A Look at the Changes in RCM that Are Happening Now and Changes that Need to Happen

Change, despite its often negative reception, can be a wonderful thing. In healthcare, change usually happens due to our strives for growth and betterment. We see an area that can be improved for our patients and staff and we set out to come up with solutions and technologies to make that improvement a reality. So let’s take a moment to embrace and celebrate change!

At the past HFMA Conference, we reached out to our brilliant Healthcare IT Today Community to ask them two questions about change: What change in RCM (besides AI) is happening now that everyone should be watching and why? & If you could change one thing about healthcare financial management, what would you change and why? The following video is a compilation of their answers to these two questions.

What Change in RCM (Besides AI) is Happening Now that Everyone Should be Watching and Why?

Erin Weber, Chief Research & Policy Officer at CAQH
There’s so much out there about AI, but I think one thing that’s really important to think about when you think about AI is it’s entirely dependent on the data and the systems that it works with. So if the data is not accurate, the AI isn’t going to be great. Initiatives like CORE where we’re looking at creating common definitions of data whether it be in a claim transaction or the provider data that goes into a credentialing system, AI is going to be largely dependent on that information. I think I would encourage the industry to look out for initiatives that are working to improve data accuracy, which is only going to make AI function better.

I think similarly along those lines, one of the things I have seen a lot recently in the industry is concern around technology or the belief that technology is going to solve all of our problems – technology like AI, FHIR, API, etc. – but again, that underlying data is going to be so important. And it’s just not a technology problem, we have workflows, there’s people involved, and there’s behavior change involved. I would encourage the industry to look for opportunities where you can engage to create whole solutions that are looking at not just the technical challenges but the business challenges, the workflow challenges, and take that all together – organizations like the CORE initiative at CAQH are doing that.

Kumar Shwetabh, President and Chief Growth Officer at Access Healthcare
We see that over a period of time, the line between the payer and the provider will blur. A lot of payers will start acting as the provider – you can see with United Health Group (they are one of the largest providers now in the nation which very few people know) and Kaiser Permanente. That is going to become a bigger phenomenon and the RCM vendors need to prepare for that.

Todd Doze, Chief Executive Officer at Janus
I think to me, prior auth is something that is top of mind for most folks because it’s a very challenging thing for providers to deal with, but there’s some interesting legislative things happening. Vermont, for example, just recently passed a law that prohibits the prior auth process. I don’t know how far it’s going to go and Vermont’s usually a sort of outlier if you will, in terms of state laws as it applies to healthcare, but it’s something to pay attention to and something that we’re watching very closely.

Robert Marinich, SVP Growth at SYNERGEN Health
It’s so often you talk to revenue cycle companies and I’ll ask them what they’re doing and they’ll say ‘well we’ve got great experience, we’ve got great people’ and they’re all kind of doing the same thing. They talk about denial trending, but it’s not about denial trending. I liken it to driving down the freeway, looking in your rearview mirror, that’s great if you’re on a straight road but if you hit a curve you’re in trouble, and we all know healthcare brings you a curve. It’s important today that you don’t think just denial trending, what we do is we actually bring forth denial prediction and be able to be prescriptive about it. Denials are going to happen but you don’t want to be touching it multiple times, so if you can actually trend the data and then start doing denials prediction and be prescriptive with your fixes, that’s when you see velocity revenue and true revenue performance.

If You Could Change One Thing About Healthcare Financial Management, What Would You Change and Why?

John Talaga, EVP of Healthcare at Flywire
Everyone at this conference I think understands that change in healthcare takes a long time, nothing happens too quickly – although I like things to happen more quickly. I think one of the things that we’re seeing is the momentum of some of the things that are starting to change. I’ve been in the business a long time and I’ve seen changes in the last 5 years greater than what I’ve seen in the last 20 years. I think providers are finally starting to embrace different ways, at least on the patient collection side, to collect from patients. We’ve seen that with our integrated financial solution for patients, of which more and more hospitals are taking that on, and frankly, I think that is the way most hospitals over time are going to start collecting from their patients.

Geneva Schlabach, CEO at Vispa
I think of the RCM process a lot like a manufacturing plant. If you think about manufacturing, it’s all about automation and then strategically inserting people into the places where there can’t be automation. I think sometimes in healthcare, we think of it in the opposite way – we think of all the people and then try to insert automation. We could flip that script around and think of all the things that we can automate and then strategically place our people – the Swedish people say they can’t afford to waste a brain, we can’t afford to waste a brain. Let’s use people strategically in those places that we can’t automate instead of thinking of just the people we have existing and then trying to fit automation in to check a box.

Huge thank you to Erin Weber, Chief Research & Policy Officer at CAQH, Kumar Shwetabh, President and Chief Growth Officer at Access Healthcare, Todd Doze, Chief Executive Officer at Janus, Robert Marinich, SVP Growth at SYNERGEN Health, John Talaga, EVP of Healthcare at Flywire, and Geneva Schlabach, CEO at Vispa for taking the time out of your day to come and speak with us! And thank you to all of you for taking the time out of your day to read this article and watch this video! We could not do this without all of your support.

What change in RCM (besides AI) do you see happening now that everyone should be watching and why? If you could change one thing about healthcare financial management, what would you change and why? Let us know either in the comments down below or over on social media. We’d love to hear from all of you!

Change, despite its often negative reception, can be a wonderful thing. In healthcare, change usually happens due to our strives for growth and betterment. We see an area that can be improved for our patients and staff and we set out to come up with solutions and technologies to make that improvement a reality. So let’s take a moment to embrace and celebrate change!

At the past HFMA Conference, we reached out to our brilliant Healthcare IT Today Community to ask them two questions about change: What change in RCM (besides AI) is happening now that everyone should be watching and why? & If you could change one thing about healthcare financial management, what would you change and why? The following video is a compilation of their answers to these two questions.

What Change in RCM (Besides AI) is Happening Now that Everyone Should be Watching and Why?

Erin Weber, Chief Research & Policy Officer at CAQH
There’s so much out there about AI, but I think one thing that’s really important to think about when you think about AI is it’s entirely dependent on the data and the systems that it works with. So if the data is not accurate, the AI isn’t going to be great. Initiatives like CORE where we’re looking at creating common definitions of data whether it be in a claim transaction or the provider data that goes into a credentialing system, AI is going to be largely dependent on that information. I think I would encourage the industry to look out for initiatives that are working to improve data accuracy, which is only going to make AI function better.

I think similarly along those lines, one of the things I have seen a lot recently in the industry is concern around technology or the belief that technology is going to solve all of our problems – technology like AI, FHIR, API, etc. – but again, that underlying data is going to be so important. And it’s just not a technology problem, we have workflows, there’s people involved, and there’s behavior change involved. I would encourage the industry to look for opportunities where you can engage to create whole solutions that are looking at not just the technical challenges but the business challenges, the workflow challenges, and take that all together – organizations like the CORE initiative at CAQH are doing that.

Kumar Shwetabh, President and Chief Growth Officer at Access Healthcare
We see that over a period of time, the line between the payer and the provider will blur. A lot of payers will start acting as the provider – you can see with United Health Group (they are one of the largest providers now in the nation which very few people know) and Kaiser Permanente. That is going to become a bigger phenomenon and the RCM vendors need to prepare for that.

Todd Doze, Chief Executive Officer at Janus
I think to me, prior auth is something that is top of mind for most folks because it’s a very challenging thing for providers to deal with, but there’s some interesting legislative things happening. Vermont, for example, just recently passed a law that prohibits the prior auth process. I don’t know how far it’s going to go and Vermont’s usually a sort of outlier if you will, in terms of state laws as it applies to healthcare, but it’s something to pay attention to and something that we’re watching very closely.

Robert Marinich, SVP Growth at SYNERGEN Health
It’s so often you talk to revenue cycle companies and I’ll ask them what they’re doing and they’ll say ‘well we’ve got great experience, we’ve got great people’ and they’re all kind of doing the same thing. They talk about denial trending, but it’s not about denial trending. I liken it to driving down the freeway, looking in your rearview mirror, that’s great if you’re on a straight road but if you hit a curve you’re in trouble, and we all know healthcare brings you a curve. It’s important today that you don’t think just denial trending, what we do is we actually bring forth denial prediction and be able to be prescriptive about it. Denials are going to happen but you don’t want to be touching it multiple times, so if you can actually trend the data and then start doing denials prediction and be prescriptive with your fixes, that’s when you see velocity revenue and true revenue performance.

If You Could Change One Thing About Healthcare Financial Management, What Would You Change and Why?

John Talaga, EVP of Healthcare at Flywire
Everyone at this conference I think understands that change in healthcare takes a long time, nothing happens too quickly – although I like things to happen more quickly. I think one of the things that we’re seeing is the momentum of some of the things that are starting to change. I’ve been in the business a long time and I’ve seen changes in the last 5 years greater than what I’ve seen in the last 20 years. I think providers are finally starting to embrace different ways, at least on the patient collection side, to collect from patients. We’ve seen that with our integrated financial solution for patients, of which more and more hospitals are taking that on, and frankly, I think that is the way most hospitals over time are going to start collecting from their patients.

Geneva Schlabach, CEO at Vispa
I think of the RCM process a lot like a manufacturing plant. If you think about manufacturing, it’s all about automation and then strategically inserting people into the places where there can’t be automation. I think sometimes in healthcare, we think of it in the opposite way – we think of all the people and then try to insert automation. We could flip that script around and think of all the things that we can automate and then strategically place our people – the Swedish people say they can’t afford to waste a brain, we can’t afford to waste a brain. Let’s use people strategically in those places that we can’t automate instead of thinking of just the people we have existing and then trying to fit automation in to check a box.

Huge thank you to Erin Weber, Chief Research & Policy Officer at CAQH, Kumar Shwetabh, President and Chief Growth Officer at Access Healthcare, Todd Doze, Chief Executive Officer at Janus, Robert Marinich, SVP Growth at SYNERGEN Health, John Talaga, EVP of Healthcare at Flywire, and Geneva Schlabach, CEO at Vispa for taking the time out of your day to come and speak with us! And thank you to all of you for taking the time out of your day to read this article and watch this video! We could not do this without all of your support.

What change in RCM (besides AI) do you see happening now that everyone should be watching and why? If you could change one thing about healthcare financial management, what would you change and why? Let us know either in the comments down below or over on social media. We’d love to hear from all of you!