Key growth initiatives in healthcare; analytics and denials management

Andrew Slotnick

For hospitals, health systems, and ambulatory financial leaders alike, improving denials performance can have a meaningful impact on revenue cycle performance and subsequently, the bottom line. That a recent survey by Becker’s confirmed that preventing denials and underpayments was a top priority in 2016, is not a surprise. The survey went on to uncover additional information about how respondents plan to achieve their goals, that was equally, if not more, interesting. 51% said that they expect to leverage new technology to address performance gaps, while less than 20% expected to use outside consulting services.  This data surprised me – denials workflows are rooted in learned behaviors and narrowly focused workflows – strong software can be a catalyst for change, but really changing that paradigm requires more than just software alone.

Software definitely has the powerful ability to disrupt (denials) workflows in new and exciting ways. Using analytics to identify previously hidden information from within denials data can show a billing group ways to re work denials more effectively and to avoid future claims from being denied before they have a negative impact on financial performance. Breaking down silo walls is another powerful affect software can have on how denials are worked. Where individuals or groups have historically focused on specific areas such as payer, location, specialty, or provider, software can provide a more holistic view of denial patterns and trends that are occurring across the organization. Better awareness and perspective should almost immediately net positive results by exposing organizational knowledge gaps, making the value proposition for new technology very compelling.

Consulting services also come in many shapes and sizes and frequently include a software component. And although consulting services focus on, well, services, they are inherently stronger at impacting people and process than just technology alone. As the shift to value-based care, technology, and payment requirements continue to cause disruption across the clinical, financial, and operational landscape, it is change management that often makes the lasting difference between a successful and forgettable transformation. Consulting services can have a profound impact on how an organization performs and denials management is no exception, but integrating world-class software into best practices driven revenue cycle services, is how to yield truly powerful results.

Delivering software enabled services is a challenge perfectly fit for the application of big data and analytics in healthcare. From denials management to population health, healthcare as an industry is lagging in its use of technology, and analytics represents a key area of focus to help deliver better outcomes at lower cost, which explains its emergence as a top executive priority. It is therefore critically important when considering an investment into analytics, that organizations evaluate core competencies as well as existing skill sets before taking the plunge. This approach will help identify the right balance of technology and service to match organizational needs.

Frost & Sullivan’s new report, “Growth Opportunities for Healthcare Big Data—An Analysis of Global Case Studies. Big data Initiatives Targeted at Health Prediction and Precision” identifies the emergence of software enabled, cross-vendor, solutions as fundamental for the future and recognized GE Healthcare Digital and Accenture’s new denials management solutions, that include DenialsIQ™ software and revenue cycle management consulting practice, as one of its two vendor focused “Flagship Healthcare Big Data Initiatives in 2016.” The other was IMB Watson and Medtronic’s’ initiative focused on the inadequate management of diabetes causing either an insulin shock or a diabetic coma. The report goes on to say, “This shows the direction of market evolution where Big Data capabilities will be cross-leveraged between industries and offered as a service, creating room for joint venture opportunities.”

Frosts’ projection is an important consideration for provider systems that are considering a denials overhaul in the near future. While improving denials performance is a top priority for executives in 2016 and can definitely a fruitful initiative, asking “Does my organization possess the skills and ability to change to the extent that adding new, potentially disruptive, technology alone could require,” will help chart the best course for success.

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