Revenue Cycle
and Billing

Throughout 2020, COVID-19 has tested every aspect of our healthcare practices and systems. This has created the necessity for new creative methods to counter-act the COVID-19 virus at all levels. Due to the lack of information, testing, and turn-around many hospitals have moved away from conventional medical care planning. 

Here at American Exchange, it has always been our belief that data-informed decisions should always trump long-standing practices. In relation to healthcare and predictive planning, we rely on Revenue Cycle Management. This system relies on a series of checks, to ensure efficacy. 

First, a strategy in relation to the business model must be defined and understood. This is critical in order to align the interests of the business’ relationship. Where are their market opportunities? What defines success for both sides? Determining a beneficial middle ground, in this case, for both the healthcare providers and their suppliers, is paramount to creating a lasting and effective relationship. 

The following step is to set reachable goals that result in a happy medium for both sides. However, it is important to not just base these goals on revenue but community impact, public perception, and longevity in the marketplace as well. In route to your primary goal, it is prudent to lay out checkpoints along the way that will facilitate that end. This can be done in a variety of ways, but at American Exchange, and increasingly across other healthcare-based businesses, a data-driven approach is most common. Identifying your key performance indicators, and ensuring they trend towards your goal is an incremental step in reaching your pre-defined definition of success. 

Following the execution of these foundational steps, you arrive at the most important part of all, analysis. In a data-driven environment, sound analysis is the key to sustainable, continuous improvement. This places emphasis on accurate retrieval and monitoring of progress and regression throughout your predictive planning in order to adjust where is most necessary retroactively. At American Exchange, we believe visualization is the most powerful approach allowing our staff to identify trends and nuance to drive the highest impact. This gives us the huge advantage of optimizing our approach in real-time with information that generates revenue, establishes longevity, and exists as an earnest healthcare service.

John Muir Health has paved the way for a lot of these alternative methods. When Coronavirus became widespread in the U.S., breaking away from traditional methods was hugely important in keeping health-care professionals and patients safe when little was known about the virus. Health systems had to account for inaccurate financial planning as a result of a litany of new restrictions, as well. The combination of these factors led to John Muir Health instituting a kind of predictive planning that would offer a sustainable effort against the coronavirus both from a healthcare and financial perspective. 

Financially, diminished volumes and different infection-related costs put a huge strain on conventional medical services, planning, and estimates. Hospitals and healthcare professionals set up financial targets many months, and sometimes even years, ahead of their needs. Covid-19 has radically changed this dynamic and requires hospitals to be more diligent in mapping their expenses. Beyond that, suppliers are now realizing how important their ability to adapt and adjust to the needs of hospitals in such a complex medical landscape. So that begs that question, how does all this efficiently fit together?

Introducing; predictive planning. John Muir has shown healthcare is now largely becoming based upon the ability to utilize verified historical hospital and patient information. This allows for relevant healthcare parties to make educated decisions based on verified data, a huge game-changer, and break away from traditional healthcare methods. Conventional healthcare planning and forecasting is an exceptionally complex practice that can take a half year or more to finish under ordinary conditions. Providers are certainly no longer practicing under normal circumstances, but even without an ongoing pandemic, this top-down approach to crafting a budget takes away precious resources from patient care.

Considering how new of a process this has become, it has put certain elements of healthcare financial planning at odds with one another. For example, clinicians and executives now disagree frequently on the ownership stake of how budgets get allocated for the work they are doing every day. The only way to alleviate this discrepancy is with more solid data that supports both the financial and healthcare needs of both clinicians and hospital executives. The more dynamic budgeting process has also saved the health system a month of time and work, which helps the system get back to serving its community.

Beyond solid data, this scenario creates a need for constant, honest communication between all departments from clinical to financial, and will result in a more efficient healthcare effort overall. While some hospitals and suppliers might be better suited to use this predictive formatting than others, it is important to establish new modern solutions to complex modern problems. Identifying whether this kind of practice could benefit your organization’s needs is of huge importance as we navigate such uncertain times.