The revenue cycle is ripe for digitalization and alignment with other core health system functions — and making the right changes can have a positive impact on the patient experience.
During Becker's 10th Annual CEO + CFO Roundtable, in a session sponsored by RCM, Will Reilly, senior vice president for marketing at R1, moderated a discussion with Todd Craghead, senior vice president for commercial relationships at R1, and Jon Sohn, senior vice president chief revenue officer of Ascension, about how an integrated revenue cycle can improve the patient experience and how automaton can revamp the revenue cycle for greater efficiency.
Four key insights were:
- Providers view revenue cycle partnerships as integral to their overall strategy. Good revenue cycle management is key to a positive patient financial experience and to operational efficiency. According to research conducted by R1, 80 percent of health systems indicated that revenue cycle partnerships — which extend from niche vendor relationships focused on a specific area to end-to-end collaborations — are important to them. Further, research from Bain and KLAS about provider investment areas for 2023 revealed that the revenue cycle is the number one priority. "Revenue cycle is the intersection of a lot that goes on in the organization," Mr. Sohn said.
- Alignment between the revenue cycle and the clinical cycle benefits the patient experience. Alignment can vastly improve the way patients experience transitions of care because it can remove onerous steps, such as patients being presented with a repetitive checklist of questions as they move across the medical office, lab, acute, post-acute and/or ambulatory settings. The revenue cycle can modernize that process by syncing all patient-related information across the clinical, operational, technological and financial areas.
Mr. Craghead recounted how a health system he previously worked at recognized that patient intake, which was designed from the provider's perspective, was not working well for users. To remedy that, the organization built a digital front door on the principle of "a three-legged stool whose legs were how patients find care, how they manage their care and how they pay for their care." That digital-first approach put more control over scheduling appointments and communicating with physicians in the hands of patients.
- For successful digital-first alignment, alignment between internal teams and specialist partners is paramount. Because front-office staff must still manage in-person and phone-based interactions, it is important that organizations figure out how to align legacy and digital-first processes without them interfering with each other. That may take the form of reconfiguring physical spaces by equipping clinics with digital kiosks and bringing reception staff out to interact or troubleshoot with patients as they are coming into the system.
Alignment is also necessary by way of streamlining and embedding financial clearance, such as insurance verification and prior authorization, throughout the revenue cycle. "It serves none of us well to not know the financial status of the patient on the back end," Mr. Sohn said. "We want to make sure we get that [sorted out] far up in the process or if the person has no coverage, we want to work with them to figure it out a way to get access."
- Automation can support revenue cycle alignment, but only if managed professionally. Robotic process automation (RPA) can be a solution to many of the inefficiencies that plague the revenue cycle, but health systems must avoid the temptation to simply layer RPA onto existing processes and staff members. "We see health systems that are managing a whole army of process automations as they're contemplating how to keep the patient experience frictionless, but you need folks that are focused specifically on [automation] issues," Mr. Craghead emphasized.