I recently conducted an interview with two innovators in the healthcare space, Steve Mooney, president, Revenue Cycle Solutions and Jeff Nieman, senior vice president, Operations, at Conifer Health Solutions. Steve and Jeff offer some insights on what the future holds for revenue cycle management.
Jim Bohnsack (JB): With the rapidly changing landscape in healthcare today, what are the key issues you see your customers facing?
Steve Mooney (SM): Among the many critical issues hospitals face today, we see two surfacing more and more. One issue is in the area of compliance and keeping up with regulatory changes.
Jeff Nieman (JN): Too many hospitals just don’t have the resources to keep up with all these changes. Some of them have what could best be described as incomplete, inconsistent and insufficient approaches to tracking and implementing regulatory changes, and the small compliance staffs they have in place have far too many areas to monitor. So there’s an incredible risk that changes go unnoticed – until it’s too late.
SM: The other issue is having the right people in the right places within the revenue cycle organization. Whether it’s not having enough staff to handle the work because of budget constraints or not having sufficiently-trained staff onboard, we are seeing too many hospitals with employee problems.
JB: What type of innovative approaches can be used to address such key issues?
JN: Becoming a process focused organization is paramount. We invest time and capital in developing and refining processes that standardize and automate the ways we do things and improve outcomes. In the area of compliance, it absolutely necessary to put people in place to keep up with and implement regulatory changes; the cost is too high not to do so. And when it comes to having the right staff members in the right seats, companies just have to commit to finding and retaining good people because not doing so is too costly in the long run.
JB: Does Conifer have a view on how the ACO model will affect the Revenue Cycle for an organization?
SM: Like everyone else in healthcare at the moment, we are doing all we can to monitor the marketplace and learn about ACOs. We’re doing a lot of research, but the concept is so new and undeveloped that it’s just too early to know for sure. We can say, though, that with our experience in Capitation environments, IPAs and other complexities in California, we believe we can leverage this experience because of the similarities.
JB: Conifer Health Solutions was formerly Tenet Patient Financial Services. In your mind, what are the key differentiators you bring to the market as a result of that evolution?
SM: We have two key differentiators that are at the core of our solution. First, our roots are in healthcare -- not collections, IT or consulting. Coming from a hospital system ourselves, we have insight into our client hospitals’ needs, as well as a true understanding of the importance of patient and physician satisfaction. Second, as part of that hospital system, we invested more than $200 million in our processes and technology, and now we’re in a position to leverage those capabilities for all of our clients.
JN: In addition, our patent pending MicroSegmentation model, hundreds of thousands of automated work flows, detailed reporting tools and extensive training are all part of the model we’ve built to maximize performance, and they are all designed to enhance patient satisfaction and the reputation of each client’s health system.
JB: If you are to look into your crystal ball, what does the future of Revenue Cycle look like? Where will organizations like Conifer spend their R&D funds?
JN: The future of the Revenue Cycle looks like continuous change to us, particularly as it relates to areas like compliance and enhancing patient and physician experiences – just to name a couple. We’re already focusing on those areas, and we’ll keep working on them as we move ahead. As we see it, the cost of keeping up is going to be steep, but the cost of not keeping up will be even steeper.
SM: We believe more payor collaboration around efficiencies in claim processing will also be key in the future. We’ll also keep investing in enhancements to our MicroSegmentation process to continue improving efficiencies and increasing yield for our clients.
Jim Bohnsack is vice president of TransUnion Healthcare.