Revenue Cycle Management Solutions of the - HIMSS conference


Moving the Industry Forward: Revenue Cycle Management Solutions of the Future Stuart Hanson FY16 Chair, HIMSS RCI Task Force SVP & General Manager, Consumer Payment Solutions ChangeHealthcare

Mike Olson Member, HIMSS RCI Task Force SVP, Treasury Solution Team Lead Fifth Third Bank

Revenue Cycle Management Challenges • Current: – Rising patient financial responsibility – Lack of understanding of most patients regarding their healthcare insurance, especially the newly insured with Bronze plans – Fragmented communications between those involved in an episode of care – Lack of interoperable systems (internal and external) – Culture of little to no focus on price of a particular service/care plan – Changing reimbursement methodologies • Immediate Horizon: – Higher consumer expectations as they become more engaged in the outcomes and costs of their care – New Payment Models

Size & Scope of US Healthcare Market U.S. healthcare industry handles transactions of >$2 trillion per year Other healthcare related spend Not including


of bad debt

Consumer payments Premiums




Providers ▪ Physicians ▪ Hospitals ▪ Pharmacie s

1 Includes an additional approximately $190 billion from foundations or philanthropic organizations 2 Approximately $240 billion of this is spent on government public health and investment: research, structures & equipment 3 Includes consumer paid portions of: Nutrition, CAM, OTC drugs, cosmetic procedures, fitness, advise, and beauty SOURCE: National Health Expenditure Data; Centers for Medicare and Medicaid Services; Office of the Actuary; McKinsey analysis


Current Provider Collection Experience is Time-Consuming According to a 2013 survey of health care providers: – Doctors and hospitals often wait 75-150 days for payment – 50% of patient obligations go unpaid

Projected financial impact for providers In 2011, patient non-POS Write-offs totaled $102 billion Billed Collections

POS Collections

By 2019, patient non-POS Write-offs are estimated to exceed $189 billion POS Collections

Billed Collections

Patient Write-Off Source: Citi analysis, based on 2011 data from the U.S. Dept. of Health & Human Services and Center for Medicare & Medicaid Services.

Patient Write-Off

Patient Obligations are Growing • Patient payments averaged 30% of revenue in 20121 • 13% of providers interviewed state higher copays and coinsurance are most pressing payment issues2

Sources: 1 Citi analysis, based on 2011 data from the U.S. Dept. of Health & Human Services and Center for Medicare & Medicaid Services. 2 Citi analysis based on client interviews, conducted by Boundary Information Group (June 2013)

Bad Debt is Increasing • McKinsey - Bad Debt is increasing over 30% each year in some hospitals. • Yet, the McKinsey study found that 74 % of insured consumers indicated they are both able and willing to pay their out-of-pocket medical expenses up to $1000 per year. • The survey respondents indicated that a lack of options for payment plans, poor timing of bills and difficulties coping with confusing statements or policies were major barriers to paying.

And billing experience is important to overall patient satisfaction… and to providers

Greatest Opportunity in RCM • The Patient Financial Experience • Current state is fragmented – every process is different, even within the same health system • High dissatisfaction with the financial process

Revenue Cycle Improvement Task Force Purpose Convene innovative stakeholders from across the healthcare industry to create a vision for the next generation of revenue cycle management business processes and tools that will keep administrative cost containment, interoperability and consumer engagement front and center.

Membership Industry thought leaders from all major stakeholder groups, including physicians, hospitals, retail health clinics, payers, financial services, health plans, consultants, industry associations, and vendors.

Philosophy • Leave industry hat at the door • Journey of possibility-thinking • Patient-centric • Transparent • Efficient/Non-duplicative business practices • Leverage existing/emerging technology • Demonstrable ROI • Standards-based • User friendly • Reimbursement methodologies will not complicate the patient financial experience

Guiding Principles • Patient-Centric • Transparent • Efficient/Automated • Non-Duplicative Business Practices • Leverage Existing/Emerging Technology • Demonstrable Return on Investment • Standards-Based • User-Friendly • Motivates Stakeholders to Change

Brief History FY15 • Developed the vision; focused on the what, not the how • Created infographic based on a basic pre-planned office visit • Published White Paper outlining vision

FY16 • Expanded scenario used in infographic to include an episode of care involving multiple disparate providers delivering care in a variety of settings • Created microsite to illustrate this scenario • Conducted gap analysis using this expanded scenario to identify potential technical gaps that will need to be addressed to realize vision • Publishing paper outlining the results of the gap analysis • Call for Case Studies

Gap Analysis Purpose • Identify technical functionality needed to realize task force vision for Patient Financial Experience of the Future • Recognize available solutions/work under way that will drive the industry forward

Approach • • • • •

Identify categories of activity involved in typical episode of care Call out the technical functionality needed to support vision List potential gaps Acknowledge work currently under way Generate ideas for possible case studies

Examples of Work Currently Under Way • Several private industry solutions aimed at facilitating communication between payers and their patients, point-of-care payment activities, etc. • ONC – Health IT Certification Program – Patient Matching Initiative – Interoperability Road Map • HIMSS ConCert Program • WEDI Virtual Clip Board • HFMA Best Practices

Case Studies

Purpose • Call attention to innovative solutions that are moving the industry forward and could help close potential gaps • Encourage development of pilot projects that will help close potential gaps • Facilitate partnerships/collaboration • Demonstrate that the future is not as distant as it may seem

Case Study #1 Sponsors • Aetna and Patientco

Overview of Solution • Resolve the barriers associated with determining patient financial responsibility at the point of care • Facilitate patient payment at point of care

Target ROI • • • •

Increased price transparency Higher consumer satisfaction Increased collection of patient payments at the time of care Decrease in bad debt activities

Status • Identifying provider participants

Case Study #2 Sponsor • Healthmania

Overview of Solution • Radically improve quality while reducing cost of patient care by bridging data communication gaps • Facilitate electronic exchange of health plan and financial information

Target ROI • Increase healthcare price transparency • Enable comparison shopping for healthcare services • Deliver accurate patient financial responsibility information at point of care • Reduce administrative expenses for providers and health plans • Reduce provider bad debt

Case Study #2 – con’t Status • Prototype developed • Seeking seed funding • In negotiations with two alpha customers

Case Study #3 Sponsor • Health Payment Solutions

Overview of Solution • Provide consolidated document that serves as both a single bill for an entire episode of care, including those involving multiple disparate providers and various points of care and as an explanation of benefits

Target ROI • Improved patient financial experience • Reduced provider bad debt

Status • Solution has been in place in Wisconsin since 2008; looking for partners to expand their offering beyond Wisconsin borders

Get Involved • Participate in one of the case studies highlighted • Submit your own case study – Case Study submission form • Join the HIMSS Revenue Cycle Improvement Task Force • Check out our work products: – Patient Financial Experience of the Future Infographic – White Paper: Rethinking Revenue Cycle Management – Patient Financial Experience of the Future Microsite – White Paper: Getting From Here to There: A Functional Gap Analysis of the Patient Financial Experience of the Future

Contact Information Pam Jodock Senior Director HIMSS Health Business Solutions (312) 507-9924 [email protected]

Stuart Hanson Chair, HIMSS RCI Task Force (630) 235-0616 [email protected]

Joanne Bartley Manager HIMSS Health Business Solutions (312) 915-9251 [email protected]

Mike Olson Member, HIMSS RCI Task Force (630) 800-8765 [email protected]



Revenue Cycle Management Solutions of the - HIMSS conference

Moving the Industry Forward: Revenue Cycle Management Solutions of the Future Stuart Hanson FY16 Chair, HIMSS RCI Task Force SVP & General Manager, Co...

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