In this business profile, Cathy Smith, leader of the revenue transformation consulting practice at The Claro Group discusses how the organization helps hospitals and medical groups reimagine their revenue cycle.

Cathy SmithTell me a little bit about your organization.

The Claro Group is a seasoned consulting firm with broad healthcare knowledge. Our professionals typically average 10-15 years of experience and have delivered healthcare operational and financial improvement solutions to more than 600 hospitals nationwide. We have helped hospitals and medical groups improve their clinical documentation, improve their annual net revenue, transform their key processes, and reduce supply chain and labor costs. In particular, our revenue transformation services leverage technology, processes, and functions/roles (people) to optimize all areas along the revenue stream, including patient access, a consistent patient experience, the documentation of care, case management, charge capture, billing and collections, appropriate charity care recognition, and patient acute care transition planning.

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

In health care, clinical and financial decisions have to be made on the spot, and one of the biggest challenges we see today is that decision-makers—whether they are c-suite leaders or staff members on the front line—are not always equipped with the right information to make the right decisions at the right time, affecting both clinical and financial outcomes.

Without actionable data and trained people who can use and respond to it, organizations can operate somewhat in the dark. Even with the volume of information that is available, hospitals and medical groups often don’t know what they have or how to interpret it—in part, because it’s not frequently in a ready form (condensed and prioritized) that enables good decisions. This problem is the driver for much of the revenue cycle work that we do. Our clients repeatedly tell us that they need our help because “they don’t know what they don’t know.”

How does your product or service offering(s) address these needs?

Our revenue transformation services help organizations know what’s real—not just what’s perception. First, we take an analytical approach to learning about an organization, reviewing a variety of data and observing processes before making any recommendations. In addition, we do sampling of accounts and medical charts to truly know what's happening and avoid making suggestions based on guesswork, allowing us to customize programs to directly meet an organization’s real needs.

After working with us, our clients are often surprised by how much revenue benefit can be found by looking in the right places. There's no one rock that you can lift and find millions of dollars. You discover a little bit here, a little bit there, and a little bit in multiple places that add up to make a big difference. However, our focus is not only on finding dollars for our clients, but giving them the necessary metrics, dashboards, coaching, and training to continue to grow the financial benefits even after we're gone. For example, one of our health system clients wanted to track their avoidable losses across the system, which involved multiple hospitals and several states. We helped them put the structure, data, metrics and processes in place to achieve and measure change.  By the end of the project, the organization was measuring net revenue improvement of about $30 million. Now, a year after the project ended, they are measuring an annual net benefit closer to $60 million.

What are some key considerations for healthcare leaders when choosing this type of product or service?

It’s important to select a consultant that has deep healthcare experience and wants to partner with you to achieve outcomes and solve problems. We are a little different from most firms in that we “teach people how to fish.” So many times a consulting company arrives onsite, does the project, and then leaves. Two years later, the healthcare organization has to invite the consultant back again because the underlying issue still exists. Because our focus is on solving problems, when an organization needs us again, it's not for the same issue. In fact, for many of our clients, we are on our fifth project, our seventh project, and so on. There will always be new issues that come up, and it doesn’t make sense to revisit the same ones multiple times.

To be most successful, both the healthcare organization and the consulting firm should have the same goals, and the patient should be at the center of those goals. Patients are under more stress today than ever due to skyrocketing care costs as well as growth in high-deductible health plans. People are seeking care without knowing how they are going to pay for it, which is causing a lot of anxiety. We work to keep patients’ needs front and center when we engage in a revenue transformation project—whether that means improving the patient experience or increasing revenue/decreasing operational costs, so the health system can funnel more money back into patient care. In the end, it’s not just about getting revenue for the health system but doing it the right way. Yes, the health system has to be paid, but we also need to make sure that patients remain top of mind.

What advice would you offer to healthcare leaders when choosing among vendors?

Organizations should set high expectations when they hire a consulting firm. By asking the following questions, a better understanding can be gained about a potential partner:

  • Do they have a passion for what they do? Is it merely a job, or is it something they thrive on?
  • Do they understand operations? Consulting without a thorough appreciation of operations does not produce the best outcomes.
  • Are they analytical? The right data can drive actionable, meaningful, and directional change
  • Do they care about your organization and its patients?
  • Are they able to measure the results of their efforts?
  • Do they teach and transition your employees so you can continue to build on the foundation the consultant provides?
  • Are they capable of adapting to the needs of your organization? Can they produce outcomes that are sustainable and value-added?

Overall, the consultant must embrace a service approach that places your organization and its patients first and foremost.

As healthcare organizations partner with you to implement use of your product or service into their day-to-day operations, what advice would you offer so they can best set themselves up for success?

The more healthcare organization leaders are onboard and involved with a project, the greater the potential return on investment. Our consulting services focus on empowerment, engagement, and growing skills and roles to create effective, measurable, and sustainable positive change. As such, it is critical to have a leadership team at the hospital or medical group that partners with us, shares ideas, and supports the right change for the organization. Robust collaboration can mean the difference in how much measurable benefit the organization receives during the project and also in the future. Our projects are not just about today, but also helping position organizations to be in a strong position for the future.

Are there any educational materials you would like to share to help healthcare providers in these efforts?

Check out these Claro Group case studies that highlight successful revenue transformation projects:

Case Study 1 – Revenue Transformation

Case Study 2 – Revenue Transformation

Case Study 3 – Revenue Transformation

Also, go here to see video testimonials from several healthcare leaders about the Claro Group’s work and philosophy.

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The Claro GroupContent for this Business Profile is supplied by The Claro Group. 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: Thursday, September 01, 2016