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Revenue Cycle Outsourcing 2021
Choosing A Strategic Partner

author - Boyd Stewart
Boyd Stewart
author - Alex McIntosh
Alex McIntosh
May 13, 2021 | Read Time: 6  minutes

Entrusting your organization’s financial health to a revenue cycle outsourcing (RCO) firm can feel like giving up the keys to the kingdom. However, these firms can offer economies of scale, industry expertise, and financial outcomes that are difficult to duplicate in-house. To determine which firms are the most trusted RCO partners, this report explores market energy data from 15 recent RCO contracts (a majority of the decisions made in the last two years) as well as satisfaction feedback from current clients.


Ensemble Excels in Delivering Tangible Outcomes to Midsized Organizations; R1 Clients Optimistic for the Future

overall score, tangible outcomes, and median bed size

Ensemble Health Partners’ clients tend to be smaller (in terms of total beds) and highly satisfied—100% interviewed would choose the firm again and nearly all say the firm consistently exceeds their expectations; some specifically say they feel Ensemble collects faster and better than competitors. Clients note that Ensemble has stayed proactive, responsive, and client focused despite recent growth. Because of this, clients view the firm as a partner in their success. In general, R1 clients, who tend to be larger, are optimistic about the firm’s direction and use of technology to drive results but note the need for more improvement and greater speed in achieving outcomes. More-satisfied clients report tight partnerships that get results. Nearly half of interviewed clients do not feel the firm has exceeded expectations, pointing to unmet revenue and collection targets (particularly for A/R) and to the firm focusing too heavily on high-dollar accounts. Clients of Guidehouse (formerly Navigant) tend to be smaller. Clients feel the firm does well at meeting expectations. Nearly half feel Guidehouse does not exceed their expectations—these clients would like more innovation and strategic involvement in identifying areas of revenue opportunity.

nThrive No Longer Seen as Trusted Partner for RCO

overall satisfaction

A majority of nThrive’s interviewed clients have lost faith in the firm—more than 80% are dissatisfied and the firm receives an overall performance score of 61.3 (out of 100.0). Existing challenges have only been exacerbated by the recent separation of nThrive’s technology and services divisions. Clients say nThrive is disorganized in getting claims out the door, and some report having to babysit nThrive for even basic tasks, like adding modifiers to claims to ensure successful processing. Additionally, missed collection expectations and unexpected costs for the underlying technology have significantly reduced client perceptions of value. Respondents have not been encouraged by nThrive’s response to concerns—several say nThrive doesn’t listen well when issues are escalated, and one stated that nThrive has “lost sight of what true customer service is” (business office VP). Client dissatisfaction is not limited to RCO—nThrive significantly trails competitors in all services segments in which the firm is rated by KLAS.

A Note about Optum: Optum’s RCO contracts were often part of larger organizational decisions that also involved technology and services outside of RCO. While KLAS contacted a few Optum RCO clients for this research, these clients felt it was either too early to rate the firm or not possible to rate Optum’s RCO performance separately from the broader Optum experience. Optum is therefore excluded from the client experience section of this report.

emr vendors in use by interviewed clients

Conifer Health Solutions’ Ongoing Execution Misses & R1’s Early Implementation Missteps Have Reduced Client Perceptions of Value

43% of interviewed Conifer Health Solutions clients report overall dissatisfaction. Dissatisfied clients often cite poor execution—several say the firm does not actively work all accounts, leading to less-than-desirable collections results and lower perceptions of value. Several respondents are frustrated that despite requests for more communication, Conifer does not proactively reach out about problems or roadblocks. Additionally, Conifer is not generally seen as innovative, and this has tempered enthusiasm for the firm among even the most satisfied clients. Though R1 currently scores similarly to Conifer for both money’s worth and engagement execution, the tone among R1’s client base is much more optimistic. Several clients that rate R1 low for execution experienced initial challenges with the implementation and go-live but say the firm is now performing well and meeting expectations. These clients haven’t quite forgotten their early frustration but believe the experience with R1 will continue to improve.

engagement execustion and money's worth

Ensemble Health Partners & R1 Clients Most Likely to Buy Again, Due in Part to High Strategic Ability

Clients of Ensemble Health Partners are impressed with the firm’s willingness and ability to proactively help clients improve internal workflows and processes so that money is not left on the table. Clients say the firm generates actionable insights to help them avoid costly mistakes and comes prepared with solutions. A CFO described Ensemble’s ability to help clients navigate “a complex, changing environment” as “invaluable”; this sentiment is shared by many other interviewed clients. R1 clients appreciate the firm’s wide range of revenue cycle services that can be scaled up or down depending on volume. Clients say R1 has strong leadership and is backed by an innovative technology platform and processes that help them meet clients’ needs and expectations. This combination of offerings, technology, and personal touch has led nearly all interviewed clients to report confidence in R1 as a trusted revenue cycle partner.

strategic ability and likelihood to buy again


What Motivates Organizations to Outsource Revenue Cycle Management?

Economies of scale are one of the most commonly reported reasons healthcare organizations engage an RCO firm. Organizations report that because firms provide RCO services to a variety of healthcare organizations, they are able to reduce the cost to collect and help providers get paid at a higher rate than they would managing the revenue cycle on their own. Many interviewed organizations also feel firms have a level of experience and expertise that would be difficult to replicate in-house. This includes revenue cycle expertise as well as experience with specific EMR vendors (mainly Cerner and Epic). Several respondents also note that local staffing challenges make it hard to find high-quality revenue cycle resources in their communities, necessitating the need for an RCO firm that has a national presence and can recruit from a wider pool of applicants.

why do provider organizations outsource their revenue cycle?

Reasons Firms Are Selected (or Not Selected)

reasons firms are selected or not selected

About This Report

Data for this report comes from two sources: (1) KLAS market energy data and (2) KLAS performance data.

KLAS Market Energy Data

To understand the RCO segment’s current market energy, KLAS interviewed 20 individuals from 13 unique organizations that have made an RCO contract decision within the last two years. Respondents were asked to identify which firm they selected and why as well as what other firms they considered and why those firms were not chosen. These 13 organizations represent the majority of organizations that made a go-forward RCO decision within the last two years.

KLAS Performance Data

Each year, KLAS interviews thousands of healthcare professionals about the IT products and services their organizations use. These interviews are conducted using a standard quantitative evaluation, and the scores and commentary collected are shared in reports like this one and online in real time so that other healthcare professionals can benefit from their peers’ experiences.

The data in this report was collected over the last 18 months; the number of unique responding organizations for each firm is given in the table below.

about this report

What Does “Limited Data” Mean?

Some products are used in only a small number of facilities, some vendors are resistant to providing client lists, and some respondents choose not to answer particular questions. Thus a vendor’s sample size may vary from question to question and may not reach KLAS’ required threshold of 6 unique respondents. When a vendor’s sample size for a particular question is less than 6, the score for that question is marked with an asterisk (*) or otherwise designated as “limited data.” If the sample size is less than 3, no score is shown. Note that when a vendor has a low number of reporting sites, the possibility exists for KLAS scores to change significantly as new surveys are collected.

Overall scores are measured on a 100-point scale and represent the weighted average of several yes/no questions as well as other questions scored on a 9-point scale.

author - Jess Wallace-Simpson
Jess Wallace-Simpson
author - Natalie Jamison
Project Manager
Natalie Jamison
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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.