Transforming the health care revenue cycle

Shoring up financial health and resiliency

The COVID-19 pandemic has only served to accelerate the financial, patient experience, and operational demands that have been building for years. The pandemic has put the spotlight on health care revenue cycle performance more acutely than at any time since the foundation of managed care arrangements in the mid-20th century, which is why investing in the revenue cycle of the future is more critical than ever.

As finance functions have been proactively investing in digital, automation, and analytics assets, revenue cycle organizations have often been slow to evolve and defined by manual, resource-intensive, and reactive processes. These legacy revenue cycle processes produce long delays in revenue realization, do not generate maximum yield on claims, and deliver a fragmented, confusing experience to patients.

The revenue cycle of the future can both drive down costs through an optimized operating model and improve revenue yield by enabling more effective collections activities driven by cognitive analytics and machine learning. It can also deliver a more seamless patient experience through more digital channels.

Investing in a revenue cycle of the future will both shore up the financial health of organizations in the wake of the pandemic and make them more resilient to the multitude of potential future disruptions that could affect the industry.

But a revenue cycle cannot be viewed in a vacuum. Anticipating the broader future of health landscape over the next decade is critical to effectively planning for and investing in the revenue cycle of the future.

Responding to industry trends

The key trends driving the future of health are interconnected and mutually reinforcing. They are defined by:

• Transformations in the availability, interoperability, and deployment of data
• Innovation in care delivery and settings of care
• The evolution of expectations for an increasingly empowered patient population

Patients are increasingly willing and able to share their health data as the interoperability of data across providers and platforms expands. Improved techniques for leveraging that data, in turn, are driving more rapid breakthroughs in population health and treatments. Along with these breakthroughs, settings of care are expanding, improving access to care and reducing costs. Finally, patients expect greater transparency and channels of engagement from health care providers.

The traditional health care revenue cycle is ill-prepared to respond to these trends. It has been narrowly focused on a limited set of financial data; been defined by inefficient, manual processes; and viewed patient interactions as mostly transactional. As the future of health landscape emerges over the next decade, the revenue cycle experience must be reimagined to play new and expanded roles, including:

• An insights hub that harnesses a health system’s data and delivers advanced analytics and insights across the organization
• An automation agent to streamline operations in an evolving, complex care environment
• A patient-centric platform to elevate the patient experience and meet consumer expectations

The next five years

The output of this operational review will yield a portfolio of transformation opportunities to be designed, developed, tested, and implemented over a one-year window. It will also serve as the foundation for a mature revenue cycle in a five-year time horizon. Initial, targeted investments are important not only to establish the technical and talent foundation, but also to build organizational momentum and demonstrate the value of pursuing a more comprehensive transformation.

While a full suite of capabilities cannot be achieved overnight, the vision of a revenue cycle of the future depends on what strategic choices and investments finance and revenue cycle leaders make today. Merely incremental changes can lead to revolutionary experiences for those inside the revenue cycle and the patients they serve.