wheels of provider-centric innovations. More often than not, providers have specific needs which require crisp strategies─ telehealth support, outreach management, automated triaging of patients─ so on and so forth. Any ambiguity in the manner in which leadership reacts to their concerns often act as the first hurdle towards streamlined revenues.
Additionally, closing revenue gaps require a tangible business model, and therefore innovative tools aimed at simplifying Revenue Cycle Management (RCM), claims adjustment, risk-analysis, et al. are becoming an integral part of healthcare organizations around the world. According to BCC research, such business intelligence tools will have a global market of about $15 billion by 2022. Financial analytics is rapidly emerging as the numero uno area for investments and innovations. Today, healthcare leaders are not only understanding its importance but also aligning their clinical practices with data-driven wisdom to optimize reimbursements.
The bottom line for ensuring organizations’ solvency: Understanding where you stand
We surely cannot imagine a hospital imparting world-class care with its operational costs running in access of reimbursements generated. But ensuring financial stability takes more than instinctive decisions or even a couple of bold choices. There is a need for gauging factors that make the biggest pie of operational costs, and then evaluating the possibility of cost-cutting.
For instance, staffing is by far the single most significant cost for an organization, but that doesn’t mean the organization can do without it. However, both under- and over-staffing can result in lower revenues. Reducing staff just for the sake of it can have a very adverse effect on the overall operations─ in the context of staffing, it is critical to understand the difference between cutting some fat here and there and losing vital meat altogether.
As the famous saying goes, we cannot improve something that we cannot measure. Therefore, almost all healthcare organizations require a comprehensive data platform to mine disparate and gigantic data files, generate enough actionable information, and trigger the right action at the right time. Presence of a centralized data repository also saves providers from the trouble of dealing with data for a major part of their day, and allow them to spend their time in engaging their patients in conversations regarding their health.
While data integration is paramount, organizations need data liquidity too
Integrating the entire patient data coming from multiple sources essentially means facilitating a more dynamic approach to care delivery. On a financial front, it equals to optimized utilization and therefore, lesser unnecessary interventions. And not only clinical or lab data, but it’s time healthcare organizations also take payer data more seriously to eliminate the chances of unjustified denials or under-reimbursements.
But unless the captured data is available at the point of care, it cannot power clinical applications. With data liquidity, providers can get rid of a major chunk of their administrative tasks, while patients too can excuse themselves from the exercise of filling the same details and telling the same story every time they visit a provider. Further, ensuring data liquidity increases physician-patient collaboration, along with making each stakeholder more accountable and well versed about patients’ health.
The need for clearly defining cost and margins associated with each procedure
Once an organization clearly defines their care delivery blueprint, they need to figure out the tentative budget that they want to allocate to each process. This has to be done beforehand so as to build on their estimates and come up with an exact figure for each task to reduce wastage or excessive utilization.
However, setting targets without benchmarking or reviewing contracts without running analytics on available data can significantly impact the financial sustainability of an organization. Further, there is also a need to comprehend underlying micro-trends such as the efficacy of referral procedures or ED visits per patient population to channelize improvement efforts in the right direction.
Cost analysis can be done in a systematic manner starting from:
- Performing detailed analysis to surface true costs associated with different processes.
- Based on those insights, calculating the cost per service, cost per patient, and different procedure variances prevalent across different facilities.
- Once such metrics are calculated, organizations can perform a detailed cost analysis to understand resource utilization.
- Finally, clubbing medical and cost-analysis judiciousness to identify the best way to impart care.
Accurate cost analysis equals accurate operational analysis
More often than not, patients are not confined to a single department of a care facility and traverse across multiple touch-points of care. However, organizations with a higher case-mix index can frequently see under- and over-utilized staff and services at any given point.
In such cases, cost and margin analysis should be followed by operational analysis to identify underutilized and over-utilized services. This can double up to creating strategies to reduce unnecessary expenditure and making each process much more rationalized and cost-effective.
Learning the nuances of Revenue Cycle Management (RCM)
Revenue Cycle process, simply put, is the financial process of unifying the clinical and business side of healthcare. For a sector as dynamic as healthcare, top management should have the most accurate information about charges, payments, days in A/R, financial class, and collections to drive transformation.
Streamlining RCM requires a holistic, data-driven approach. Further, such a solution should adopt a framework for continuous cycle improvements to enable robust financial management. This could be done by monitoring trends over time and generating relevant data that can further generate actionable information through intelligent iteration processes.
Ideally, an RCM solution should have the following attributes:
- Ability to provide in-depth insights into financial and clinical operations.
- Illustrative graphs and charts to easily comprehend and monitor financial trends over a long period.
- Allowing revenue cycle and financial teams to view and investigate key and varying metrics on demand, thus saving a substantial amount of time.
- Empowering management to drive changes across the continuum and redefine the way they deal with their finances.
The road ahead
It’s not difficult to imagine how smoothly a system can work if there are no redundant processes and information gaps. If a specialist knows as much about the patient as the PCP, and if a pharmacist and nurse are on the same page regarding the best medicinal practices for a patient based on their vitals, disparities in the care delivery process will take a backseat. And such a system is in the best interest of both organizations and patients. In healthcare, inaction is a form of deliberate action and how organizations utilize their data will shape our healthcare system in the years to come.
To learn more about how a unified data platform can help you in improving your care outcomes and reimbursements, get a demo.
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Join Team Innovaccer at booth #11 at NAACOS Fall 2018 Conference in Washington D.C. on 3 -5 October, and learn how you can power your data-driven initiatives with Innovaccer’s unified healthcare data platform.