success story

Presbyterian Healthcare Services

Achieved remarkable revenue cycle performance improvements across the health plan and care delivery system

Measurable impact

Presbyterian Healthcare Services collaborated closely with MedeAnalytics to deploy the robust, comprehensive revenue cycle and business analytics necessary to achieve big goals across both their payer and provider sides. In total, this partnership drove $3.4M in value—equivalent to a 344% ROI and a nine-month payback on their investment.

$K
reduction in total cost to collect
%
of reporting automated
$K
reduction in overall denials
$K
reduction in bad debt and charity
$M
improvement in reimbursement from CMI
%
reduction in time managing audits

The story behind the numbers...

The Challenge

After making a series of strategic technology investments, Presbyterian found themselves in a disconnect. Each application and tool they had introduced had a unique, system-specific purpose, making them rich in siloed data but poor in actionable insights. As a health plan and a care delivery system, Presbyterian needed to unite technologies and optimize its revenue cycle management analytics and reporting across the organization to drive sustainable success.

About PHS 

  • Integrated delivery system in New Mexico
  • Nine hospitals and 32 clinics
  • Annual patient encounters:
    • 60,000 inpatient discharges
    • 420,000 outpatient hospital visits
    • 5M physician office visits
  • Delivered care for 110+ years
  • Financed care for 21+ years

“The benefits that we receive from integrating the MedeAnalytics solutions in conjunction with other tools that we have at Presbyterian have become critical to our processes. We've improved efficiency, speed to insights, and staff efficiency. We've standardized reports across revenue cycle functions. We have embedded insights into operations and workflow. We have near real-time analysis and decision-making. When you add up the benefits, the value generated from these MedeAnalytics solutions totals to about $3.4 million—and this is just the beginning.”

Soyal Momin, SVP, Chief Analytics Officer, Presbyterian Healthcare Services

The Solution

Presbyterian had put together a strong, data-focused team. But they did not have the capabilities necessary to provide efficient reporting and generate impactful insights, even after a significant investment in their Epic electronic health record (EHR).

Their Epic EHR did not enable drilldowns into claim level details or allow them to easily identify trends with the needed granularity. Effectively tracking revenue cycles across multiple care settings was nearly impossible, and they were unable to proactively identify gaps in accounts receivable (A/R) collections and denials likely to happen. These gaps and challenges led to their revenue cycle management being reactive, and they lacked visibility into gaps in RCM staff productivity, resulting in sub-optimal revenue cycle performance.

By partnering with MedeAnalytics, Presbyterian transformed their approach to data and decision-making by weaving powerful analytics into simple, daily workflows. This enabled the organization to:

  • Standardize and automate reports that used to take weeks to collect and deliver (reduced month-end close cycle time by 5 days)
  • Provide accessible, cohesive data to empower strategic choices and improvements across the enterprise
  • Equip business, finance and revenue cycle staff with the real-time, self-service analytics necessary to understand and apply insights to their processes and programs
  • Utilize a risk rules engine as the backbone of improving clinical documentation, benchmarking case mix index, and comparing comorbidity against internal and external cohorts
  • Identify key areas for improvement in AR and denials
  • Improve efficiency and speed-to-insights across the enterprise
  • Execute descriptive, diagnostic and prescriptive analytics

Presbyterian is already working on plans to further their predictive and optimization analytics with MedeAnalytics innovative solutions.

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