Optimize your revenue cycle for today’s challenges and tomorrow’s goals

In this dynamic LinkedIn Live discussion, Christine Stetler, BSN, RN and AVP of Solution Engineering at MedeAnalytics, unearthed strategies for tackling current fee-for-service challenges in the revenue cycle while making steady progress toward value-based care payment models. Check out the interview recap below—and make sure you don’t miss Christine’s lightning round!

Q&A

Q: How have your conversations about revenue cycle changed since the transition to value-based care models began?

Christine: Over the better part of the last decade, we have been seeing an increase in shared savings programs as the catalyst or crosswalk to value-based care. It is both concerning and, for some of us, exciting. The concern is justified; we absolutely must get our arms around cost. The value-based care model, and I want to reiterate that I’m saying the ‘model,’ is straightforward in its endeavor. The belief—which I hold true to as a nurse—is that the healthier we keep a patient, the less costly they are, and the fewer unexpected ER visits and hospital stays they have.

In part, it’s about making the most out of preventative visits to create collaborative care plans, establish follow-up check-ins, and ensure patient plan adherence. But it’s also about the non-clinical processes. You asked how the conversation changed: Revenue cycle leaders are talking more than ever about what tools they need to invest in to track patient interactions, monitor quality measures, find follow-up activity, and assess outcomes.

Q: Value-based care models might be the hot topic of conversation right now, but fee-for-service arrangements are still very much intact, and providers continue to need solutions to help them in this area. What are a few things that providers can do—regardless of what payment models they use—to ensure that they are set up for success with value-based care?

Christine: No matter what type of provider you are or what models you are engaged in, understanding cost of care and improving the quality of care are absolute essentials.

Let’s say, for example, your health system has a high population of type 2 diabetics in its community. What is the cost of care on that population? What do quality measures look like? Are there accessible support programs like diabetic self-care classes or nutritionist referrals? What is the utilization of those programs?

If your health system does not have answers to these questions and/or strategies to address them, health plans and employers will be hesitant to align with you.

On the other hand, organizations that can show detailed data tracking and strong quality outcomes will become the ‘go to’ organizations that everyone, including large employers, will want to align with.

If you’re not quite at the value-based care model stage yet but you are working to prepare for it, be fastidious about knowing and tracking the cost of care. In your fee-for-service contracts, be laser-focused on prevention and recovery of denied claims. This includes having tools that show you exactly where your processes are successful and where you may need to take additional steps to achieve strong metrics.

Q: What factors are currently impacting providers’ revenue cycle performance?

Christine: A huge one is denials. As a KFF article last year said, denials have been “getting weirder” for a while. When we look at data from the past five years (which I lovingly call “vintage” data), it’s clear that denial reduction initiatives have worked. Many of the issues that were causing denials regularly in the past are now presenting infrequently—and that’s great news! But the less great news is, there are still many challenges keeping denial rates high.

Think about the game whac-a-mole. If you hyper-focus on whacking just one or two of the moles (no moles were harmed in the creation of this content), you will have solved some problems but left many others to grow bigger and invade your processes. On the other hand, if you take some time to explore denials data, prioritize problems, and devise a strategic plan of attack, you may be able to whack all the important moles. Dig into A/R. Get to know your payer mix. Understand root causes—and how to change or avoid them. Have a self-pay POS collection plan. Make a focused “chase” list for actionable denials and a “not again” list for avoidable denials. Essentially, get your denials ducks in a row because it is a massive factor affecting revenue cycle performance right now. An analytics-driven, stepwise plan for denials management is key to maximizing resources and results.

Q: What is one thing you would recommend providers do right now?

Christine: Get to know your data…really well. I can almost guarantee that you are going to find at least a few gaps—and you may find many. Focus on what you can change, fuel yourself with a lot of grace and grit, and stay the course. Finally, remember that the greatest act of courage you can take is to ask for help. Tap your network for support, from trusted peers to tech partners. This collaboration will spur transformation.

Lightning Round!

At the end of each LinkedIn Live session, we ask our guests three quick, big-picture healthcare questions:

1. What is one thing in healthcare that has you really excited right now?
2. If you could solve one major challenge for healthcare organizations, what would it be?
3. What is one key trend that you’re keeping an eye on? Anything we should be watching and researching?

Hear Christine’s answers: