provider looking at a digital version of the revenue cycle

Revenue Cycle – How Green are the Fields?

I was able to attend the 2019 Digital Health Investment Symposium and sat in on a breakout session about innovations in revenue cycle. Since the session was relatively small, attendees were able to ask questions tailored to their specific organizations and experiences, allowing them to get specific answers in return.

The two panelists—Todd Craghead, Vice President of Revenue Cycle at Intermountain Healthcare, and Deborah Vancleave, Vice President of Revenue Cycle at Mosaic Life Care—discussed their own personal experiences with revenue cycle at their respective organizations.

Using Artificial Intelligence in Revenue Cycle

Artificial intelligence is a hot topic right now, and organizations seem to be bringing it into several different areas of healthcare. When asked about her feelings on AI, Vancleave mentioned that people often say they aren’t ready for AI. But she insisted, “We can do so much with AI to achieve ROIs that we would be doing ourselves a disservice if we didn’t jump on board with it.”

Craghead agreed, highlighting the fact that much could be saved by introducing robotics into the revenue cycle. He stated, “Bringing in process automation for certain repetitive labors is a big opportunity. Intermountain Healthcare currently has around 100 process automations running. Those automations are helping to stabilize the workforce so that we don’t have to add staff members to keep up with the work.” For Intermountain Healthcare at least, AI seems to be working.

A provider then asked about AI specifically in terms of the patient portion of the bill. Mosaic Life Care wanted to embed the patient portion in the financial screening piece so that Vancleave’s team could look at the information before the service. The organization has a self-pay cycle, and they capture scores with data analytics. Intermountain Healthcare chooses to calculate the propensity-to-pay score. If that score is within a certain range, the organization writes the payment off to presumptive charity.

Offshoring the Labor

In terms of offshoring, our panelists held differing opinions. Vancleave mentioned that her previous company used an offshoring model, but her current company does not. She believes there is no reason to outsource labor when there are plenty of opportunities here.

Craghead, on the other hand, highlighted the benefits of offshoring labor. He pointed out that outsourced laborers are working while we are sleeping. His organization sends revenue cycle work to an outsourced-labor company, and the work gets sent back before the organization’s people are even at work. Craghead also visited the company in India where the work is actually done, and that visit gave him more confidence in the value of work they were providing.

In terms of what the marketplace thinks about offshoring, Vancleave said, “It is a mixed bag; it depends on the level of sophistication in a particular organization.” She believes that different people’s experiences change the way they think of offshoring, and her experience made it seem like controlling quality of outsourced labor is nearly impossible. Craghead stated,“We should do our part to influence the cost of delivering healthcare. Healthcare is expensive and often even unaffordable, so we need to find a way to influence affordability, and outsourcing is one way.”

Final Thoughts

One provider asked about how to deal with revenue cycles on the front end, and both panelists mentioned moving things further upstream in the work to do before patients arrive. Vancleave talked about registering patients, updating their insurance, and getting cost estimations even before the actual service happens. The more work that is done before the patient comes in, the less that has to be done when the patient does come in.

Craghead focused on the metrics that his organization uses, such as how long the scheduling person takes to answer the phone. He also said that most patients are financially cleared before coming in. Intermountain Healthcare does self-scheduling and provides forms online so that the process can be streamlined. Doing all of the prework allows for a smoother process and fewer issues on the front end.

While I listened to both panelists share their different experiences, it became clear to me that all organizations have different needs. However, it seemed clear that all participants in this discussion benefited from the sharing of ideas and everyone took away what they needed most.




     Photo cred: Adobe Stock, thicha