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by Jeff Hurst
Published on April 14, 2017

The health IT landscape is constantly evolving. Shifting consumer behavior patterns, coupled with the industrywide transition from fee-for-service to fee-for-value models, means that hospitals and health care providers must structurally adapt in order to remain successful.

As these trends continue, there's an enormous amount of pressure on health care organizations to take a long, hard look at their revenue cycle management (RCM) operations. There's a significant opportunity for organizations to evolve their current RCM strategy across acute and ambulatory venues by optimizing existing workflows, connecting clinical and financial data and controlling cost to collect. These initiatives will not only protect revenue, but will ultimately deliver the best financial outcome for the consumer.

How the shift to value-based care is impacting RCM strategy

One of the most important strategies to help navigate value-based care is to align financial and clinical operations. This is essential to build one cohesive view so that administrative staff and physicians alike can deliver improved value in terms of financial and clinical outcomes, as well as the consumer experience and access to care.

Aligning clinical and financial information has a twofold goal: improve clinical outcomes and reduce cost. Health care organizations are compelled to optimize their revenue cycle and make sure they are collecting payment for the care they delivered. They cannot afford to leave money on the table because of disjointed systems, processes or resources.

The value of an integrated revenue cycle

As we move toward value-based care, payment will no longer simply be tied to the services provided. Rather, it will be tied to the accuracy and completeness of the documentation of services provided. However, with disjointed systems in place, it can be very challenging to collect all the necessary clinical information to appropriately document care for reimbursement. That is why more health care organizations are uniting their clinical, financial and operational data within a single, integrated platform across acute and ambulatory settings.

An integrated platform also comes with the benefit of analytical data. The ability to pull and derive meaning from data is becoming increasingly important. Analytics can be used to drive better clinical and financial outcomes across an entire organization. Ultimately, what gets measured gets managed, and having insight into even the most granular data can influence the decision-making process and refine workflows. When data is aggregated and shared on a single platform, it has the power to improve revenue cycle intelligence and the quality of health care.

Additionally, an integrated platform helps create a better experience for the consumer. Zane Burke recently shared his thoughts on how health care should embrace consumer-centered, proactive RCM. Consumers deserve easy accessibility to their health information and are more proactively researching health care organizations to compare quality and price. This presents an enormous opportunity and responsibility to educate consumers about their care. An integrated, cohesive RCM strategy that promotes transparency with consumers will help establish trust, improve engagement and build loyalty.

Connecting people, processes and technology with RCM services

Entering the era of value-based payments and population health management will require more solution and care team integration. Already, health care organizations should be thinking about putting the foundation in place to create sustaining and thriving businesses. Many financial leaders are considering RCM services, which can free up labor resources and dedicate focus to the consumer-facing side of the revenue cycle. In fact, nearly 50 percent of hospital CFOs acknowledge that outsourcing RCM has become a more viable alternative to insourcing.

Impacting a health care organization's bottom line

Implementing a Clinically Driven Revenue Cycle is a significant step toward improving RCM performance and preparing for value-based care. It combines clinical, financial and operational health information to be available when and where it's needed so our clients can optimize workflows, improve cost-effectiveness and ultimately, build a healthier bottom line.

Cerner's Clinically Driven Revenue Cycle&trademark; portfolio of integrated solutions and services are designed to help health care organizations of all sizes navigate today's complex environment, drive down costs and increase cash flow. Contact us to learn more details about our integrated revenue cycle management solutions and services.

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