Rehoboth McKinley Christian Healthcare Services CEO David Conejo shares why he thinks 2018 won’t just be about managing revenue cycles, but creating them.

One ageless trend emerging for 2018 is the quest of hospitals, larger carriers and clinics to identify new revenue streams; not just managing revenue cycles, but creating them.

Factors such as increasing focus on improving quality of care and clinical outcomes, the rising need to reduce healthcare costs and minimize errors in medical facilities along with government support for healthcare IT solutions will drive the market. Increasing adoption of advanced software including EHR and EHR connectivity systems, e-prescribing, and clinical decision support and clinical trial management software is helping to improve healthcare productivity.

Specifically, and through our own experience, the healthcare industry is now looking at revenue which can be generated through the interoperability of annual wellness visits (AWVs), chronic care and service care transitions between physical and behavioral health services. Hospitals and healthcare clinics that can connect these services with technologies such as bi-directional information flow will benefit by creating new profit centers of revenue through reimbursements by CMS and private insurers.

Driving this trend are apps and innovations that address the payment gap caused by medical billing and collections processes with outdated EHR platforms and inoperable systems. New technologies fueled by the growth of cloud computing in the healthcare industry are improving real-time communication and data exchange.

One example has been our hospital’s deployment of Zoeticx’s ProVision Wellness app which helps us drive new CMS revenue and insurance payments from private insurers like Blue Shield. This software enables us to integrate data for AWVs by offering that bi-directional data flow, providing us with management capabilities that support population tracking.

The chemistry of linking unrelated hospital IT landscapes to revenue
While the hospital revenue trend for 2018 looks promising, we are still facing the same old interoperability issues despite the advances in technology. What can hospitals and clinics do to be a revenue leader? As we move through 2018, it’s a good time to examine what is necessary to solve a complex problem like the ability of hospitals to link data and the benefits that arise from adopting tools, technologies and concepts from unrelated landscapes.

When we look at the value generated in healthcare, we remain enamored with acute care administration to address patients’ concerns with a new illness or exacerbation of a chronic condition. One of the stated goals of widespread EHR adoption was to assist in this aspect of care. The design of EHRs allows for the capture and subsequent analysis and billing for the care delivered however the value of health IT lies in the robustness of applications. This might seem obvious since most of the technology we have direct experience with relies on the applications which drive value, such as cloud-based assets.

For hospitals, investing in an application seems more prudent then investing in a protocol. However, by looking at the problems faced in healthcare, changing the perspective of the problem from an application-centric one to that of a protocol-centric view brings new revenue possibilities.

Protocols do exist in EHRs but instead of being the major component, they are accessories to help “glue” things together. What happens when hospital CIOs invert the focus away from the application doing most of the work to the protocol? With this focus, hospitals have the potential to increase value while reducing the overhead on application maintenance and expansion.

Teaching old data new tricks
There is a driving principle to a protocol-centric solution: Remove the data from the application and place it in a distributed, shareable container. With the separation of data from the application, data sequestration and dependencies are removed which reduces the barriers to entry and the development of innovative products. This separation also allows for greater flexibility and an ease of switching if and when an application fails to deliver or is deemed risky for use.

Currently, the cost of maintenance and improvements to existing applications adds a burden to many healthcare administrators, with little justification on an increase in revenue or value that such enhancements might bring. It is almost impossible to consider switching to another application, when one fails to meet the needs or becomes too costly to continue to maintain. Not to mention, the expense, frustration and challenges to migrate the already contained data into a new tool.

When protocols have free access to the underlying data and the transactions that lead to the access of and interpretation of data in the course of care delivery, healthcare facilities twist the ecosystem from a competing one to one where non-cooperative or geographically separated healthcare systems are able to interoperate and use the data when the solutions are built upon identical, open protocols. This changes the forces in the market away from added expenses to reduced costs, less duplication and the ability to design and implement new products and services that change the way healthcare is delivered.

Applications driving revenue in 2018
From the perspective of hospital administrators and providers, the goal is to capture relevant patient information and ascribe meaning to disconnected pieces of data. It is not missed on healthcare professionals that productivity and revenue capture is an important component of the care delivery process. The adoption of technology in healthcare has added the additional burdens of ensuring that patient data has been captured and critically analyzed to ensure high quality and efficient care. At the same time, the data need to placed in a context that supports diagnostic and billing codes to complete the cycle of care delivery.

Most systems have not been designed to integrate the billing and care delivery workflows, necessitating healthcare professionals to bring the integration to these two aspects of care. Technology has the potential to bridge this divide by automating and integrating the revenue capture with the care delivery component, we can achieve the clinical and financial requirements without the use of “human-powered” integration.

Using the abstract perspective of protocols and applying this to the areas of the AWV and chronic care management, clinics, hospitals and health systems have been able to improve or create new revenue streams while healthcare professionals have gained enhanced performance by the automation of tasks that required manual tasks to complete their workflow.

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