Extended Business Office Services 2024
How Are Provider Organizations & Firms Responding to New Market Pressures?

Performance Insights

A note about component firms: GetixHealth, R1 RCM, State Collection Service, and TruBridge are designated “Component” for varying reasons. See the About This Report section for more information.

PwC Excels in Performance Visibility & Relationships; AGS Health Improves Client Partnerships

For firms that serve organizations of all sizes, high client satisfaction is driven by partnership, consistent knowledge and abilities across staff, and positive outcomes. With their broad revenue cycle consulting portfolio, PwC leads in overall performance, and interviewed clients feel the firm maintains strong relationships, responds quickly, and accommodates their needs. Respondents also value PwC’s analytical tools, which increase visibility into PwC’s performance. While a few respondents would like the firm to be more hands-on and engage more proactively in identifying and addressing performance gaps, all would purchase the services again. Client satisfaction with AGS Health has significantly improved over the last year, partly due to resolved turnover issues. Likewise, respondents report greater transparency from AGS leaders that has led to a strengthened partnership, and many also appreciate their account managers’ responsiveness and proactive problem-solving. Respondents also report general satisfaction with offshore resources. Dissatisfied respondents want AGS to improve their strategic engagement by offering best practices and handling complexity in billing/collections. Guidehouse respondents appreciate the firm’s strong revenue cycle expertise, attentiveness, and collaboration in addressing problems. Most feel the firm drives strong value through their work on cash collections and A/R management. One client experienced misses due to insufficiently trained frontline staff. Acclara (formerly Tegria) was recently acquired by R1. Their most satisfied respondents, especially those at larger organizations, highlight the firm’s involved executive team and willingness to listen to and accommodate client needs, such as returning accounts to the client or assisting with additional projects. Small interviewed clients feel Acclara struggles training staff to have necessary expertise and the ability to work accounts with sufficient speed and quality. Firstsource’s client experience is inconsistent. Some would like the firm to be more collaborative in teaching clients how to improve the revenue cycle. Respondents also mention additional work caused by staff mistakes, poor handoffs, and inflexibility regarding client needs. While some are satisfied overall and note an improved attention to quality, respondents generally wish the firm were more proactive and did more to meet their engagement expectations.

For Smaller Organizations, R1 RCM’s Partnership Drives Meaningful Outcomes; TruBridge & Savista* Fall Short Due to Inconsistency

For R1 RCM validations, all but one come from small organizations (<200 beds), and all are Oracle Health customers. R1 is transparent and collaborative in guiding responding organizations to improve their revenue cycle operations, and respondents highlight R1’s partnership in optimizing processes and achieving prioritized outcomes, such as improved A/R and cash on hand. While some report challenges with undertrained offshore staff that affected the firm’s execution, all would buy the services again. TruBridge respondents—all small organizations—report challenges with the firm’s staff, saying frontline workers don’t have the necessary training and expertise to proactively identify problems, find solutions, and improve the overall revenue cycle. Respondents report the firm has struggled to hire and retain staff, resulting in some offshore work that has introduced high variability into the client experience. The lowest-scoring respondents feel TruBridge struggles with transparency and producing accurate reports and cash postings, resulting in clients having to do additional audits to ensure information is correct. That said, respondents often speak highly of the firm’s account managers and higher-up leaders and point to strengths such as the firm’s responsiveness and partnership. Four interviewed Savista* clients with 1–500 beds say their experience has been heavily influenced by staff and management turnover, noting disruptions to cash collection efforts and the level of expertise of those working accounts. Two very dissatisfied clients say Savista has struggled to execute in meeting deadlines and other expectations. That said, challenges appear to arise mainly from frontline staff, and most respondents agree that the firm has good managers and leaders.

*Limited data
Note: See the Firm Insights section for more details on the satisfaction difference between small and large clients.

Market Dynamics

Nearly One-Third of Organizations Plan to Expand Outsourcing within Their Revenue Cycle

Data shows that the strength of a firm’s partnership drives an organization to broaden their plans with the same firm. Respondents who plan to decrease their scope are typically less satisfied with their firm’s partnership. Firms need to focus on actively partnering with clients to help them achieve their organizational goals.

Offshoring Generally Perceived Negatively, but Most with First-Hand Experience Report Benefits

“Sometimes there is a perception that we get with the offshore people who have PhDs and medical MDs, but we all deal with the same things every day, including people calling in sick, turnover, inflationary pressures, holidays, and funerals. In many ways, our offshore people are really no different. In fact, managing the work can take more work. We have to be very explicit, almost like we are with coding or preparing automation. There are different cultures and perceptions. It is hard to describe the amount of management and oversight that is involved and required. That is probably what catches a lot of companies off guard.” —VP (GeBBS Healthcare Solutions client)

Note: KLAS began asking about sentiments toward offshore resources in May 2023. Thus, the sample size is smaller than elsewhere in the report. KLAS will continue to monitor and report on the adoption and perception of offshore resources with EBOS firms.

About This Report

Each year, KLAS interviews thousands of healthcare professionals about the IT solutions and services their organizations use. For this report, interviews were conducted over the last 18 months using KLAS’ standard quantitative evaluation for healthcare services, which is composed of 9 numeric ratings questions and 3 yes/no questions, all weighted equally. Combined, the ratings for these questions make up the overall performance score, which is measured on a 100-point scale. The questions are organized into five client experience pillars—loyalty, operations, relationship, services, and value.