healthcaretechoutlook

Why Integrated Revenue Cycle Management Makes Sense for Healthcare Systems

By Bryan Bliven, CIO, University of Missouri Health Care

Bryan Bliven, CIO, University of Missouri Health Care

The old adage of “if it ain’t broke, don’t fix it” has never made much sense for healthcare systems. There are always improvements to consider when it comes to providing patient care. As the Chief Information Officer & Executive Director of the University of Missouri Health System (MU Health Care) and Tiger Institute for Health Innovation, I’m focused on helping to improve care delivery through innovative processes. The role of technology professionals is far less visible than that of a doctor, nurse or therapist, but the behind-the-scenes work we do can make a substantial difference for patients.

Revenue cycle management is a perfect example of how healthcare technology and operations professionals work to streamline processes and improve patient experiences. From the documentation of care in clinical settings to claims generation and accounts receivable management, the healthcare revenue cycle is a complex process. Though we see the coordination between patient, payer and health system as meticulous, outsiders already overwhelmed by healthcare might see a needlessly complicated headache.

"Integrating the clinical and financial data will lead to a smoother revenue cycle process that improves reimbursements and limits errors in claims"

Our current revenue cycle management system is not broken; however, we recognize that there are always opportunities for improvement that benefit both our staff and our patients.

That’s why University of Missouri Health Care has partnered with Cerner to unite/combine/meld our system across our five hospitals and 50-plus primary and specialty care clinics. The fully integrated approach will combine registration, scheduling, patient account and practice management solutions, and transaction services with our existing electronic health records (EHR).

Integrating the clinical and financial data will lead to a smoother revenue cycle process that improves reimbursements and limits errors in claims. Bottom line is: the new financial experience for MU Health Care’s patients and staff has the potential to alleviate stress and be more efficient.

We like to call this new, fully integrated process a clinically driven revenue cycle, but that new moniker truly hinges on one key factor—our ability to implement a streamlined process that enhances efficiencies. By thoroughly documenting the process from the point of care, MU Health Care will be particularly attuned to the concerns of the patient. Adopting this approach will better control costs and ease billing procedures.

Recent technology developments and transformations within the healthcare industry make the early detection of discrepancies and reduction of errors in the revenue cycle that much more important, as inaccuracy can lead to under or over charging. Mistakes are unavoidable, but an integrated system greatly limits them. Technology is the game-changer in developing and modifying best practices, enabling healthcare systems to be nimble as they collect more data and highlight key metrics on processes.

The trend toward value-based, at-risk contracts in payment plans necessitates a move toward integrated clinical and revenue cycle systems. The flexibility afforded by these systems makes alternative payment models such as bundled payments significantly more manageable. One patient, one payment, with the healthcare system responsible for properly allocating the revenue to ensure that everyone is properly compensated. Alternative payment models push risk to the healthcare provider placing more focus on efficiency on the clinical side, which makes it even more of an imperative to run clinical and revenue cycle all through a single platform.

We’re not fixing our revenue cycle management system because it’s damaged; this change simply makes us more flexible and more tightly integrated moving forward. Efficient collaboration is critical, so we are implementing an agile development approach and workshop that will allow us to build out decisions and workflows. This will demonstrate to our employees how a clinically driven revenue cycle works and how the process has changed. We’ll get the right people involved to test our systems and work through new challenges. We’ll find out how our team interacts with new workflows. We’ll also pay special attention to analytics—timing, clarity, accuracy, efficiency—in assessing the power of our platforms as we move through this transition.

Working with Cerner on this transition is a huge opportunity for MU Health Care, and we are going in with eyes wide open. Our priority is to build out solid infrastructure and flexibility before debuting the new system. We will maintain quality in the current model while building an integrated system that works for alternative payment models. That’s the way of the future, and we’ll be ready for it.