Embracing New Technologies to Reimagine the Revenue Cycle
The shift toward fee-for-value and the rise in healthcare consumerism are two of the most disruptive trends in health care because these movements require healthcare organizations to fundamentally rethink how they deliver and receive payment for care. To be successful amid these dynamics, healthcare organizations must find ways to consistently deliver high quality at a lower cost while providing a patient experience that is efficient, compassionate, and patient-centric. As organizations work toward these goals, they are learning they must operate more as a system in which they interweave clinical and financial data across the continuum and retool processes to deliver an optimal experience from a clinical, financial, and patient satisfaction perspective.
A key element in reimagining healthcare delivery and reimbursement is a robust technology infrastructure that seamlessly links clinical and financial operations and allows consistent and effective exchange of information among key stakeholders in a patient’s care—both providers and payers. Unfortunately, many of the systems used in health care today were not built to support this degree of collaboration and information sharing. Change Healthcare is striving to address these gaps by leveraging its Intelligent Healthcare NetworkTM to innovate in the revenue cycle space.
Reimagining patient billing and payments
One area in which Change Healthcare is focused relates to cost estimation and billing. “We are working with both payers and providers to improve cost and billing transparency and simplify patient payments,” says Kris Joshi, PhD, executive vice president and president, Network Solutions, for Change Healthcare. “For example, patients often have trouble making sense of the many bills they receive after a procedure. In some cases, an individual might get three or four different bills, and some may arrive weeks or even months after the care episode. A person may also receive a statement, which he or she may not understand or know whether to pay. Although many organizations aim to simplify patient bills, they frequently approach the task from either the payer or provider perspective—which, unfortunately, only partially addresses the problem. However, simplifying things from all sides can yield transformative results—and this is what we’re trying to do.”
Because Change Healthcare works with payers and providers, the company is in a unique position to simplify communications with the consumer. With this goal in mind, Change Healthcare is currently partnering with some of its health plan and health system clients to develop a fully integrated patient statement that clearly explains what was charged and how much a patient owes based on a complete review of his or her claims and estimation of benefits. The bill includes information from all providers as well as payers, so there is no need for multiple statements. Within the bill, Change Healthcare also offers an opportunity for patients to pay all the providers at once by simply clicking on an embedded link and providing a credit card, health savings account, or other payment type. “This kind of simplicity and transparency is only possible if you can address the payer and the provider side of the system at the same time because information from both sides is needed to deliver a true picture of what the patient owes,” says Joshi.
Welcoming next-generation technology
Change Healthcare’s revenue cycle vision does not stop with improving patient billing and payment tools. The organization is also committed to taking a leading role in the development and utilization of next-generation technologies for health care, such as blockchain. This class of distributed data technology allows various stakeholders to work together on a single source of truth. Blockchain stores transactions that are cryptographically connected into a chain, which becomes immutable. This provides transparency to all stakeholders around transactions while assuring everyone involved in the transactions that they have not been tampered with. “Essentially, a blockchain is a trusted and accurate shared record,” says Joshi. “It is unlike any other technology that currently exists, and we believe it has the potential to address some key healthcare pain points. Hence, we have taken a leadership role in working with it for healthcare transactions. If the goal is to bring healthcare technology into the 21st century, we have to look at everything that next-generation technologies have to offer. Healthcare organizations shouldn’t assume that because blockchain is new and is being used by other industries that have historically been early adopters of new technology—such as financial services—that somehow it is premature to use blockchain in health care. The reality is that we can start evaluating healthcare applications now.”
Change Healthcare is well positioned to leverage cutting-edge technologies like blockchain because of its large network and transactional volume. “We don’t have to evolve very far to be able to use these technologies productively,” says Joshi. “We are focusing on applying blockchain capabilities appropriately and thoughtfully within our products and networks. Our goal is to begin to expose our customers to these technologies through our interfaces and then, over time, enable our customers and business partners to directly interact with them, with the ultimate goal of creating a next-generation interface and ecosystem. Our view is that bringing blockchain to health care is not just going to replace some old technologies, but actually help solve some of the problems that are difficult to address with traditional technologies.”
One possible use for blockchain that Change Healthcare is exploring relates to keeping track of a complete patient encounter, starting from the very beginning, when an individual might arrive for a pre-operative visit, all the way through the procedure and then the billing and payment steps until that particular encounter is closed and the last bill is paid. “Blockchain could allow anyone who is involved in the patient’s care and billing—the primary care physician, the anesthesiologist, the surgeon, the billing professional, the payer—to see the entire encounter and what happened,” says Joshi. “Through this technology, organizations could track information and have a single source of truth for what went on during the encounter, making things more accurate and streamlined while improving the patient experience. This will remove costs from the system and increase transparency.”
Although new technologies have tremendous potential, merely implementing them will not realize change. Collaboration and community-building must occur for the industry to effectively leverage new solutions. For example, new interfaces would have to be adopted by all stakeholders in order to develop a single, shared source of truth. “Today, these groups are transacting in a fragmented way using systems that don’t talk to each other, and compensating with expensive manual checks and balances,” says Joshi. “This level of partnership must emerge to move the needle on cost. We are leveraging our long-standing relationships with payers and providers to convene various parties to work together. As a neutral enabler between all stakeholders, we view it as our responsibility to not only bring new technologies to the healthcare marketplace, but also drive adoption through a community-based approach. This will let us all rapidly scale improvements, reduce administrative costs, and enhance the healthcare experience for everyone.”
Change Healthcare is focused on helping providers and payers navigate the transforming healthcare marketplace. By partnering with all stakeholders, exploring and advancing new technologies, and fostering collaboration, Change Healthcare aims to enable a new paradigm in which health care is more efficient, effective, and patient-centric.