The Future of Revenue Cycle - Big Data and Business Intelligence. You Need a Plan! Derek Morkel, President & CEO, GAFFEY Healthcare

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1 The Future of Revenue Cycle - Big Data and Business Intelligence. You Need a Plan! Derek Morkel, President & CEO, GAFFEY Healthcare

2 The Future of Revenue Cycle - Big Data and Business Intelligence. You Need a Plan! Call to Action: Hospital s typically lose 1-4% of Net Revenue due to Revenue Attrition this number is expected to grow with ICD-10, ACA & new methods of payment. Key Terms: Revenue Cycle, Big Data, Business Intelligence Key Concept: A central, dedicated enterprise data warehouse for use by your primary Revenue Cycle Workflow Application with integrated Business Intelligence and analytic query systems will yield much better results and allow for significantly greater flexibility and capacity than trying to analyze a distributed set of separate, independent data silos (Excel hell). Introduction: Revenue Cycle (RCM) is definitely not a new term, but for many Big Data and Business Intelligence are relatively new terms. In this White Paper we lay out how they can work together to improve results for your facility. The business fundamentals of healthcare are changing rapidly before our eyes due to the many new and different payment methodologies that have been introduced over the last 5 years. While they currently represent only a small portion of total reimbursement, this is likely to change over the next 5 to 10 years. Some of the broad changes/trends that are already taking place are: Changes in value proposition payments that are currently being made based on episodes of illness are moving to rewards for healthy behavior. Reimbursement by individual patient and individual encounter to group payments risk bearing contracts. Single provider payments to bundled payments across 2 or more providers ACO s. Payments and penalties tiered by outcome. These changes in addition to the cost pressure brought on by the fiscal crises, Obamacare/ACA, reduced reimbursements etc. are causing many hospitals to look very closely at what resources are going to be necessary to adapt to these and other changes to come. Getting an ROI from your IT Investments leverage all the data you have: This inevitably leads to the question how do I improve my RCM operations and leverage the value of all the investments that I have made in IT over the last 3-5 years? That is where Big Data and Business Intelligence come in. Healthcare data is nothing new, but yet, why do healthcare improvements from quantifiable data seem almost rare today? Healthcare administrators have a wealth of data accessible to them but do not have the tools to use it and aren t sure how much of that data is usable or even correct. Page 1

3 The Short Answer: Deploying a central, dedicated data warehouse that can organize all the Big Data for use by Business Intelligence & Analytic Query systems like GAFFEY s AlphaAnalytics platform will yield much better results and allow for significantly greater flexibility and capacity than trying to analyze a distributed set of separate, independent data silos. What is Big Data & where is it? Big Data Definition: In 2012, Gartner updated its definition as follows: Big data is high volume, high velocity, and/or high variety information assets that require new forms of processing to enable enhanced decision making, insight discovery and process optimization. In healthcare, Data is generated in many places. Think of all the data that your organization generates and what do you do with it? EMR & Clinical IS Patient Accounting Billing & EDI Data Quality & Risk Physician Practice Data The tantalizing promise of big data is that for the first time, with an abundance of data sources and efficient analytics tools, healthcare will finally have the information necessary to plan, achieve, and measure those quantifiable program improvements improve efficiency from the beginning to the end of the Revenue Cycle (and many other areas). How about the efficiency gained from having a single RCM analytic platform tied into your workflow analyzing the top areas for revenue attrition? Charge Capture & Late Charges ED Level Coding Underpayments Denials & RAC Appeals Potential Denials Having a single data repository Enterprise Data Warehouse with the right analytic tools provides the ability to not only have a single end to end view of your RCM operations but also a single point of truth to make sure that you are getting paid not only correctly, but timely for your services. These platforms also provide for data flexibility in changing RCM methodologies. Applying analytics to the world of healthcare data isn t a set it and forget it proposition. You need a lasting solution that can react to changes in the status quo and also predict new and impending disruptive technology. By applying good data against gold-standard improvement strategies, you can enjoy a wealth of improvements for years to come and avoid costly analytic disasters. Page 2

4 How does Business Intelligence fit into the plan? A significant issue with many applications today is that they are single purpose and do not interface with your primary workflow applications death by 100 work lists (Excel hell). The data is not integrated into how you do business it is data not actionable information. Business Intelligence (BI) is the process of transforming all of the raw data that companies (providers) collect from their various operations into actionable information. With all the data available today this is not as simple as it used to be. BI used to just be a set of tools that allowed you better insight into your data that is not enough today. With all the constraints on resources today it is critical that BI applications deliver not only an immediate ROI, but also interface with the primary RCM applications (workflow tools) so that efficiency along with revenue is improved. Integrated applications like AlphaCollector and AlphaAnalytics are the next generation RCM & BI applications all the key data generated by the BI application is completely integrated into the Billing & Collections Management platform. The result is a reduction in the 1-4% Revenue Attrition combined with improved Billing and Collection efficiency. Revenue Integrity queries from GAFFEY Revenue Detective are automatically directed to the correct person to resolve less spreadsheets more action. Page 3

5 Conclusion Every hospital organization has invested a significant amount of money into IT applications over the past 3-5 years and these applications are generating a massive amount of data. A new tool set is necessary to ensure that we provide an ROI from these applications while increasing the efficiency of our employees. An Enterprise Data Warehouse (EDW) is the foundation of this approach it not only allows each facility to have access to many different data sources it also provides the flexibility to change direction as needed. The second benefit to EDW is the ability to have all your primary workflow applications utilizing the same platform tying BI, Analytics and Workflow together = a better ROI. Deploying a central, dedicated data warehouse for use by your primary Revenue Cycle Workflow Application with integrated Business Intelligence and analytic query systems will yield much better results and allow for significantly greater flexibility and capacity than trying to analyze a distributed set of separate, independent data silos (Excel hell). About the Author: Derek Morkel is CEO of GAFFEY Healthcare and a pioneer in the use of Business Intelligence applications to drive Revenue Cycle efficiency. In the early 2000 s he helped build one of the first completely integrated BI systems at IASIS Healthcare. Aside from RCM operations, the BI platform also coordinated operational areas like Productivity, Cost Accounting, Case Management and Clinical Documentation improvement. He has put similar systems in place at several other hospital companies. Page 4