Three impediments hinder most healthcare providers. Closing the gap that exists between revenue cycle and IT is the first major issue. This challenge, although common in all industries, tends to strike the healthcare sector particularly strong because of the advancements and investments in unified electronic healthcare records (EHRs).
Secondly, the need for healthcare organizations to blend clinical and financial accountability is another issue. Exacerbating this challenge is the increased need for data-driven metrics under value-based payment models. According to a recent Leidos whitepaper, more and more hospitals and health systems are finding that a portion of their revenue is tied to meeting or exceeding certain clinical quality measures.
Thirdly, at the same time, healthcare organizations struggle to achieve broader system goals in order to achieve today’s value-based-reimbursement models, while struggling to demonstrate cost effectiveness. This challenge includes the need to find and drive more efficiency within the revenue-cycle processes.
Complicating the ability to align the clinical with the financial systems of a healthcare provider is the need to develop efficiencies given that healthcare data tends to be siloed in multiple core, best-of-breed technology systems. As a result, the mission of many CIOs and information technology departments is to overcome that obstacle by aggregating data and creating financial reports capable of helping revenue cycle leaders effectively manage costs and reimbursements.
Healthcare organizations need to commit to greater clinical and financial alignment in order to overcome these obstacles- doing so, however, requires that the following two steps occur:
- Develop the role of Financial Informaticists.
Clinical Informaticists support clinical quality improvement and in a similar way that Financial Informaticists should help drive higher revenue cycle and financial performance- by maximizing reimbursement, thereby, accelerating cash flow and reducing costs.
- Make the revenue cycle a superseding “chain of custody” that bridges both clinical and financial processes.
Tighter collaboration between clinical and financial teams builds efficiency and helps drive performance from enhancing opportunities across the healthcare enterprise. There is a symbiosis between clinical delivery and financial responsibility. This relationship is the basis for value-based reimbursement models that only grow stronger as healthcare payments become more linked to clinical performance, resource use and patient experience.
To achieve and maximize the relationship between financial and clinical processes, any investment in talent or technology should focus on alignment, purpose, and strategy by employing a skilled advisor who has experience matching healthcare’s clinical, finance and IT goals. This can drive the strategy discussion and help healthcare organizations find direction. This strategic role can also help align Clinical and Financial Informaticists to empower the enterprise with alignment and accountability, thereby leading to a fully-supported revenue cycle.
Bridging the gap between revenue cycles and IT, blending clinical and financial accountability, and reaching broader system-goals to achieve today’s value-based reimbursement models represent three of the toughest challenges in the healthcare sectors. With a tighter collaboration between clinical and financial teams, these issues are resolved and more efficiency and performance enhancing opportunities occur across the healthcare enterprise.
Optimizing the Revenue Cycle: Moving Past the Financials