Thursday, May 5, 2022

Bridge the gaps between payer and provider by automating your revenue cycle

The health care industry is rapidly evolving. COVID-19 has uncovered a litany of flaws in health care systems, leading to massive changes in the way patients, providers, and payers communicate and operate. One of the highest impact changes in the industry is the widespread shift from a traditional fee-for-service reimbursement system to value-based care. Instead of being incentivized to fill beds, order tests, and perform procedures, care providers are compensated based on patient health outcomes. Innovations in how care is delivered, like the shift to value-based care, are not so simple as a turn of a switch. One process contingent on the success and longevity of provider innovation is their relations with payers.

How payers and providers collaborate to ensure patients receive adequate care is critical to positive outcomes. So, it would seem essential that these two separate, but complementary entities develop a positive, efficient relationship to streamline the claims adjudication process and ultimately provide each other value. This is not the case, though, as the relationship between payer and provider has been historically challenging. Consequently, over 75% of clinicians, clinical leaders, and executives polled by NEJM (New England Journal of Medicine) said misalignments between payers and providers prevented them from realizing improved value.

Payers and providers must align administratively, clinically, and economically to mitigate these problems. While this is hard to achieve, it becomes more realistic when communication and visibility are strengthened. On the provider side, deploying an automation-driven revenue cycle management (RCM) strategy will help align the two parties. Antiquated RCM strategies are prone to manual errors and add unnecessary stressors to the payer-provider relationship. By deploying an RCM strategy that leverages intelligent automation, providers and payers can cut down on ambiguities and errors, reducing the odds of claims denials, miscommunication, and lost revenue.


Find the value in data



Automating RCM allows providers to extract, analyze, and deliver data key to keeping the revenue cycle running efficiently and effectively. One piece of the provider-payer relationship that heavily influences misalignment is information. When the data in question and the way it is being shared are points for disagreement, alignment becomes nearly unattainable. With the growing complexity of reimbursement and collection requirements from payers, implementing an automated RCM platform increases a provider’s productivity gain. If providers can pull value and insights from their data, they are given actionable information that improves workflows, streamlining communications between payer and provider.

Cut down on claims denials


Cutting down on claims denials is a massive step towards alignment. Providers often feel that their arms are tied behind their back when settling claims with payers. The claims process is so fragmented and inefficient that any tiny data discrepancy will result in a denial. The claims process has become so complex that health care providers spend nearly $30 billion a year on billing costs. Integrating an automated RCM solution will help reduce the difficulty around claim and payment management. Most automated RCM systems also include denials management services. Providers can easily avoid manual errors, cut down on administrative tasks, and ultimately automate a complex billing process. Fewer denials inevitably mean less back and forth between payer and provider, de-stressing the relationship between the two parties. Using machine learning to revolutionize the collection and management process automates the denial processes, improving collection efficiency and accuracy while boosting payer-provider alignment.

Bottom line? Automation


Automation has taken the health care industry by storm. Its effects can be felt from the patient experience to clinical trials. From streamlined workflows to improved care, automation has transformed health care. The same reality exists for RCM solutions. Revenue cycle automation tools empower your organization to cut down on the inefficient processes and massive workloads that face health care. Without an automated revenue cycle, the relationship between the payer and the provider will remain as fractured as ever.


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Wednesday, May 4, 2022

How every medical practice can meet patient demands for digital convenience

In a world with Amazon Prime and Uber, everything revolves around customer convenience—and that's a big deal for physicians trying to build a successful practice.

Global consumer brands are setting the expectations that even the smallest healthcare organizations must meet. We're all accustomed to managing almost every part of our lives using our phone or laptop. We buy groceries and bank online. We request a ride or make a dinner reservation with a phone app. With smart speakers, songs and even jokes are just a spoken word away.

But too often, people find that contacting their physician's office takes them back to the old days of phone calls and hold music. And they expect better.

The demand for digital


In a recent survey, 61% of respondents said they'd like healthcare to mimic the experience provided by a customer service digital app.[i] Even more (79%) said they want the ability to use technology to manage their healthcare experience.

There's clearly a demand for modernization, and the practices that can meet that demand will thrive in the years ahead. Without the ability to offer convenient service, practices risk falling behind in an increasingly competitive healthcare market, especially as the rise of telehealth gives patients more options about where they go for care. Plus, if patients can't interact with their providers in the ways they prefer, there's a risk that they won't engage fully with their care, increasing the likelihood of adverse outcomes.

By creating a "digital front door" for your practice— a means of “greeting” patients and quickly directing them to what they need—you can attract and retain more patients, reduce the workload for your staff, and encourage patients to be accountable for their care.

But taking on digital transformation by implementing single point solutions that solve for, say, online appointment scheduling or patient portal password resets isn't enough. To deliver its full value, a patient engagement strategy must meet the patient where they are — on the phone, online, or over SMS — and be infused with intelligence. That's where AI comes in.

AI multiplies the value of digital engagement


One of the biggest advantages of powering patient engagement solutions with AI is that it enables a high degree of automation.

With AI-powered virtual assistants, you can automate support for many common patient inquiries, delivering assistance within conversational dialogs. Patients are happy because they get fast answers to their questions. And practice staff are happy because they have fewer routine inquiries to handle, so they can focus on more valuable tasks.

The best virtual assistants integrate data from various sources and use advanced natural language understanding (NLU) technologies to determine what patients want to achieve, understand the context of the conversation, and provide relevant, personalized responses.

For example, a patient who lost their discharge instructions after a hospital visit might have questions for their physician. An intelligent virtual assistant can intercept that contact, understand that the patient was recently in the hospital, ask them if they need a copy of their discharge instructions, and text or email them a link to the information right away.



But of course, sometimes you don't want to wait for patients to get in touch—you need to make the first move.

It pays to be proactive


If there's one problem every physician can relate to, it's appointment no-shows. They're a constant thorn in the side for most practices; they delay care, waste physician's time, and damage revenue—but there's a simple way to reduce no-shows dramatically.

Patients often miss appointments because they forgot or weren’t notified. But even when they receive reminders, rescheduling or canceling can be time-consuming and difficult. Nobody wants to wait on hold for 20 minutes to cancel an appointment, so plenty of people give up or don't even bother trying.

Now, imagine a patient receives an SMS appointment reminder with the option to confirm, cancel, or reschedule simply by replying to the message. There's no need to call, and if they need to reschedule, the AI behind the message engages them in a natural, two-way dialog to find an appointment that suits them. Everything's done in a matter of seconds — they have an appointment they’re likely to keep, and waiting list or last-minute patients can fill the vacated slot.

Automated, proactive communications like these can be useful throughout a patient's care journey. For example, AI systems can automate delivery of reminders about follow-up actions ("Did you book your lab appointment yet?"), care plans ("Do you need assistance with your prescription?"), and preventative care ("You’re due for your annual mammogram.").

This proactivity increases patients' engagement with their care, improves outcomes, and bolsters your practice's reputation—all without adding to your staff's workload.

AI isn't just for digital


The phone may be considered a low-tech means of contact, but even here, AI can revolutionize this means of communication. An AI-powered interactive voice response (IVR) system can steer calls to automated assistance with common inquiries in the same way a virtual assistant on a website helps patients schedule appointments, refill prescriptions, find answers to questions, and more.

Today's conversational IVR can be incredibly sophisticated and use advance NLU to deliver a natural interaction that's like talking to a human. Patients quickly resolve their issues by expressing their needs in their own words and rather than choosing from presented options or navigating complex menu trees.

Convenience is king


It's vital to create a patient engagement strategy that meets patient expectations and fits into busy lifestyles. Patients want the convenience of connecting with your practice however and whenever they want — by phone, website, or text, inside or outside of office hours. With intelligent patient engagement solutions, practices can automate interactions and deliver 24x7 high quality service that meets those needs.

By making it easy for your patients to manage their care, you create stronger relationships, reduce workloads and costs, and ensure a long and fruitful future for your practice. Most importantly, you improve care outcomes for the patients you serve.

______________

[i] Tegria/Harris Poll survey of more than 2,000 US adults, February 2022


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Tuesday, May 3, 2022

Hallmark indicators: Signposts to chronic care management

For clinicians, the key to chronic care management is having ready access to hallmark indicators that can mark the progression or control of a disease.These hallmark indicators (also called ‘key indicators’) are typically a set of six or seven measures that a physician would monitor, over time, to track the progression or regression of a particular illness. With diabetes, for example, indicators would include blood sugars, glucose levels, renal function, foot neuropathy, and other measures.

With easy access to hallmark indicators at the point of care, providers can proactively engage the patient, their family, and home care providers and make them aware that these are things that must be monitored closely, as they could indicate a problem.

Monitoring and reporting key indicators in real time can help communication between the provider, the patient, and the payer and make chronic care management vastly more efficient. However, the success of such a dialogue hinges on providing comprehensive, problem-oriented views of clinically contextual information to providers at the point of care.

Ideally, hallmark indicators are presented on a ‘dashboard’ at the point of care––providing physicians and nurses with at-a-glance access to historical data for the patient and the ability to identify trends and determine where a condition is heading. But most clinicians don’t have ready access to such information. Many indicators are results from lab tests, are not compiled in a list for a specific condition and are usually strewn throughout an EHR––packed in with everything else and requiring time and effort to locate.

One example of such a dashboard is at Phoenix Children’s Hospital, which has over 60 disease-specific panels displaying key indicators for clinicians to use at the point of care. Using them, the hospital reduced disease progression for juvenile arthritis by about 80% by actively monitoring a hallmark indicator––joint counts––both in the physician’s office or with the patient calling them in from home, and then coupling that information with the medications and lab tests. With that view, physicians can determine that by fine tuning the medications how they can improve outcomes. They are successfully moving the quality-of-life needle––both for the afflicted children and those who monitor their condition. Today, the hospital uses these dashboards to monitor 60 distinct diseases ranging from chronic lung conditions to gastrointestinal disorders and are seeing similar results.

This clearly illustrates that when clinicians are given the data they need in an accessible, consumable format, they can improve the quality of the patient’s life much more easily. The same is possible for nearly all the chronic diseases because they all have hallmark indicators. It’s just a matter of getting the right information in the right place, at the right time, in front of the right person.



The sharing of this information benefits payers as well. Payers are interested in reducing cost, which is done by keeping members out of the hospital and carefully managing their chronic conditions. The technology to make this connection exists. For example, there are many home monitoring systems to provide data directly from the patient to the HER, and then to the doctor. This allows the care team to see in real time if they are treating a particularly vulnerable patient who must have their insulin frequently adjusted. It’s an easy way to connect the dots.

The same applies for a condition like COPD. Symptoms such as shortness of breath can be reported on a phone and recorded into the EHR. The physician is alerted and can start intervention earlier. Similarly, with congestive heart failure (CHF) a sudden weight increase can indicate water retention, which could signal an exacerbation. Patients can track their weight with scales that log the results directly to a smartphone app, where it can be tracked in real time. If a provider and a patient are communicating––even electronically––there can be alerts set up. The provider can respond and ask about a weight increase, which could be as resolved with something as simple medication adjustment. Again, access to indicators and having an automated dialogue in place is essential.

Such real-time tracking is increasingly mainstream and will become more sophisticated over time. Apple now offers a watch that includes atrial fibrillation detection, and will soon offer blood sugar detection. These advances will make chronic care much easier by providing real-time data in a window where interventions can be applied patients become critically ill.

During my years as an internist, many of my patients had four or five different conditions, and many had some overlapping/common indicators. Multiply this by the number of patients covered by a practice, and you get a sense of how much data is flooding the medical record.

This raises the question: How does a clinician, in a timely manner, navigate and sort all that information to find the data pertinent to a specific condition? The data must be filtered and presented so the clinician has all the information pertaining to this patient related to this disease. To be effective, the presented information needs to be purged of ‘clinical noise’ to allow the clinician to focus on a particular problem. Then they can easily switch to the next problem and focus on that to make the needed decisions.

Clinicians are constantly putting this type of information into clinical context––in their heads. However, the volume of incoming data today is so immense that things can easily be missed. Since we have the technology, why not let the computers do the heavy lifting so physicians can drive better outcomes?


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