Revenue

Insights

Marlowe Dazley

Predicting Denials to Improve the Healthcare Revenue Cycle and Maximize Operating Margins

Healthcare financial leaders are constantly brainstorming ways to increase operating margins through better revenue cycle performance. These efforts often lead revenue cycle leaders to denied claims—when a payer doesn’t reimburse a health system for a service rendered. Although denials are a common reason for lost revenue, experts deem nearly 90 percent avoidable.
Effective denials management starts with prevention. Organizations can use revenue cycle performance data, combined with artificial intelligence, to predict areas within each claim’s lifecycle that are likely to result in a denial. With denial insight, health systems can optimize revenue cycle processes to prevent denials and increase operating margins.

Robert DeMichiei

Will the Revenue Ever Return? COVID-19 and the Rise of the Insurers; the Case for Operational and Cost Transformation

Join our live webinar with Rob DeMichiei, Strategic Advisor for Health Catalyst and former Executive Vice President and Chief Financial Officer for University of Pittsburg Medical Center (UPMC), to learn more.
What You’ll Learn

How insurers look at their medical expenses, and their plans to reduce utilization and steer volumes away from traditional providers.
The implications of price transparency; why a rational pricing strategy is critical to success.
Using existing EHR data to measure and assess 100 percent of your clinical costs.
How improved costing enables service-line management and allows for improved clinical care delivery and insight into profitability.
How activity-based costing can help identify physician and clinical variation.
Implications of inaccurate RVU/RCC costing on contract negotiations, resource management, and productivity reporting.
Benefits and simplicity of activity-based (consumption) costing.

Bob Alexander
Mike Andrews
Robert DeMichiei

The 100-Percent Solution to Improving Healthcare’s Operating Margins

Healthcare organizations face unparalleled pressure to increase operating margins as they adapt to the revenue compression from COVID-19 and growing competition from insurers and digital disrupters. Yet, many health systems rely on outdated, revenue-centric cost accounting solutions that are ill equipped for strategic financial decision making. As a methodology for today’s complex healthcare environment, activity-based costing (ABC) can capture healthcare resource use at a granular level. With this service-level insight into clinical cost, ABC provides actionable intelligence to help organizations improve profitability and make strategic cost-reduction decisions. These comprehensive costing solutions give health systems a full understanding of cost across the care continuum—the only level of insight that will enable strategic cost transformation in the industry’s new normal.

Health Catalyst

Population Health Analytics Enables Improved Quality Increasing Revenue by Nearly $1M

Advanced payment models incentivize Accountable Care Organizations (ACOs) to deliver high-quality care and close gaps in care for members, thereby earning shared savings and increasing profits. However, in order to succeed and identify gaps in care, ACOs must be able to rely on solid data and analytics to avoid losing income that could be invested back into patient care. Utilizing its analytics platform and a quality measures solution has allowed Hospital Sisters Health System to close care gaps, improve ACO quality measures performance, and enhance reporting accuracy and effectiveness.

Health Catalyst

Denials Management Analytics Reduces Denials by Nearly $5M

On average, claim denials cost each healthcare provider $5 million every year. This loss of revenue resulting from claim denials is a concern for healthcare providers. Billings Clinic sought to determine the cause of claim denials and realized that it needed an analytics solution that could integrate data from multiple sources. The health system leveraged its data platform and analytics applications to pinpoint the sources of the denials, allowing the organization to implement prevention plans and procedures for recovering the denials. Billings Clinic achieved significant results, including:

Health Catalyst

Using Analytics to Improve Clinical Coding

Responsible for coding approximately 380,000 episodes annually, clinical coders at Guy’s and St Thomas’ NHS Foundation Trust review documentation across several systems. The overwhelming amount of data, burdensome manual review processes, and limited coding resources made reviewing all data unfeasible. To address its coding challenges, Guy’s and St Thomas’ leveraged its data platform to combine and standardise data across disparate source systems. The organization now has access to data and technology that can be used to augment coders’ work, automating data gathering to better identify patients whose diagnostic coding could be improved.

Health Catalyst

Optimizing Space Utilization Improves Patient Access and Revenue

Texas Children’s Hospital had dramatically improved patient access, yet it recognized that it could advance access further by improving space utilization and proactively reallocating underutilized exam rooms. The organization developed a space visualization analytics application, and conducted a comprehensive space assessment, identifying opportunities to improve utilization of current space to increase clinic offerings—resulting in improved access for patients and families by utilizing space efficiently.

Health Catalyst

Analytics Improves Population Health and Drives Efficiencies

agilon health, an organization that partners with physician organizations in full risk contracts, needed a way to help its physician partners and care management staff quickly identify patients in danger of deteriorating health status and increased cost. However, taking a deeper look at the health status and costs associated with these patients was complicated by the slow manual review of data. By developing an analytics application, agilon health was able to turn its data into actionable insights, automate many manual processes, and ultimately provide targeted improvement interventions aimed at better care delivery.

Bobbi Brown, MBA

The 2021 Healthcare Financial Forecast: What to Expect, How to Prepare

As healthcare financial leaders plan for 2021, they can expect COVID-19 to shape their strategies. Pandemic response and recovery will continue to dominate the industry, inform new perspectives on existing issues (e.g., the shift to value-based care and health equity), and shape priorities. Meanwhile, the Biden administration will start to puts its stamp on U.S. healthcare, further making 2021 a pivotal year for the industry.
Healthcare finance teams can best navigate 2021 by monitoring and preparing to take action in five prominent areas:

Election impact.
Price transparency.
Financial forecasting.
Value-based care.
Health equity.

Bob Alexander
Mike Andrews
Robert DeMichiei

The 100-Percent Solution to Improving Healthcare’s Operating Margins

Healthcare organizations face unparalleled pressure to increase operating margins as they adapt to the revenue compression from COVID-19 and growing competition from insurers and digital disrupters. Yet, many health systems rely on outdated, revenue-centric cost accounting solutions that are ill equipped for strategic financial decision making. As a methodology for today’s complex healthcare environment, activity-based costing (ABC) can capture healthcare resource use at a granular level. With this service-level insight into clinical cost, ABC provides actionable intelligence to help organizations improve profitability and make strategic cost-reduction decisions. These comprehensive costing solutions give health systems a full understanding of cost across the care continuum—the only level of insight that will enable strategic cost transformation in the industry’s new normal.

Health Catalyst Editors

Shifting to Virtual Care in the COVID-19 Era: Analytics for Financial Success and an Optimized Patient Experience

The COVID-19 era has seen a decline in visits to ambulatory care practices by 60 percent and an estimated financial loss for primary care of over $15 billion. Shutting down elective care is financially unsustainable for health systems and for patients, who continue to need non-pandemic-related care. While virtual medicine has emerged as a viable and mutually beneficial solution for patients and providers, the shift from in-person to virtual health is logistically and financially complicated.
Processes and workflows from in-person care don’t directly translate to the virtual setting, and a financially successful shift requires deep understanding of the factors driving patient engagement and revenue in the new normal. As such, meeting patient needs and financial goals requires robust enterprisewide analytics that drill down to the provider level.

Marlowe Dazley

Reduce Bad Debt: Four Tactics to Limit Exposure During COVID-19

Health systems have always faced bad debt—from charity care to insurance claim denials—and COVID-19 has exacerbated its impact on revenue. While hospitals and clinics are responsible for providing care to populations, they can still generate revenue from care delivery without compromising care accessibility or quality. An effective bad debt management approach provides the patient with every financial resource possible and allows the health systems to focus less on payment and more on delivering the best care.
With four tactics, health system leadership can identify bad debt and implement effective processes to minimize it without undue burden on patients:

Identify bad debt exposure early.
Educate patients about alternative payment options.
Leverage technology within the workflow.
Understand the true cost of care.

Health Catalyst

Reducing Clinic No-Show Rates Increases Revenue by $1M Annually

Memorial Hospital at Gulfport (Memorial) knew that decreasing clinic no-show rates was an opportunity to increase revenue, eliminate delays in care, and improve care coordination for its patients. With a robust data platform, Memorial leveraged its data and analytics to better understand the reasons behind its high no-show rates. With actionable data, the organization implemented measures to effectively improve its no-show rates and increase revenue.

Health Catalyst

Decreasing Durable Medical Equipment Variation Yields Nearly $1M in Additional Revenue

Community Health Network identified that inconsistent oversight of durable medical equipment (DME), and process variation, were a likely source of waste and lost revenue. The health network sought a systemwide, data-driven process for the purchasing, dispensing, and billing of DME. A data platform and analytics applications were utilized to understand organizational performance, identify opportunities for improvement, and evaluate the impact of these changes on patient, financial, and organizational outcomes.

Health Catalyst

Data-Informed Decisions Drive Revenue Improvement by More Than $48M

MultiCare Health System’s Pulse Heart Institute (Pulse Heart) recognized that better care coordination was required for patients receiving cardiac, thoracic, and vascular care. The organization wanted to further improve quality outcomes, provider engagement and recruitment, and its own economic health. To meet these objectives, Pulse Heart focuses on clinician engagement and organizational alignment, ensuring widespread access to meaningful, actionable data and analytics to inform decisions and drive improvement.

Health Catalyst Editors

How to Optimize the Healthcare Revenue Cycle with Improved Patient Access

Despite pandemic-driven limitations, health systems can still find ways to optimize revenue cycle and generate income. When health systems improve and prioritize patient access through a patient-centered access center, they can improve the revenue cycle performance through decreased referral leakage, better patient trust, and optimum communication across hospital departments.
Rather than relying on traditional revenue cycle improvement tactics, health systems should consider three ways a patient-centered access center can positively impact revenue cycle performance:

Advance access.
Optimize resources.
Engage stakeholders.

Marlowe Dazley
Todd Halpin

Healthcare Revenue Cycle: Five Keys to Financial Sustainability

With COVID-19 challenges continuing in the near-future, health systems must continue delivering quality care in the midst of the pandemic, without compromising financial well-being. Historical approaches to revenue cycle add value but fail to leverage data to drive financial sustainability in a time of crisis. To financially survive tumultuous economic times, health systems must leverage data to drive a more comprehensive revenue cycle strategy.
Five best practices generate the actionable data that allows health system leaders to understand financials at a nuanced level, promoting effective processes that lead to financial sustainability and optimum revenue cycle management:

Identify and measure the right metrics.
Define clear lines of accountability.
Create consistent workflows.
Define key performance indicators.
Understand the right metrics at the right place at the right time.

Will Caldwell, MD, MBA

The Medicare Shared Savings Program: Four Tools for Better Profit Margins and High-Quality Care

Medicare patients make up the majority of health systems’ revenue; yet, organizations earn only a one percent profit while caring for this population. Despite historically low profit margins, Medicare can be lucrative for health systems, and through the Medicare Shared Savings Program, healthcare organizations can increase revenue with four tools:

The ability to aggregate and analyze data.
The ability to align financial incentives between payers and providers.
The ability to engage patients in behavior or lifestyle modifications.
The ability to garner support from clinicians and encourage them to lead the shift to VBC.

As the shift from fee-for-service to value-based care continues, health systems can leverage MSSP to deliver the highest level of care while also increasing profit margins.