How is the Revenue Cycle in Healthcare Changing?
Lyman Sornberger
President and CEO, LGS Health Care and Chief Strategy Officer, Capio Partners, Cleveland, OH
As revenue cycle management (RCM) in healthcare has morphed over the last several years, RCM systems have focused on optimizing federal, state and commercial claim processing. In particular, the onset of consumerism in healthcare has required the industry to be more “patient centric” and has forced industry leaders to revisit the patient financial experience. In theory, the development of the patient experience is modeled from a clinical perspective. In the last few years, providers have recognized that it extends far beyond patient care into the challenging world of finance. I am a firm believer that an institution offering the best clinical care can botch total patient satisfaction with a negative financial billing experience.
This article reviews the patient care journey, from pre-care through treatment, including coordination of care, financial challenges and, ultimately, patient satisfaction. The healthcare industry historically looked at this process—from scheduling to final resolution of the patient’s bill—as very linear. Those days ended with the advent of consumerism, new tools, and the patients’ increasing desire for a customized process. The old-school way of designing processes in a vacuum and believing that we, as healthcare leaders, know what is best for the patient is gone. The decision-making process directly parallels patient satisfaction. The challenge now is that while the patient would prefer a simplified administrative process, providing the flexibility that helps in decision making is not always congruent with their understanding and expectations. This article is designed to help readers think outside of the traditional healthcare process and see it from the patient’s perspective.
Within the past few years, have you gotten the sense that someone said, “Self pay is going away?” Growing consumer financial responsibility has led to the expected billing and collections challenges that were weak points of most legacy RCM systems and processes. However, what providers didn’t consider was how much more information a patient with greater financial responsibility would come to expect.
Traditional models for accessing and sharing health insurance and financial and clinical information, and the siloed systems that support these models, are insufficient for providing the price transparency and real-time information patients now demand. As patients assume larger amounts of direct financial responsibility for their healthcare, they begin to view the process as more of a retail experience. As such, they may expect a typical Visa, American Express, MasterCard and/or banking transaction to work for their healthcare experience. More patients are also researching their options before deciding where to go for care. They expect to be able to use their day-to-day tools—computer, phone, etc.—to determine the level of care available to them through their health plan’s provider network, or to quickly access pricing and patient satisfaction information. They want the ability to compare providers in the same way they might compare products when shopping online. In addition, they expect their financial responsibilities to appear in one single bill or statement, just as they receive one consolidated bill for buying a home or a vehicle—even though multiple parties may have participated in producing the final product.
Healthcare leaders have acknowledged the need for health plans and providers to share clinical and financial data with patients in a more coordinated fashion, to both promote consumerism and enhance the patient experience. Hence, we find ourselves in the new healthcare millennium that recognizes the link between clinical and financial systems to improve RCM and the patient financial experience.
Numerous examples of providers working to improve the patient financial experience are emerging across the industry. Up to this point, however, the healthcare sector has only dabbled in each segment of coordination and communication. We are guilty of picking and choosing our battles rather than accepting that the process will force us to take a more holistic approach. New reimbursement models are here to stay. How they are affected by the shift from the traditional model to payment reform is yet to be determined. We as healthcare leaders cannot have blinders on—those of us who lived through capitation, ACOs, big data/fast data, and Obamacare realize that the only constant about healthcare is change. With that said, many of us have made a career out of that, and in some sick way enjoy it.
Want to continue reading, Click Here!