Revenue cycle integration, opportunity for health care organizations


Revenue cycle integration

Creating sustainable value and enhancing market position

One of the more significant areas of opportunity for many health care providers lies in increasing the integration of their revenue cycle organizations—acute, ambulatory, and post-acute. Effective integration strategies enable providers to increase efficiency, reduce costs, increase collections, and improve net operating margins.

A significant area of opportunity for health care organizations

Finding ways to add value, eliminate operational silos, gain efficiencies, and drive down costs is critical as health care organizations strive to combat market pressures and changing regulatory environments, and increase patient engagement in their care. Integrating acute, professional, and post-acute revenue cycle operations can provide numerous benefits and aid in value realization, strategically positioning health care providers for the future.

Revenue cycle integration: Creating sustainable value and enhancing market position is a brief, informative piece that shares:

  • Key market pressures and their impact on integration
  • Five types of integration opportunities
  • Considerations for revenue cycle operating model strategy

While the integration process can be daunting, a focus on cross functional engagement, integration planning, and project management mitigates the risk associated with a large scale organizational integration. The steps recommended in this paper serve as a high-level blueprint to guide organizations through both the visioning and alignment process.

Five types of revenue cycle integration opportunities

“Revenue cycle integration” refers to the degree of alignment of leadership, operational teams, and business support systems across the various business units that support the continuum of care. However, it should be noted that this a relative concept, and the appropriate form of revenue cycle integration varies from one provider organization to the next depending on a variety of factors. Organizations with little to no integration typically function in a fragmented fashion, with independent operational silos and supporting IT systems. More integrated provider organizations utilize consolidated governance structures, centralized business units focused on specialized functions, standardized processes, and a uniform technology platform.

Leadership alignment, organizational structure, and technology standardization are all key factors in the integration equation, and as such, there are a variety of ways in which organizations can increase the integration of their revenue cycle. In order to better understand the various integration levers and their associated impacts, it helps to organize integration opportunities into several domains:

  • Customer engagement—The revenue cycle function has perhaps the greatest number of interactions with a patient; more than any other function in a health care organization. From the first time a patient calls to schedule an appointment to the time the patient’s last bill is paid, revenue cycle operations have a profound impact on patient experience and, therefore, customer engagement. Organizations are recognizing revenue cycle integration is a competitive advantage that distinguishes the organization in its market; here, all patient-facing functions are integrated and have the same look and feel across all care sites, so the same patient will have the same experience no matter the setting.
  • Talent operating model—Providers should seek to maximize integration by utilizing a consolidated leadership structure and centralized shared service departments for key areas of revenue cycle operations across the organization. Establishing enterprise-wide revenue cycle leadership sets the foundation for integration and enables the creation of key centralized business units for Patient Access, Health Information Management, Patient Financial Services, and Customer Service. Organizing in this fashion enables staff to specialize in critical end-to-end revenue cycle functions while supporting patients across the various service lines that comprise the continuum of care.
  • Process innovation—The creation of shared service departments enables the standardization of leading practice processes for key revenue cycle functions. As a result, efficiency is increased through enhanced specialization and the reduction of handoffs and miscommunications. In addition to improving productivity and reducing costs, this also creates a more transparent and consistent experience for patients as they are scheduled, financially cleared, charged, and billed for services.
  • Technology enablers—Provider organizations will need to support the centralized service offerings of an integrated revenue cycle with standardized technology platforms that enable comprehensive data management and reporting of cross-disciplinary quality metrics for value based compensation models. Use of these unified technology platforms across care-delivery service lines will allow data to be tracked across the enterprise, which enables better patient and population health management. Additionally, these technologies will also drive accountability for quality and standardized patient communications, thus providing the transparency required to meet the evolving demands of healthcare consumers.
  • Measurement and analytics—Implementing strategically balanced improvements across these domains can improve revenue cycle integration and yield improvements in both service quality and financial performance.

Effective integration strategies enable health care providers to increase efficiency, reduce costs, increase collections, and improve net operating margins.

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