Revenue Cycle Management In Healthcare: Analytic Driven Insights And .

Success StoryRevenue Cycle Management in Healthcare:Analytic Driven Insights and EfficienciesHEALTHCARE ORGANIZATIONAccountable CareOrganizationTOP RESULTSIncreased ability to identifyfinancial managementimprovement opportunitiesUp to 99% improvement intime to access data97% reduction in staff timeto identify root causesPRODUCTSLate-Binding DataWarehouse Revenue Cycle ExplorerSERVICESInstallation ServicesTo run efficiently and use the money they earn to improve the healthof a community, healthcare institutions must manage their revenuecycle well. The Healthcare Financial Management Associationdefines revenue cycle in healthcare as all administrative and clinicalfunctions that contribute to the capture, management, and collectionof patient service revenue.1 When such functions are managedpoorly, organizations may struggle to keep up in an industry wheremargins are shrinking and efficiency is key. At worst, they can findthemselves in the position of not having the cash on hand to operate.Crystal Run Healthcare, one of the fastest growing multi-specialtygroup practices in the country, and a physician-led accountable careorganization (ACO) was one of the first ACOs to participate in theMedicare Shared Savings Program (MSSP).2 As an organization,they are committed to ensuring that the dollars they earn serve theirpatient population and are not wasted on inefficient processes. Thisexpanding ACO—currently composed of 325 providers in morethan 20 locations with 25,000 commercial lives at risk and 10,400attributed beneficiaries—had already adopted a successful strategyusing clinical analytics for managing population health. Its leadersdetermined that it also needed to apply its analytics strategy toimproving revenue cycle management.Copyright 2016 Health Catalyst1

Becoming a data-drivenorganization is anevolution, not a singleevent. We started outusing analytics to driveimprovement in certainclinical and operationalareas. Now we’re tacklingrevenue cycle. We aremoving toward access todata in multiple analyticsapplications that help usas an organization makefaster, more data-drivendecisions.Lou CervoneDirector of Business IntelligenceBI is evolving. We have onlyscratched the surface ofwhat is possible with thegrowing flood of data andthese new technologies formaking sense of that data.We will be gaining utilityand sophistication as weget more experience withthe advanced analyticsapplications.Lou CervoneDirector of Business IntelligenceCopyright 2016 Health CatalystSpecifically, Crystal Run sought to optimally manage the timeto payment on account, measured as accounts receivable (A/R)days. The organization also aimed to eliminate operational wasteresulting from inefficient and ineffective processes for gatheringand using data.THE CHALLENGE: DATA-DRIVEN REVENUE CYCLEMANAGEMENT IN HEALTHCARETo achieve its growth and population management goals, CrystalRun needed the ability to provide data to clinical and operationalpersonnel to support informed decision-making. The organizationhad already implemented a late-binding enterprise data warehouse(EDW) from Health Catalyst. The organization’s leaders’ strongcommitment to using analytics to inform critical decisions hasnurtured a culture of data-driven improvement throughout theACO. With the EDW, clinical and operational decision-makers haveaccess to data from a single source of truth integrated from severaldisparate systems across the enterprise. They use self-serviceanalytics applications running on the EDW platform to support timelyand informed decision-making.While the EDW platform supported Crystal Run’s efforts inpopulation health management and risk-based contracting, theorganization had not yet deployed revenue cycle managementanalytics on the platform. Instead, the organization relied oncobbling together reports from multiple, unrelated data sourcesto obtain revenue cycle information. Leaders had to requestcustom reports from the business intelligence (BI) departmentwhen investigating the source of variation in key financial metrics,such as A/R days, collection rates, charges, and payments. Newcustom reports would take five days to develop on average, andeven existing reports required four days for the BI team to populatethem with updated information. These inefficient processes made itdifficult to make quick, well-informed decisions related to revenuecycle management.In a data-driven environment, Crystal Run needed a solution thatwould provide quick access to A/R and other key financial metrics.In addition, to address any problems proactively, the organizationalso needed more in-depth, physician-specific metrics and access totrends on demand.2

SOLUTION: ADVANCED, SELF-SERVICE REVENUE CYCLEANALYTICSCrystal Run implemented Revenue Cycle Explorer, an advancedanalytics application that runs on the EDW platform. This applicationprovides increased data validity, access, and utility for financialinformation related to charges, payments, days in A/R, financialclass, and collections.The application delivers self-service analytics to finance andoperations personnel so they don’t have to rely on BI for reports.Users are able to access the data quickly and have the ability todrill down to view data by provider. This in-depth insight provides abetter context for decision-making and helps identify opportunitiesfor improvement. The enhanced analysis available through RevenueCycle Explorer also includes trending and analytics visualizations sothat users can quickly interpret the data.FIGURE 1: SAMPLE ACCOUNTRECEIVABLES MANAGEMENTVISUALIZATION11A/R comparative data(current month, 3 monthaverage, prior year)2Total trended A/R days3A/R metric details byprovider4Filters that enabledrill-down analyticscapabilities (e.g.,location, financial class,payer, provider, etc.)5Detailed A/R agingbreakdown by days andaccount balance4235Figure 1: Sample account receivables management visualizationRESULTSThe implementation of a Revenue Cycle Explorer analyticsapplication represents another step in Crystal Run’s evolution to adata-driven culture. Though still in its early stages, the results of thisstep are already significant:Increased ability to identify financial management improvementopportunitiesWith the new analytics application, Crystal Run is able to quicklyidentify opportunities for improvement in policies, reporting, andCopyright 2016 Health Catalyst3

Revenue Cycle Explorerenables us to dig into theroot cause of any problemsourselves without havingto request a custom reportfrom BI. For example, wewere looking at accountsreceivable by payer andfound some variance. As wedug deeper into the data,we discovered that thevariance didn’t come fromthe payers. It stemmedinstead from the fact thatsome providers who hadjust joined our organizationwere in the midst of gettingthe necessary credentialingfor CMS billing. With thehelp of the application,we were able to identifythe billings being delayed,obtain an estimate of thetime that it would take forthe billing and subsequentrevenue to be realized, andaccount for this variance inour financial report out tothe executive team.Ilene RodriguezDirector of Patient Accountingand Revenue Cycleworkflow both on the executive level and in the trenches. The analyticsinform the executive team at their weekly financial meetings. Andthe revenue cycle team has immediate access to data and trendinganalyses—making it easier to identify variances in the data and toinvestigate root cause before taking action to correct problems.The ability to identify weak points in its revenue cycle processes hasprompted Crystal Run to come up with new solutions for processimprovement. One such solution resulted from an identified problemwith self-pay collections. The organization designed a new processthat introduces electronic tablets into physician offices. Using thetablets, patients can quickly view their co-pay and any open charges.They can then make a payment or set up a budget plan basedon their needs. Crystal Run expects this new process to have animmediate impact on A/R days for self-pay accounts and to help theorganization achieve its goal of no more than 5 percent of self-payA/Rs beyond 90 days.Up to 99% improvement in time to access dataFinance department personnel can now look at charges per monthper provider on demand, a process that takes approximately fourminutes. Finance used to have to wait four days to get this informationin report format from BI. Furthermore, in the past, when reports cameback from BI, finance did not have the ability to drill down to look foradditional information—which frequently created the need for anotherreport request and another delay. The new analytics application haseliminated that issue. In fact, for the most recent Joint Commissionaccreditation visit, the data was so readily available, there was noneed to ask BI for any reports. The team estimates that the applicationprovides in a single visualization what would have required a minimumof 20 reports from BI in the past. As for BI, the application is savingthat department a lot of time as well. In the past, some reports wouldtake five hours or more to build, and up to five days to deliver. Now, BIcan pull the data they need from the EDW in five minutes or less.97% reduction in staff time to identify root causesThe revenue cycle team is now able to investigate variances,unusual increases in A/R days, or other performance metrics withoutrequesting reports from BI. Whereas researching an issue used totake the team eight or nine hours, they can now perform this analysisin 15 minutes. This represents a 97% reduction in the time required toresearch variances and identify root cause. Since the team researchesapproximately a dozen such issues per month, the cumulative timesavings is significant. This time savings creates capacity to performdeeper analysis and further improve the outcomes of the department.Copyright 2016 Health Catalyst4