In this Business Profile, Emad Rizk, MD, president and CEO at Accretive Health, discusses the uncertainty facing hospitals today and the transitions affecting revenue cycle management. With more than two decades of experience in both payer and provider organizations, he offers a blended perspective on revenue cycle management solutions.

Emad RizkTell me a little bit about your organization.

Accretive Health partners with provider organizations to help them navigate the changing healthcare revenue cycle management landscape. Our company supports the mission and business objectives of hospitals and health systems—and their affiliated ambulatory clinics and physician practices—by effectively managing their revenue cycle processes and strengthening their financial stability. Our core business model is unlike any other company—we offer comprehensive end-to-end revenue cycle management.

Our company motto, "Operating together," stresses the value we place on operational excellence and the partnership we strive for with our clients. Accretive Health's goal is to deliver unrivaled revenue cycle management results as we integrate with our partners' front-, middle-, and back-end revenue cycle processes. We don't give advice from afar—we are at our clients' elbows, with our sleeves rolled up, ready to work alongside them to improve performance.

Accretive Health's customer base has expanded to nearly 100 hospitals and health systems across the country. Many of our customers are faith-based, non-profit hospitals or teaching institutions, including a number of the top-rated healthcare systems.

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

Hospitals have always experienced rules and regulations changes, which affect the way in which they are reimbursed. However, current industry changes are unlike any others and have put increased pressure on hospital leaders to control care quality and be accountable for costs. These are not subtle changes, but seismic shifts, creating new and tremendous challenges.

The traditional role of the hospital is also changing. More services are being conducted in pre- and post-acute care centers; the length of stay has been reduced; outpatient surgical centers have expanded capabilities; and we continue to see the emergence of large health systems and super systems. The small, independent hospital or physician practice is quickly becoming obsolete.

These new changes may cause providers to struggle when deploying health information systems, building front- and back-end financial infrastructure, and reengineering claims submission. As a result, merger and acquisition activity will keep growing, and physicians and health systems will continue to integrate and align.

For the most part, providers understand the need for change in order to combat rising healthcare costs and improve quality. Those that are quick to adapt and assimilate will survive and prosper, and those that remain stagnant run the risk of margin contraction, at the very least.

How do Accretive Health's products or services address these issues?

Accretive Health is a leader in the field and well positioned to help customers through the current transition, offering flexible resources that fit evolving provider needs. We help our partners significantly reduce the administrative costs associated with revenue cycle management. We also maximize a hospital's current revenue by constantly monitoring and optimizing all front-, middle-, and back-end processes. Our end-to-end offering is comprehensive, and it rests on a foundation of operational excellence.

We have always been on the cutting edge of revenue cycle technology development. Our technology allows us to automate processes—such as intelligence gathering and metrics management—as well as monitor changing conditions in real time and remain nimble to our clients' needs. For example, we are developing tools that will immediately inform us if a certain procedure is denied, why it is denied, and where in the process it is denied. This will allow us to better align clinical and financial outcomes.

What is the key to successfully transitioning from fee-for-service to value-based reimbursement?

More than a decade of experience integrating revenue cycle functions throughout a variety of hospitals and health systems has taught us valuable lessons on how to move seamlessly from fee-for-service to value-based reimbursement. There are three key aspects to successfully making the transition:

First and foremost, payers and providers must form a strong partnership. It is imperative they work together to ensure contract terms are clear and financial incentives are aligned.

Second, as patients begin to think more like consumers, patient engagement is becoming increasingly important. It is essential that providers manage patient care by encouraging wellness visits and preventive screenings, especially in patients with chronic conditions. These efforts will improve HEDIS and PQRS scores, which are so important in emerging value- based models. Additionally, engaged patients tend to have better health outcomes and are more inclined to seek in-network care.

Last, but certainly not least, analytics are a high priority because without actionable data, providers will have a difficult time succeeding with new payment models. When assessing metrics, organizations should make sure they have quality measure assurance, population analytics, and contract modeling capabilities.

How is Accretive Health preparing providers for the transition?

Accretive Health has been getting ready for this transition for quite some time by developing proprietary technology and shifting our attention to services that better align with value-based reimbursement.

Over the last 18 months, we have changed our focus from back-end payer reimbursement processes to front-end patient and provider activities. Our coding emphasis has also moved from CPT and EM levels and medical necessity to health conditions, quality measures, and risk scores.

Under value-based reimbursement, our approach integrates clinical and financial functions, which is more strategic from a provider perspective and more beneficial for the patient.

What are your recommendations to leaders considering revenue cycle management vendors?

First, I suggest completing an internal assessment and pinpointing specific functions with which you need assistance. It is crucial for providers to weigh what is best for their particular organizations. Healthcare CEOs and CFOs are ultimately responsible for ensuring their organizations deliver outstanding care to patients while maintaining financial viability. A revenue cycle vendor must understand a healthcare provider's mission and have the ability to adapt quickly to changes, which will further unfold in years to come.

Second, technology prowess should be a top priority when searching for the proper partner. At the heart of any good revenue cycle management vender is its technological capabilities, because automation drives all business functions.

We believe that our model is unique in the industry and produces the best results for providers. Our integrated approach allows us to stand side-by-side with clients to best serve their missions and strengthen their financial foundations.

Where can readers learn more about Accretive Health's solutions?

I encourage readers to take a look at our newly redesigned website, where they can find more information about our innovative solutions and proprietary technology.

I also recommend reading our whitepaper, The Provider Crossroad to Value-Based Reimbursement, which provides further detail about overcoming the industry challenges associated with evolving payment models.

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AccretiveContent for this Business Profile is supplied by Accretive Health. 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: Tuesday, December 01, 2015