In this Business Profile, Jeff Chester, senior vice president and chief revenue officer at Availity, shares his thoughts on “Revenue Cycle 2.0” and how to best meet its challenges.

Jeff Chester, SVP and Chief Revenue Officer at Availity, shares his thoughts on Revenue 2.0Tell me a little about your organization.

Availity was founded in 2001 by Florida Blue and Humana with the goal of making it easier for health plans to engage with providers in the state of Florida. Currently, Availity is one of the nation’s largest healthcare information networks, with more than 575,000 active providers, and is now owned by Florida Blue, Humana, HCSC, Anthem, and Blue Cross and Blue Shield of Minnesota. We’re active in 26 Blue markets with a minimum of 60 percent of payers in those markets, and we manage more than 7 million transactions daily through our web portal. Over the past decade, Availity has built a portfolio of Revenue Cycle Management Solutions with a continued focus on improving the exchange of information between health plans and providers. Most recently, Availity acquired RevPoint, a patient-access solution helping providers manage the impact of high-deductible plans and increased patient financial responsibility.

Today, we think of ourselves as a platform and network that supports the standardization, integration, and automation of the critical data that needs to be shared between health plans and providers. As the industry transitions to value-based payment models (from fee for service), different kinds of data must be shared between physicians and providers for payments to be made. It’s “Revenue Cycle 2.0,” if you will. Availity is uniquely positioned to efficiently move information and address these needs, because of our experience working for both health plans and providers over the years.

Tell me more about “Revenue Cycle 2.0.” What are you seeing exactly?

In the past, health plan and provider systems were built in silos and unintentionally worked against—versus with—each other, which has led to a 30 percent average claim denial rate industry wide. Under value-based payment models, clinical, administrative and financial information systems need to be integrated.

Revenue Cycle 2.0 demands improved sharing of cost and quality data. Models such as accountable care and shared savings programs are based around performance metrics. Yet many organizations lack the tools to properly track and manage these metrics across care settings. Without these metrics, providers won’t be able to demonstrate achievement of their efforts. Proper data management and associated workflow practices must be in place for value-based payment efforts to succeed.

How does Availity support this value-based shift?

What’s exciting about the platform we built and network we’ve created is that they facilitate information exchange among providers and health plans in ways that will be vital to drive value. For example, one area of focus for us is automating the exchange of information between providers and health plans who are managing risk- based agreements, such as Medicare Advantage. This is a very expensive and labor-intensive process today that Availity can simplify. By more efficiently sharing information about the patient’s level of illness, care providers and health plans can improve care delivery while simultaneously reducing risk when they focus on populations with chronic conditions, such as diabetes and congestive heart failure.

Are there any other issues that should be top of mind for financial executives as they face the coming era of health care?

Another key issue is the shift that is occurring with the patient’s role in revenue cycle. For many years, the healthcare economy has operated in such a way that patients didn’t hold ownership for many costs. Physician appointments and tests have been paid for by third parties in a fee-for-service world. But this dynamic is changing, as many individuals are now participating in high-deductible plans. These patients are far more engaged as consumers and want to know how much they will be expected to pay out of pocket. Going forward, it’s critical to empower providers with cost estimation tools that help them to better anticipate and address patient financial responsibility.

We’re supporting providers in addressing this need with our Patient Access solution. The tool gives healthcare providers the ability to quickly capture and manage patient financial responsibility at the point of service to protect and accelerate cash flow. It even assists point-of-service staff with guidance and scripting, so they can appropriately educate patients about their financial responsibilities and payment options. Our customers are seeing significant improvement with collections.

What tough questions should organizational leaders ask when evaluating companies that offer these types of data solutions?

It’s important to ask vendors about their platforms from two perspectives: security and innovation. First, what measures are they taking to keep their customers’ information secure? And second, do they provide a platform that will position their customers to innovate with the current pace of industry change?

I would also ask about a supplier’s three-year business plan and current ownership status. Mergers and acquisitions are hot in this area right now, but acquisitions can be disruptive. When you look at companies that sustain success over time, they typically remain true to their purpose at inception.

From the beginning, Availity’s solutions have been informed by the real-time communication needs of both provider and health plan stakeholders. So we bring more than a decade of experience in reducing wasteful transactions and adding value. Also, because we have no plans to go public, our decisions are driven by the customer experience, rather than meeting quarterly financial targets. We measure success through a user experience that delights our customers, as evidenced by net promoter scores that far exceed industry averages.

Any other advice for making the best match?

Ask to speak with a current, established customer (more than a year) that is of a similar size, geographical location, and IT footprint. Find out which products they are using, ease of implementation, and whether they are noticing any workflow improvements. Ask if they are using a basic product, or if they’ve added any features that might have enhanced their user experience. You should expect to see success with a like organization. It’s the best way to feel confident about your decision.

Where can readers learn more about Availity’s suite of solutions?

I invite readers to visit us online to learn more about our products and solutions. I also encourage them to look at our original e-books, research papers, and training opportunities. We have made a significant investment in creating original content that can help our customers understand and prepare for market changes that could impact their businesses. Lastly, watch for us at industry conferences and events throughout the year and make a point to visit our booth and speak with our representatives.

HFMA 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.

AvailityContent for this Business Profile is supplied by Availity. 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: Wednesday, April 01, 2015