Payment
Volume
Expansion

Increase Collection Rate & Cash Flow

Healthcare systems are faced with significant margin compression, increasing costs, threat of increased debt service, fragmented business models, and associated loss of revenue. Managing the revenue cycle to reduce bad debt and denials—and improving clinical documentation to capture unbilled receivables and late/missing charges—can lead to significant financial improvements.

Accelerate Revenue Integrity & Reimbursement

Revenue integrity (the achievement of operational efficiency, compliance, and accurate reimbursement) is essential to the financial health of healthcare organizations. Improving clinical documentation and coding to confidently charge and collect for the services performed—while adhering to federal regulations and commercial contract rules—can result in improved revenue capture accuracy and revenue enhancement.

Optimize Payer Contracts

The shift from fee-for-service to value-based payment systems forces healthcare organizations to evaluate their contracts as payers shift risk to providers. More quality and cost data will be needed to successfully negotiate terms and evaluate risk. Government payers’ margins have been declining—and in many geographic regions, the payer mix is shifting to lower-margin payers. This challenge is exacerbated by declining market share of commodity (high-margin) services to low-cost ambulatory providers.

Increase Capacity

Many health systems face problems with both acute and ambulatory capacity, which limits volume and revenue growth—and potentially reduces patient and staff satisfaction. Focusing on increasing capacity by adjusting service offerings, scheduling, and other key processes to improve patient throughput can significantly increase capacity without relying on costly construction and other measures.

Improve Access

Healthcare leaders increasingly seek to expand ambulatory care access as a means to build their network and brand, so patients want to stay in the system, thereby increasing patient satisfaction and generating new revenue. But to prevent cost increases and physician burnout, organizations need a thoughtful, data-driven strategy to ensure various goals and priorities are balanced.

Reduce Referral Leakage

When patients are referred outside your network for care, the health system not only loses that business, but also risks losing future business if patients are happy with the care they receive elsewhere. Organizations that focus on building physician relationships and improving physicians’ perception of the quality of care across their network can help minimize leakage and associated lost revenue.

Expand Care Across the Continuum

Between 75 and 85 percent of U.S. healthcare costs are attributable to patients with chronic diseases, but the model of acute, episodic care fails to meet their needs. The result? Gaps in care, poor outcomes, rising cost burden and lost revenue. Organizations that leverage analytics to efficiently identify and address gaps in primary, acute, and preventive care can mitigate challenges and ensure patients get the right care, at the right place, at the right time across the continuum.

Optimize Service Lines

As part of their overall strategic planning, healthcare leaders increasingly review service line programs, looking to identify those with the strongest positive margins, capitalize on the need for new areas of specialization, and discover opportunities to improve performance. Organizations with effective service-line strategies integrate clinical and financial data, leverage technology to assess demographic needs, improve coordination of care delivery, and deliver better care and higher value.

Improve Mergers and Acquisitions

Financial and operational pressures continue to drive the pace of mergers and acquisitions, with healthcare organizations increasingly seeking to grow and diversify revenue, decrease cost, and improve outcomes for patients and populations. However, it’s not clear these consolidations lower cost or improves care. Organizations need a disciplined data-informed approach to evaluate potential M&As, set financial and non-financial goals, and integrate information systems, data governance processes, operations, and leadership.

Increase Revenue Through Sponsored Research

Given the complexity of healthcare finances, organizations should always be evaluating new sources of revenue that will also positively impact care. Providers and principal investigators have the ability to identify and implement studies, clinical trials, and sponsored research that can be operated alongside ‘normal’ care delivery and impact several types of treatment categories: targeted therapies, digital therapeutics, and digital health / remote care tools.

Expand Digital Retail

Americans spend 12 or more hours each day with online media—and we now demand from healthcare the speed and convenience we experience in our online interactions. To stay competitive, healthcare organizations are electing to provide digital experiences that allow patients to search, schedule, pay for, and interact with healthcare. Done well, this can increase patient satisfaction and operational efficiency; done poorly, it further fragments the patient experience and damages engagement.

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