As today’s hospital margins are increasingly in the red, and health systems are asked to do more with less, all eyes are on cost removal. According to a survey on healthcare outsourcing conducted by Black Book Market Research LLC, 90% of healthcare executives are exploring cost savings through relationships with third-party vendors.
Achieving long-term sustainability in the evolving healthcare sector demands strategic cost takeout initiatives. Here we discuss leveraging targeted approaches in three main areas for cost takeout – call center/customer service, accounts receivable (AR) resolution and clinical functions.
Call center/customer support
In the past 10 years, providers have responded to consumer demand with more focus on the patient financial journey and a unified, seamless experience. Omnichannel outreach leveraging both technology and phone conversations is essential to addressing the needs of a diverse patient base. Technology has improved but the phone calls have suffered since the pandemic because of the labor shortage. This continues to create problems whether it’s with scheduling, pre-arrival financial counseling, prior authorization, or inbound/outbound calls related to patients’ balances after insurance. Recent research points to increasing average hold times and the negative impact this has on patient satisfaction.
In this new environment, hospitals and health systems are leveraging revenue cycle management (RCM) service companies to augment and scale their workforce. These partners bring essential capabilities to improve the patient experience pre-visit but also address essential clinical functions like prior authorizations preventing denials. These resources can be a mixture of onshore, offshore and nearshore talent who can assist with insurance, support functions, patient calls (both inbound and outbound), as well as provide much-needed bilingual support. The review of this process, cost, and scalability can provide substantial operational cost savings, greater operational stability, and an improved patient experience.
Accounts receivable (AR) resolution
Hospitals and health systems are facing increased labor costs and payer requirements while reimbursements have fallen. Technology has accelerated progress with bots performing real-time claim statusing, AI driving intelligent workflows, and automation removing highly repetitive/repeatable steps. With all of these advancements, there is still the need to review, handle exceptions, and write appeals to maximize reimbursement promptly. Not only has COVID-19 caused a labor shortage in business offices but the cost of resources has increased at an alarming rate. According to a PWC and Becker’s Hospital Review survey, 83% of respondents reported experiencing labor shortages across the revenue cycle. Insurance companies have moved many of their call centers offshore to contain these costs and hospitals are increasingly embracing this move. Business offices looking to increase capacity, remove cost, or mitigate risk are seeing a huge impact as they look to India/Philippines to not only meet the needed scale of their office but do it at less than half the cost. The right partner can bring expertise, technology, and visibility to provide confidence for those facilities looking to remove expenses from their cost to collect with this approach.
Clinical support resources
Recent American Hospital Association (AHA) research states that 95% of providers spend increasing time seeking prior authorization approval. Often this is attributed to a lack of front-office staff and clinical resources to have payer conversations or improper documentation. Again, technology is assisting here but the need for resources, especially clinical, are increasingly expensive and difficult to find. This presents an opportunity to partner with organizations that have access to clinical resources both here in the U.S. and in the established clinical environment of the Philippines. The most frequent functions for cost takeout are nursing support, case/care management, care coaching, transitions of care, navigating network, case management referral, care plan generation, transport coordination and remote patient monitoring. With blended delivery models, outside experts can provide the requisite scale and significantly reduce cost.
From shortening patient appointment hold times to taking the frustration out of prior authorization and billing – the right cost takeout strategies also deliver improvements in patient experience. Incorporating these cost takeout strategies across these key areas not only addresses immediate cost pressures, but also positions health systems for sustained efficiency and strong fiscal health. As hospitals continue to reduce their cost to collect, they increasingly turn to RCM service providers for the required scale, cost removal and risk mitigation.
Titus Leo
Titus leads the Provider business at Sagility. Titus has been with the Provider practice for over 26 years. He joined this practice when it was part of Deloitte in 1997 and transitioned to HGS when the group was acquired from Deloitte in October 2012. Titus has extensive experience managing large and complex Revenue Cycle Outsourcing engagements for hospital, physician and laboratory clients. Titus also plays a key role in managing Sagility’s revenue cycle proprietary workflow tools. Titus has 32 years of industry experience in Business Process Outsourcing, Information Technology and Analytics. Prior to Sagility, he was a Project Manager in IT department of Citibank for four years and in software development at Tata Steel for two years. Titus received a bachelor’s degree in Electrical and Electronics Engineering from the Birla Institute of Technology and Science, Pilani, India and a MBA from the Indian Institute of Management, Bangalore, India.
Jason Besterfeldt
Jason Besterfeldt, Senior Vice President for Sagility, boasts an impressive career spanning nearly 25 years as a senior executive in healthcare Revenue Cycle. Throughout this extensive tenure, he has collaboratively engaged with various entities, including health systems, hospitals, ASCs, physician groups, payers, and banks. His professional emphasis revolves around strategic resource allocation, prudent technology investment, and the optimization of workflows. This targeted approach has consistently yielded significant benefits for his clients, empowering them to enhance cash reserves, minimize collection costs, and mitigate operational risks.
