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In this Business Profile, Rick Heise, senior vice president, revenue cycle, at Cerner Corporation, discusses the importance of integrating clinical and financial data to excel in health care’s changing payment environment.

Cerner Rick HeiseTell us a little bit about Cerner Corporation.

Although we are part of the healthcare IT industry, we consider ourselves a health company. Our focus is on solving healthcare challenges by leveraging innovative clinical and financial IT solutions. We continuously work with our clients to leverage automation for reducing costs while improving care. 

We continue to see strong demand for our solutions and services, which has allowed us to continue to invest in advancing our capabilities. We’ve invested more than 12 percent of Cerner’s revenues in research and development annually, with more than $450 million of investment expected just this year. 

My role at Cerner is to ensure we’re aligned with our clients to deliver solutions that help with the complex financial management needs in health care. We support our clients with a traditional set of core financial solutions focusing on patient access, health information management, and patient accounting as well as innovative solutions that connect clinical and financial data, such as integrated case management and contract management. We also provide revenue cycle management services where clients need support beyond technology in their revenue cycle operations.

We often get asked how many clients we have live on our solutions. Our footprint in the industry across all of these solutions is quite large. Clients who have adopted our full revenue cycle suite include 150 unique organizations across more than 1,300 facilities.

What are some of the biggest challenges you see affecting how healthcare organizations financially manage their business?

Healthcare organizations are under tremendous pressure to reduce costs and prove quality outcomes. With declining reimbursement and an increasingly complex regulatory environment, it’s making it extremely challenging for these organizations to maintain margins and continue to invest in care delivery.

At the same time, there is also a shift underway whereby healthcare organizations are taking on a higher level of financial risk through various population health delivery models. The focus of these strategies is to take a different approach to managing populations through more proactive patient engagement and effective quality based incentives. This shift is also creating a different set of payment models and measurement systems. The real challenge for these organizations is they will need to operate in both the traditional event-driven reimbursement environment in addition to dealing with new reimbursement models (accountable care organizations, bundles, narrow networks, etc.).

What changes do you see for healthcare organizations as they begin addressing the shifting payment environment?

What we measure today in health care will be different from what we measure in the future, as organizations take on more risk in these outcomes-based models. 

The shift will, over time, see less of a focus on event-driven reimbursement and a greater focus on utilization and proactive, long-term health for patients. We are working with our clients to measure utilization trends such as unplanned care, gaps in care, out-of-network services, and so forth. Cerner’s excited to be at the forefront, leveraging our integrated clinical and financial solution portfolio and our significant investment in capabilities to manage these changing delivery models and financial environments.

Can you share some key considerations for healthcare leaders when considering how best to integrate clinical and financial data in such a way?

Over the past few years, we’ve seen advancement in clinical automation due in part to a significant boost from the Affordable Care Act and Meaningful Use incentives. This has created an important opportunity for organizations to leverage clinical automation to drive efficiencies in the revenue cycle. Organizations that can efficiently connect clinical and financial information across all care venues will be most successful in the current and evolving healthcare market.

The integration of clinical and financial data is a requirement for both current and future reimbursement models. When a healthcare organization has a clinically driven revenue cycle, it can create leverage across its IT infrastructure and revenue cycle operations.

For example, having technology in place that makes revenue cycle a byproduct of clinical activity creates an opportunity to automate workflows that previously required human intervention. Automated scheduling and charging are several of the key areas of benefit. There are also a number of more complex workflows that we’ve automated to ensure efficient communication between patient financial services staff regarding clinical denials management. For example, we’ve developed decision support technology that enables denial/variance indicators to automatically notify clinicians that key information is needed to avoid a denial before it happens. This kind of centralized, efficient method of communication reduces a previously fragmented approach to interdepartmental communications and delays in cash.

How can Cerner’s innovations help organizations position themselves for success when transitioning from legacy revenue cycle solutions and supporting daily operations?

Making the shift off of a 20-plus-year-old legacy revenue cycle solution can be disruptive, but necessary, and it requires strong change management around how your revenue cycle staff completes their work. Historically, revenue cycle tasks have been performed through batch processing and an inventory model where a majority of all transactions are audited and reviewed. We’re moving our clients toward a vision of an exception-based model, where revenue cycle staff reviews only exceptions and the amount of human intervention is reduced.

Key investments we have made include integrated workflow for the complex environment of EDI [electronic data interchange]. Functions such as integrated eligibility, medical necessity, and claims management have been embedded into the core workflow for end users, therefore reducing the need to launch into a bolt-on solution to accomplish key revenue cycle tasks.

Most recently, we released our integrated contract management system to support expected reimbursement variance analysis, and soon we will be releasing contract modeling and patient bill estimation functionality—all of which are fully integrated into the core revenue management solution.

Those are just some of the development examples of how Cerner thinks about the revenue cycle, and how we’ve tightly aligned our clinical and financial solutions using a single platform. Organizations are finding integration to be increasingly important to take out cost in their revenue cycle. This level of integration has allowed us to help clients automate and connect clinical and financial data across all venues of care, enabling them to maximize efficiencies in both care delivery and payment processing.

Where can readers learn more about Cerner’s suite of solutions and services?

Cerner provides a number of ways for the industry to learn more about what we’re up to, and how we can better support our clients. We encourage clients to connect with each other and learn from each other’s decisions and experiences, so they can understand new and creative ways their peers are leveraging our suite of solutions and addressing workflow challenges. In 2009, we made connecting clients easier when we introduced uCern, our social media-like platform that offers clients the opportunity for real-time connections with their peers and Cerner associates.

We also encourage providers to visit www.cerner.com/revenuecycle. There they can easily explore the solutions and services we provide to different healthcare venues, hear from some of our clients through videos and testimonials, and see what Cerner-sponsored events and industry events we’re participating in throughout the year. 

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

Content for this Business Profile is supplied by Cerner. 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. 

 

Publication Date: Saturday, November 01, 2014