Get Ready For The New Realities Of The Revenue Cycle

August 20, 2014

How do you update your IT systems to efficiently and effectively manage the new reality that population health tracking, management, and analysis are now part of the revenue cycle?

Prepare to add population health tracking, management, and analysis to your RCM arsenal – and claims data as a key source for understanding and managing patient care.

The effectiveness of population health and revenue cycle processes and systems – and the financial and clinical success of your healthcare organization – are becoming increasingly dependent on their interconnection with one another, driven by value- and outcome-based reimbursement models, known collectively as fee for value (FFV).

Healthcare reform, changing private-sector payer policies, and a widespread conviction that healthcare costs have spiraled to economically unsustainable levels mean that FFV will continue to capture an ever-larger share of the provider reimbursement space traditionally occupied almost entirely by the fee-for-service (FFS) model.

The forms FFV takes will vary depending on the size and type of your organization, the sectors and geographical locations you operate in, and the patient populations you serve. Further complicating matters, FFS will continue to exist alongside FFV – albeit in a diminished role – for decades to come, and perhaps indefinitely.

The question is, how do you update your IT systems to efficiently and effectively manage these new realities as they unfold, while minimizing risks and maximizing potential benefits? Here are some principles to follow as you adapt your IT systems to support FFV.

Insist on interoperability
It may seem obvious that tracking and managing your patient population’s health would start with and build on the data in your EHR system. But the truth is, not all of the information in existing health records is sufficiently standardized to meet the accountability demands of FFV.

You may find that the largest pool of already standardized data on patient health history resides in your RCM records. The standardized codes used in claims are carefully vetted, rigorously reviewed, and provide detailed records of the individual and collective health histories of patients. And that data will only get better with the mandated adoption of ICD-10 – now officially scheduled to go live on October 1, 2015 – thanks to the new code set’s much greater specificity.

That’s a key reason why, in meeting the accountability demands of FFV, information will need to flow easily in both directions between population health and RCM systems. That can’t happen unless you choose systems that are fully interoperable with one another. Look for solutions that not only interoperate with your current systems, but offer broad technology- and vendor-agnostic interoperability. You may be happy with your current EHR, PM, and RCM systems – and sure you’ll stick with them – but things may look different in a year or two.

Stay flexible
As FFV grows, the specifics of reimbursement models and the best practices associated with them will continue to evolve, probably in unpredictable ways due to new innovations, changing regulations, and real-world experimentation and experience.

That means you need to do everything you can to avoid vendor lock-in and massive investments that risk becoming losses if it turns out you’ve bet on the wrong horse. At the same time, however, you can’t afford to take a wait-and-see, do-nothing approach even in the short term, because you’ll need to proactively meet the demands of whatever FFV reimbursement models control (or are about to control) whether and how much your organization gets paid.

So how do you act while avoiding lock-in and large, risky investments of money and time?

Leverage cloud-based technologies
The answer can be found in cloud-based solutions. Population health, RCM, and analytics solutions that run in the cloud don’t require massive up-front investments, and can be implemented much more rapidly than installed systems. They also make it much easier to manage scale and growth – while shifting the burden of hardware and software maintenance and upgrades from your organization to the vendor. That not only helps you extend budgetary resources and staff time – it also makes it easier and far less costly to change direction when needed.

Expect rapid change
The growth of FFV means that the financial performance of your organization will increasingly depend on your ability to capture, access, combine, and analyze multiple streams of clinical, patient, and financial data in concert. So don’t be surprised if you start getting requests to connect or deeply integrate systems that previously operated in separate universes – and don’t be surprised if those requests come straight from the top.

About the author
Mary Hardy is the Director of Health Data Analytics at ZirMed. She has over 24 years of healthcare experience, half of which she spent leading very successful Channel Partner teams. Prior to joining ZirMed, Mary was the VP Sales at Alere Analytics (formerly DiagnosisOne) where she led the Sales and Partner team and doubled their revenue year over year by designing a solid go-to-market strategy. Before joining Alere Analytics, Mary worked at GE Healthcare for 21 years, holding various successful sales positions.

Get Ready For The New Realities Of The Revenue Cycle

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