Revenue Cycle Innovation: You Don't Have To Go It Alone

White PaperRevenue cycle innovation:You don’t have to go it aloneHealthcare providers face a unique and growing set of challengesthat impact the health system as a whole and the revenuecycle in particular. These include decreasing reimbursements,increasing consolidations, managing the transition toward valuebased care, and, of course, surviving the COVID-19 crisis. Thereis also the need to provide a better patient experience and drivequality throughout the organization. How today’s health careorganizations face these existential challenges will go a long wayin determining their future.Innovate or stagnateInnovation, particularly in the revenue cycle, is key to remaining relevant in avery competitive marketplace. Eliminating administrative expenses will onlytake you so far. Growth is the top priority, and if you are not innovating, youwill not grow.The power of innovation to transform the revenue cycle is no secret tohealthcare executives. According to a recent report from the Center forConnected Medicine and KLAS, revenue cycle management was the areamost frequently cited by respondents as needing significant innovation anddisruption.1 The question is, how do you get there from here? Because manyprovider organizations struggle to find enough dollars and enough talent toinvest in impactful innovation, it’s difficult to grab the golden ring withoutgoing around the carousel again and again.optum360.comAccording to a recentreport from the Centerfor Connected Medicineand KLAS, revenuecycle managementwas the area mostfrequently cited byrespondents as needingsignificant innovationand disruption.1

Revenue cycle innovation: You don’t have to go it aloneWhite PaperBarriers to innovationWhile it’s clear that innovation is fundamental to revenue cycle success, mostorganizations face considerable barriers. Healthcare providers that adopt a“go-it-alone” innovation strategy face numerous and often insurmountablechallenges.First, innovation can be costly, and in today’s uncertain and extremelydemanding healthcare environment, it’s hard to find extra budget dollars.Next, there is the matter of expertise. Innovation takes technical knowhow, analytical thinking, and specialized experience. Most revenue cyclemanagement professionals are, by necessity, focused on critical day-to-dayactivities and are not experts in innovation. Finally, there is a matter ofperspective. Delivering integrated solutions that align across the entire revenuecycle requires a broad understanding of the operational landscape.To thrive moving forward, providers need to be more open to the newerstrategic partnership model versus traditional outsourcing. In this model,the strategic partner manages all or a sizable portion of the revenue cyclecontinuum, reducing costs, sharing risk, and promoting bold innovation. Witha modern strategic services partnership, you can drive innovation aroundtechnology, workforce management, and more efficient processes whilecutting costs. A strategic partnership has a much broader value profile thantraditional outsourcing.Comparing ModelsTraditional outsourcing Commodity-oriented contractingNot focused on innovationSupport for limited revenue cycle functionsLess sophisticated technology and sometimes capital expenditure requiredStrategic partnership Contract based on trust and co-created visionFormal pathway to innovation and co-ideationExpertise across revenue cycle continuumAdvanced proprietary technology delivered with little or no capital expenditureUnlike traditional outsourcing models, a revenue cyclestrategic partnership offers an enterprise-wide strategydesigned to meet today’s health system challenges.optum360.comPage 2

Revenue cycle innovation: You don’t have to go it aloneWhite PaperStrategic partnership: A better approachA revenue cycle strategic partnership offers a creative new pathway that canaccelerate innovation and reduce risk. Here are some key reasons to considerengaging a proven and committed strategic innovation partner.Economies of ScaleA single investment from a strategic partnership positively impactsthe multiple organizations and facilities that it services. This globalapproach produces economies of scale that prove more cost-effectivethan developing one-up innovations in-house or managing multiplepartners.Specialized ExpertiseTo successfully innovate, you must keep abreast of the latest industrydevelopments. This can be particularly daunting when it comesto technology and changing healthcare regulations — areas thatrequire constant attention. An outside firm can commit resources andspecialized expertise to stay on top of the latest updates. Additionally,experience across multiple markets and facility types is a hugeadvantage when determining the best processes and technologies.No Capital InvestmentYou can benefit from the latest technologies and ongoingenhancements without having to invest precious capital. Advancedtechnologies such as artificial intelligence, advanced analytics and thelatest applications can be delivered as part of a partner’s proprietarytechnology arsenal — if your partner has those capabilities — at noextra cost to you.Speed to transformationIf you try to innovate internally, chances are you will not be ableto transform quickly. With the full weight of your strategic servicepartner’s sizable resource base, and the chance to benefit immediatelyfrom its existing technologies and best practices, you can react quicklyto changing market conditions.Shared riskA vendor that sells you technology has no skin in the game. Thevendor gets paid no matter what the outcome. A strategic partnershares the performance risk with you and is incentivized to deliver onlytechnologies and processes that add value to your organization.Furthermore, by cutting costs and innovating via a strategic partnership, you willhave more funds to apply to non-revenue-cycle innovation areas.optum360.comPage 3

Revenue cycle innovation: You don’t have to go it aloneWhite PaperHealthcare executivescited artificial intelligence,predictive analytics, chatbotsand automation as thetechnology solutions mostneeded to improve revenuecycle management.1Expect moreWhat should you expect in the way of innovation if you team with the rightstrategic partner? At a minimum, this partner should provide transformativeimprovements in two vital areas: technology and process management. If donecorrectly, this can dramatically improve patient satisfaction, increase efficiencyand drive positive financial results across the entire health system.Technology innovationLet’s start with technology. It begins at the front end of the revenue cycle.Consumerism and today’s digitally empowered patients have dramaticallyincreased patient expectations. While the quality of care may be the mostcritical element in the patient experience, non-clinical activity is not farbehind. Scheduling, registration, automated reminders and other areas such asmanaging eligibility, referrals, prior authorization and cost estimates are alsovital parts of the patient experience. Your strategic partner should be able towork with you to offer the latest solutions in these areas, including the use ofmobile devices and outreach by text, email, and phone.According to the study by the Center for Connected Medicine and KLAS,healthcare executives cited artificial intelligence, predictive analytics, chatbotsand automation as the technology solutions most needed, to improve revenuecycle management.1 The need for advanced technology is clearly evident in themiddle revenue cycle.“I consider my strategicpartner as part ofmy team. It’s likehaving another C-levelexecutive at the table.”— Shelly Schorer, CFONorthern California DivisionCommonSpirit HealthThe most complex area to automate with the highest reward, the middlerevenue cycle is where clinical and financial data merge, and the work donehere is key to accurate billing, reduced denials, better cash flow, and, in turn,improved patient satisfaction. Look for a partner with clinically intelligent AIbased solutions, including natural language processing and machine learning,for applications supporting computer-assisted coding, clinical documentationimprovement, clinical validation review and medical necessity determination.Clinically intelligent AI can quickly gather deep insights from large clinical datasets to help make middle revenue cycle processes and decisions more effective.There are also opportunities to apply technologies such as machine learning,advanced analytics and robotic process automation across the rest of therevenue cycle, especially at the back end.optum360.comPage 4

White PaperRevenue cycle innovation: You don’t have to go it aloneProcess innovationTechnology alone can only provide persistent innovation if revenue cycle processesare oriented toward innovation and seek opportunities to deploy technology toaddress critical business problems. Your partner should have a proven processmanagement methodology that strategically aligns purpose, people, performance,and technology while fostering continuous innovation. By leveraging industrystandard best practices such as Lean principles and experience drawn from multipleimplementations nationwide, your strategic partner can drive standardization,streamline processes, and improve efficiencies across your organization.Look for the following:Innovation-oriented methodology. Your partner should have a process to monitorand detect key problem areas in the revenue cycle, understand the root cause ofthe problem, and resolve the issue through process change, staff education, or theaddition of technology.Standardization. It is essential to standardize processes across all facilities so thatprocess improvement gains can be uniformly implemented throughout the healthsystem. This requires consistency in maintaining and updating the process librarywhen problems are resolved or innovations take place.Collaboration. Developing collaborative processes and innovative solutions iskey to redefining the historically adversarial relationship between payers andproviders. Your partner should focus on working with payers to develop creativestrategies and technologies that reduce friction, decrease denials, and create abetter financial experience for the patient.Registration robots to the rescueThe pandemic upended the registration process at CommonSpirit Health.Like most healthcare providers nationwide, patientfacing staff were at risk for COVID-19 exposure. Asa result, leaves of absence and sick leave left a 30percent vacancy in patient-access positions. Lessstaffing means longer patient wait times and can leadto increased patient dissatisfaction.Strategic partner Optum, working closely withCommonSpirit, crafted a solution worthy of thespace-age Jetsons. Leveraging state-of-the-art robotictechnology and Optum’s remote patient contact center,registrars can now safely communicate with patientswithout risk of infection.optum360.comHere’s how it works:Telepresence robots facilitate secure audio and visualcommunications with patients. Trained registrars atthe centralized contact center engage with patientsto efficiently complete the registration. Because of itsmobility, the telepresence robot can greet patients inthe lobby to begin registration and literally walk themdown the hall to the correct location for services.The innovative solution also holds great promise postpandemic. It can be applied to reduce wait times inhigh-volume areas during peak periods and supplementstaffing to provide better service in off-hours.Page 5