Advertisement

In this Business Profile, Amy Amick, president, revenue cycle management, and William Davis, vice president, revenue cycle advisory solutions, both with MedAssets, share insights on the industry and techniques to drive sustainable performance improvement.   

Tell me a little about your organization.

Amy Amick MedAssetsAmy Amick: Today, providers are burdened with increasing financial pressures, which not only challenge organizations’ aspirations to provide the highest quality of care for their communities, but also their ability to remain financially viable. Our objective at MedAssets is to help our clients overcome this pressure via sustained improvements. More specifically, we help our clients across both supply chain management and the revenue cycle continuum to reduce the total cost of care, enhance operational efficiencies, align clinical delivery, and boost revenue performance. We provide an informed approach to not just surviving, but thriving in the changing healthcare market.

William Davis MedAssetsWilliam Davis: We are in four out of five hospitals in the United States, and support more than 122,000 providers. We focus on the core challenges in an organization’s revenue cycle through the use of proprietary technology solutions, data analytics, and deep subject matter consulting to support the organization in efficiently and effectively optimizing processes and improving workflow. Whether an organization needs help with contract modeling, capturing revenues, or developing dependable pricing strategies, we bring great breadth of expertise through a comprehensive portfolio of revenue cycle solutions that range from access integrity all the way through collections. 

What are some of the biggest challenges you see affecting healthcare organizations?

Amick: Healthcare delivery is a low-margin industry to begin with, so the unprecedented pressures to minimize cost and maximize revenue in our current operating environment are very real. With the growth in Medicare and Medicaid populations, most organizations are challenged to do more with less. And at the same time, dramatic industrywide payment reform is underway with the shift from fee-for-service to value-based care. Most providers are working in a mixed model with multiple types of reimbursement reform in play.

Davis: Transparency is also bringing new challenges. Price transparency means that providers need to have clarity around their business goals and market strategy so that they can manage to those objectives, whether they want to be recognized for value pricing or clinical quality in key market segments, for example. Also, as consumers spend more of their own money due to higher deductibles, they are becoming increasingly active participants in choosing which services to receive as well as where to receive them. This trend is really just gaining momentum. It’s also important to note that transformation is taking shape differently in individual markets, and due to unique constraints, it’s critical to gain visibility into what is occurring locally in the regional market. 

How do your services address these challenges?

Amick: When an organization is navigating change of this scale, a number of levers can be used: technology, new processes, and/or outsourcing those areas that are not core competencies, to offer a few examples. That’s where we can help. Our breadth of experience and depth of products and services allow us to design, implement, and support a customer-specific strategy and a holistic solution that meets the true needs of the organization. It’s not a cookie-cutter approach. While some providers may just need assistance in leveraging a new technology, others will need information, training, education, and ongoing real-time support to excel and sustain higher performance.

Davis: We also really emphasize providing the right solution at the right time. An organization may be struggling with a number of operational pressures—revenue compression, personnel, and a new service line, for example—so we will identify actionable solutions that are sustainable to address whatever those pressures are. The key driver is really our ability to leverage data through analytics on a go-forward basis for incremental adjustments that drive long-term gains. For instance, understanding where an organization ranks when benchmarked against peer organizations or the industry as a whole can inform one’s decision on how to best manage risk. Likewise, an accurate snapshot of current cost and payment structures with respect to current performance and clinical outcomes is the best way to determine financial viability under alternative payment scenarios or before entering payer negotiations.  

Can you share some key considerations for healthcare leaders with these kinds of needs?

Davis: Although point solutions are useful, it is even more important to ensure you are partnering with a supplier that offers an integrated spectrum of solutions. Unless you drill down with a root-cause analysis and corrective action planning to ensure sustainable improvement, you may end up with a temporary fix for one part of the revenue cycle that will break somewhere else. Also, performance improvement is data-driven, so it’s important to have those analytics capabilities to help understand both key performance indicators within the organization and to benchmark the industry. 

Amick: As an additional example, I’d offer that there is a danger in choosing a claims solution that simply reflects published codes in the table. Because there are substantial differences based on the location and type of care that organizations provide, it’s critical to engage a partner that has the competency, technology, and staffing to keep current on payer trends. We provide more than 1 million claim edit checks in less than a tenth of a second, automatically. You want that automated capability so you can constantly refresh and to ensure your approach reflects recent marketplace dynamics, allowing you to keep pace with change. And as another example, in our chargemaster service area, our benchmark database ties to over 95 percent of a hospital’s growth revenue. There’s very seldom an exception where one would need to gather work off-cycle.

Improve Revenue Performance Solutions MedAsset

Any other tips for how organizations can best set themselves up for success in integrating these types of services into daily operations?

Davis: In our most successful engagements, we commonly find three things: first, a strong executive and operational sponsorship that results in a common understanding of the challenge and how to solve it; second, a culture of visibility and transparency that promotes buy-in and discourages silo thinking; and lastly, a core belief organizationwide that the approach is valid. Meaningful performance improvement is very difficult to achieve in the absence of any of the three. 

Where can readers learn more about strategies and tactics for improving revenue and sustaining performance improvement?

Amick: Related to pricing, we’re offering an HFMA hosted webinar on Thursday, Oct. 9 entitled, “Six Strategies to Keep Your Hospital Out of the Pricing Headlines.” MedAssets also is committed to leading the industry in meeting the requirements of the ICD-10 code set transition, so we’ve made a playbook available for how to maintain profitability.

In addition, I recommend readers check out our blog to learn more about our current recommendations on a range of best practices for performance improvement. And finally, I’d encourage people to read our recent Industry Insight on bundled payments and global capitation, two methodologies with multiple considerations and moving parts under value-based care. 

MedAssets

HFMA is the nation’s leading membership organization for more than 40,000 healthcare financial management professionals. This Business Profile is funded through advertising with leading solution providers. Learn more.

Content for this Business Profile is supplied by MedAssets. This published piece is provided for advertisement purposes. HFMA does not endorse the published material or warrant or guarantee its accuracy. The statements and opinions of those profiled are those of the individual and not those of HFMA. References to commercial manufacturers, vendors, products, or services that appear do not constitute endorsement by HFMA.