A CIO’s Guide to Smarter RCM Solutions

CIOs are under pressure from CFOs to drive higher utilization of their IT assets. And if you are an organization that has invested millions into an electronic health record (EHR) or practice management systems, or are part of an organization that has grown via acquisition, it’s important to recognize upcoming opportunities to consolidate platforms.

This checklist is for the CIO who is looking for a strategic partner to help build their IT roadmap, maintain security standards and maximize the value of their EHR investment and operations. Included are nine key areas to keep in mind, focusing on why it is so critically important to carefully consider a number of factors when shopping for a platform.

1

Maximize value of EHR investment

At the top of the list is one of the most important lenses to keep in focus as you look for a strategic partner to support your IT department and your organization’s revenue cycle goals. You’ve already invested significant money into your EHR and as such don’t want its full capability left unrealized. When you utilize all workflows and integration points or augment them with solutions to address a business gap, you drive higher utilization of your asset—something your CFO will love.

2

The power of shopping for a platform

Point solutions can be constrained by a linear and narrow path. That often comes at an expense that is hard to ignore. Even with a simple scenario for a health system or hospital’s revenue and payments cycle, there can be over 20 separate yet vital business operations, all of which will need some kind of software solution. Platforms can reduce operational and overhead costs in the long run and better connect data and information with the user experience to yield better outcomes.

A revenue cycle platform should have solutions that cover services from pre-visit, patient access and financial clearance through to mid-cycle coding, billing and claims management, adjudication, appeals and patient payments, just to name some key areas.

4

Seek out digital-first patient payment + engagement capabilities

At a time when one out of four patients defer treatment because of the cost of care¹, and when 20-30% of provider’s revenue are the responsibility of their patients, delivering the right experience to the patient is critical to the provider experience. In today’s digital world, look for a platform that supports patient payments with omnichannel, personalized experiences. Payment platforms connect broken journeys, from the creation and communication of price estimates to pre-service collections. Selecting a unified solution ensures those broken journeys are transformed into a seamless process.

5

Seek out solutions for complex revenue cycle problems

Don’t shy away from accounting for your more complex revenue cycle challenges when looking to consolidate. Some of the most visible problems are also the hardest to solve. Look to solutions that can streamline or even fully automate complex manual processes like authorization, price estimation and claim monitoring. It’s also important to confirm your strategic partner can showcase results and differentiation when it comes to these areas.

7

Look for integrations + workflows that cater to your needs

There are several keys to maximizing your EHR investment, but one of the most important is allowing your users to operate within native workflows as much as possible. The best outcomes in the revenue cycle occur when actionable intelligence (alerts, dispositions, workqueue activity) allows users to only touch accounts that need their attention. Perhaps more important is that users should be able to do so without having to leave the original application. Bolt-ons can are often warning signs you will be dealing with double touches and a swivel chair workflow. Instead, look for platform partners that can effectively speak to integration and complementary workflows versus standalone applications.

8

Security + reducing risk

Too many point solutions simply create too much risk. HiTrust Certification and SOC II compliance are important to critical patient, revenue cycle and business applications. Choosing a primary revenue cycle platform partner offloads IT overhead related to security audits and application management. It also helps build trust in your organization, allowing for better utilization of your IT staff.

9

Look for a better partner brand experience—one that patients like

One of the best indicators about a brand’s quality is how likely your peers are to recommend them. Net Promoter Score® is a great barometer for measuring how a brand delivers on its promises of technology, implementation and service experiences. Great brands often break a score of 30, and top ones can go well beyond that. But don’t stop there. Check to see how patients score their experience with the platform.