Top Revenue Cycle Trends in 2019

Top Revenue Cycle Trends in 2019.jpg

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2018 has been an eventful year for the healthcare industry. The shift to value-based career, increased outsourcing and offshoring by healthcare providers, increasing patient responsibility for payments, rising adoption of robotic process automation, rapid evolution of artificial intelligence solutions custom built for revenue cycle, and most importantly, increasing seamless in the flow of data between Payers and Providers, are some of the trends that will shape the industry in 2019. In this brief, we take a deeper look into these trends and the implications they have for revenue cycle providers:

1. Shifting Physician concentration to larger entities

Physicians are increasingly consolidating into larger physician groups, hospitals, and health systems to achieve economies of scale, create a stronger, branded healthcare experience and to have improved access to better technologies, all while leveraging better negotiating power with health plans.

Typically, the fee schedules of the larger entity get adopted during consolidation. More often than not, this leads to higher costs as health systems tend to add components of facility costs on top of the typical professional fee. Further, physicians operating in larger organizations tend to see fewer patients each day as a result of additional administrative work. The objective is for physicians to spend more time on care with improved coordination of care. However, the long-term impact of this will be increased cost of providing care and lower profitability.

2. Improving the Patient ExperiencE

Consumer-Directed Health Plans (CDHPs) are becoming more popular resulting in greater patient responsibility for the costs of care. As a result, collecting patient deductibles upfront is becoming a key to success. Further, value-based care is becoming a more viable reimbursement model – replacing the traditional fee-for-service model. With the overall patient experience in mind, healthcare needs to adopt a point-of-sale (POS) retail model where the cost of care and patient responsibility is communicated upfront.

3. Digital healthcare and focus on total well-being

The use of wearable devices that facilitate continuous monitoring combined with an increased application of analytics on population segments is on the rise. The total well-being concepts that tie medical, emotional, financial, and social well-being are more utilized in the delivery of care.

Connected healthcare technologies will potentially reduce costs, improve cost transparency, and provide improved access to healthcare.Patients want to know more about the healthcare conditions, get increased access to care when they want it, and be able to pay for the cost of healthcare.

4. Consolidation and technology trends

2018 has seen some of the largest multi-billion-dollar consolidation deals including CVS-Aetna, Cigna-Express Scripts, and other moves such as Amazon, Berkshire Hathaway, and JPMorgan Chase, creating a joint venture to reduce healthcare costs. Further, the industry has also seen multibillion-dollar investments by private equity companies (KKR acquisition of Envision and Veritas Capital/Elliott Management acquisition of Athenahealth) as well. Never before has the healthcare sector seen such intensified levels of investment flows.

Looking at broader trends, some of the key reasons for the investment flow into the provider technology space include 1) industry participants trying to own more components of the healthcare value chain, 2) technology companies making investments to enable a more connected healthcare system, 3) best practices from other industry verticals such as retail and financial services being applied to the healthcare space, and 4) the need for increased cost transparency and mechanisms to reduce costs.

5. Revenue cycle platforms – strengthening cloud-based models

The shift to cloud-based revenue cycle platforms will continue to surge. While numerous platform players have begun to focus on different specialty niches, we anticipate further consolidation of platform players as the new connected ecosystem demands increasing investments in analytics and more seamlessness between inpatient and outpatient platforms. We see significant consolidation of revenue cycle platform players with this increased focus on consolidated inpatient and outpatient environments.

6. The rise of value-based reimbursement models

The Affordable Care Act led to value-based reimbursement models, which are now expected to surpass fee-for-service payments in the next three years.  An increasing number of healthcare institutions – commercial insurance and health systems – are innovating and developing newer models for value-based reimbursements. As per Aetna’s 2018 Healthcare Trends report, over 59% of healthcare payments will be value-based by 2021.

7. Cost containment focus

Cost containment focus takes center stage to address 1) high deductible plans/out of pocket costs, and 2) value-based reimbursement and 3) increased regulatory compliance (i.e. ABN, MSP, MIPS, HIPAA, Utilization Review/Case Management, and Site of Care Policies). Healthcare executives are continuously looking for ways to reduce costs – particularly labor – and increase profitability without sacrificing patient care quality.

8. Intelligent revenue cycle automation technologies

According to many industry analysts, about one-third of revenue cycle processes can be automated. Revenue cycle processes are comprised of a high volume of business rules-driven repeatable processes – a perfect business case for applying intelligent, robotic process automation technologies. 

The priorities for revenue cycle decision makers have been shifting to the front office - improving the complex prior authorization, eligibility, and benefits verification processes to determine patient responsibility effectively. Further, the back-office revenue cycle is seeing higher claim denial rates. Web-status automation and intelligent analytics that can address denials effectively are technologies that will increasingly become more utilized.

9. Telemedicine is finally coming of age

With more than a quarter of the US population subscribing to managed care plans, telemedicine is a key component of value-based care. Today’s healthcare is increasingly being provided by accountable care organizations and managed care groups. Large employer groups/self-funded plans are utilizing telemedicine to cut costs and expand access to providers, and we anticipate that there will be increased adoption of telemedicine trends. This trend is further fueled by the growth of wearable devices and the ability to monitor chronic conditions in real-time.

10. Population health to improve the delivery and cost of care

Population health analytics enables caregivers to achieve the dual objective of reducing healthcare costs while providing better care outcomes. The process requires a three-stage approach 1) patient risk stratification to identify patients with high risk of negative health outcomes 2) understanding the cost of care for these high-risk individuals, and 3) effective care coordination.

The transition from an understanding of healthcare data of patients to driving effective care delivery is by no means an easy task and needs to be embedded in patient-specific workflows.

11. Utilize the power of analytics to improve the effectiveness of your revenue cycle

With reducing reimbursements, provider organizations are under pressure to ensure their healthcare revenue cycle is operating at maximum efficiency. While industry-standard KPIs, such as HFMA’s Measure, Apply, Perform (MAP) Keys, and MGMA’s DataDive, provide effective mechanisms to assess performance against industry benchmarks, the time has come to shift the paradigm and integrate these insights into your operational workflow.

12. Getting serious about cybersecurity

A total of 4.4 million patient records were compromised in 117 health data breaches in the third quarter of 2018, according to the latest Protenus Breach Barometer. As many as 50% of these incidents were a result of hacking, followed by about 23% coming from insider incidents. Protecting the privacy and security of consumer information to maintain consumer trust in sharing data is critical to the success of the changing business of healthcare. On one side, there is a need to allow a seamless flow of information, on the other side, there is the growing number of information security incidents to contend with

About the Author:

Manish Jain brings over 15 years of experience in solution design, sales, and marketing healthcare and financial services customers. He has extensive knowledge in healthcare business process and IT outsourcing solutions. He heads all marketing and sales enablement activities for Access Healthcare. He can be reached at manish.jain@accesshealthcare.com.