WITH THE AMERICAN RECOVERY AND REINVESTMENT ACT (ARRA) and Medicare’s Recovery Audit Contractor (RAC) program expected to dominate the headlines in 2010, developers of financial products for the healthcare market say the year’s buzzword should be accountability.
Healthcare providers “have to start focusing on how they capture charges and whether they’re getting reimbursed legitimately for what they do,” said Ann Marie Brown, executive vice president of marketing for Craneware. “In the past, they haven’t thought a lot about outpatient services. Well, with a decline in hospital stays, that mix is changing.”
According to Brown, hospitals will need technology that not only captures charges from all sources, but develops and fosters new streams of revenue.
Experts see this shift in the marriage of clinical and financial tools, or combining personal health records and electronic medical records at the front end with the revenue cycle management tools in the back. It’s a trend, says Jeff Margolis, founder, chairman and CEO of The TriZetto Group, that’s being pushed by healthcare consumers who want to know just how their money is being spent.
“It’s not just doctors being given information,” he said. “It’s about consumers wanting to understand their responsibility.”
Jim Corrigan, vice president and general manager of GE Healthcare IT, said providers who traditionally dealt with insurance companies and health plans will now have to take into account a new payer: The consumer. This means they’ll be looking for financial tools that allow for real-time adjudication and patient-facing, self-help functions such as portals and kiosks.
While some see a preponderance of smaller, specific solutions that benefit the best-of-breed approach, Glen Tullman disagrees. The CEO of Allscripts-Misys Healthcare Solutions says providers will be looking for all-encompassing systems favored by the big vendors. That includes kiosks and technology that helps physicians collect what they’re owed.
“Last year revenue cycle management became very interesting to the market, and this year it starts to go mainstream,” he said. “Users won’t want to replace their practice management systems because that’s money they won’t get back from ARRA. They want a comprehensive system.”
Margolis feels the market will push providers and payers to work more closely, developing alternatives to hospital-based care that include retail clinics, online care, telemedicine and health plans tailored to specific geographies. “There’s a lot of variability in the design that’s going to occur,” he said. “Some health plans are finding success in designing models for the frail and elderly that combine care coordination and preventive care. It’s letting health plans be health plans.”
Brown and Tim Weakley, a project manager at Craneware, see the industry adopting integrated financial systems that include chargemaster maintenance, deductibles, uninsured market growth, pharmacy management and even supplies.
“They have to have a financial model that makes a contribution to the clinical outcome,” Brown said.