Value Based Care, Predictive Analytics and Consumerism 3 Trends Impacting Revenue Cycle Management
At the annual HIMSS conference in Orlando this year I spent some time talking to Ric Sinclair, the VP of Product for ZirMed. We always like catching up with Ric, as his insights on current and future trends impacting revenue cycle management are always on point. You can also listen to the podcast of my interview.
How should healthcare organizations be adapting their revenue cycle processes and strategies for this new world of value-based care? It’s a primary focus of the healthcare industry and a big theme this year at HIMSS.
Ric: You know, that’s been a hot topic at the booth too, as well as quite a few sessions. What we see is this return to normalcy and pragmatic behavior, where healthcare providers of all shapes and sizes are starting to focus on two keywords, and that’s “cost” and “utilization.” So understanding what their true cost is for every procedure and understanding how all of their resources, both personnel as well as non-technical, are being utilized ultimately is what’s making up bottom line. So when we see people going to value-based contracts, when we see people moving off of fee-for-service arrangements, if you don’t understand your charging patterns incidentally and you don’t understand what your services are actually costing you, it becomes very difficult to properly negotiate a contract with a payor or be looking at market expansion or be looking at an acquisition. When you’re going to move into a world that’s paid on quality, not quantity, you just have to rethink things.
So what do you see as some of the challenges organizations are facing when it comes to protecting revenue? Obviously, this is part and parcel of our world moving into value-based care.
Ric: Yeah. We see clients have this just unbelievable focus now on protecting revenue from all of the walls of their business. And by that, what I mean is not only do you have to focus on costs, like I talked about, but you still have to be just insanely aware of your reimbursement processes and practices from insurance companies, and you also have to be aware of the continued rise of just the consumerization of healthcare.
And so, when you think about kind of that triangle, at the top or the bottom, if it’s an upside down triangle, let’s say, I don’t know what that shape is called. It’s probably still a triangle, but at the bottom of it you have your costs and utilization, and then that is interconnected to how I’m reimbursed from payors, and how do I do that efficiency through leveraging analytics and leveraging really smart tools and processes, to how I’m reimburse by patients and how I understand what their payment expectations are and deploying really good technology and deploying really good just services and treating people well. And you have to balance all three of those things. You can’t focus on one or the other.
You talked about the consumerism of healthcare last year, and that’s a narrative that obviously is expanding. What are your current thoughts?
Ric: It’s continuing to grow. Earlier this year even, we launched just a massive upgrade to our financial services platform, where we’re processing over \$2 billion of credit card payments. We have patient-facing payment plans now, where patients that are empowered themselves to set up a payment plan on their terms with healthcare providers, and they can do that from their phone, or they can do that from the comfort of their home. And we’ve seen massive explosion of the number of payment plans we’ve set up even in the last 45 days since this thing launched.
What do you see on the horizon for revenue cycle management?
Ric: Organizations are starting to really embrace predictive analytics and starting to embrace analytics to drive things like prevention and prediction. So historically, when people thought of analytics, it was let me report on things that have happened and let me think through how I can do some analysis for that, right? So whenever anybody says “analytics,” they think of these KPIs and they think of these dashboards. Where we see the kind of forward-thinking organizations going now is they’re starting to look at things that they used to manage, say something as tangible as denials, and they’re looking at how they can now prevent and predict denials. So we’re working with organizations across the country to take all of their data and aggregate it together, put it in some algorithms, and then ultimately stop claims from going out the door that have a high likelihood of being denied, and then intelligently routing that back to our provider clients.
So just doing things like that, where you start to see other industries have invested hugely in this technology and now it’s really coming to light in the healthcare. We’ve been talking about things for a while, and ZirMed has always been more of a doer. We really value execution, and to start to see our providers around the nation embrace the technology that we’ve been building, sometimes ahead of even the market adoption curve, it’s just been really humbling to see and it’s been really great to see, because ultimately we’re driving cash and helping our customers get paid.
So before I let you go, can you talk a little bit about your new contract modeling solution? What’s that about? How does it benefit providers?
Ric: So we took a product that exists in the market kind of randomly today, that we viewed as being a little legacy and commoditized, and that’s just other vendors’ contract management modeling products, and we launched something brand new on really, really fresh, modern technology. And so we co-launched a contract management, modeling and payment variance platform, and what that allows our customers to do is take kind of the burdensome process of figuring out how they can forecast out the best reimbursement terms for them in near real time. And this is something that typically took organizations days to do. And we give them enterprise-wide analytics that go across their entire facility, their payer reimbursement process down to the individual claim level and manage the entire appeal process, the entire payment variance process as well.
So it’s truly an analytical tool that allows a healthcare organization to look strategically at where they should be making investments, how they should be entering negotiations with payers, where they should be going at risk, where they should potentially even be making acquisitions. And we’ve had some great results from case studies. In fact, we recently released, in our press release, a CFO of a hospital that used it has been blown away by the results, and they’re a valued partner of ZirMed. This is something we just announced at HIMSS, and so it’s starting to build a lot of market traction, and we expect this to be kind of a gangbuster product for ZirMed and for our clients in the next year.