Improving Healthcare at the Intersection of Advanced Data Analytics and Financial Management

Updated on January 5, 2023

Changes in healthcare have accelerated in recent years. For many organizations, the pandemic amplified these shifts with significant patient increases, staffing challenges, supply chain complications, and substantial financial risks – with impacts felt facility-wide from the bedside to the back office. There’s a strain on the remaining team members that’s only continuing to grow. This affects all departments, which can lead to reduced high-quality patient care and increase the accounts receivable going uncollected. Today, organizations are searching for their next move to improve decision-making and optimize administrative efficiencies.

As leaders in healthcare systems look for new ways to ensure high-quality care and increase revenue, they must also provide their teams with the necessary support. Many organizations are turning to innovative digital solutions that rally behind staff and optimize performance. Some organizations are applying advanced data analytics to produce insights that improve workflow, administration, and revenue cycle management (RCM). These healthcare organizations increasingly leverage data analytics and machine learning (ML) to meet their ever-changing management needs. After implementing these tools, organizations have improved revenue, increased efficiency, lowered costs, and returned crucial time to patient care.

Enhancing Revenue Cycle Management with Advanced Analytics

As healthcare organizations are struggling with staffing shortages across all departments, it has led to an increasing volume of accounts written off as uncollectible. RCM is a key opportunity for improvement in many organizations. Advanced analytics solutions help to improve the revenue cycle by using data to understand complex situations. The most effective solutions use this technology to guide staff to the next recommended actions. At the same time, the best solutions also prioritize the proper steps at the right time to maximize revenue cycle performance.

Accounts receivable (AR) management provides an important opening for improving healthcare management and operation. Many healthcare organizations collect 85% of their revenue from only 15% of their accounts. That means up to 85% of AR accounts are uncollected, leaving substantial revenue unrealized and on the table. With advanced AR offerings, teams can work 100% of the AR and increase collections by up to 1% of the total net patient service revenue (NPSR).

Advanced analytics software can help capture the missing piece of AR by analyzing financial transactions based on millions of data points. Top solutions create a detailed discovery roadmap to generating more revenue. Such targeted recommendations can make the decision-making process easier and increase return on investment.

Advanced data analytics enables more efficient use of an employee’s time, improving productivity. By prioritizing the workflow, the AR team can decrease time spent on negative ROI accounts, capture more cash, and collect revenue for accounts that would have otherwise been considered uncollectable. This approach ensures that facility decision-makers spend less time evaluating financial solutions and devote more time to enhancing patient care – returning their focus to what matters most.

Support Staffing and the Bottom Line with Data and AI

In the 2022 State of Revenue Integrity survey published by the National Association of Healthcare Revenue Integrity (NAHRI), more than half (57%) of the respondents said a lack of staff had a negative impact on the backend and cited this as an operations pain point. Without the proper support, these employees can burn out. RCM performance is critical though and impacts all areas of a hospital. As the administrative side of healthcare also experiences staff reductions, advanced technology solutions can help improve efficiency, decreasing stress on individual employees and bringing more revenue into the hospital system.

One of the largest areas with AI-enabled products and functions for RCM is denials management. By leveraging AI with data analytics to target areas of high-dollar, as well as high-volume and low-return, organizations can proactively pursue the denials which are most feasible to overturn. Once errors in backend processes are managed and visible, teams can move toward upstream process improvements. Identifying and implementing upstream fixes can help improve the revenue cycle. This investment return ensures the facility can focus on providing high-quality patient care instead of potentially lessening healthcare offerings.

Another challenge AR teams may face is the ongoing need to return to tasks put on hold due to the pandemic. With a large portion of the previous projects still on deck, there’s extra work to do with a reduced team.

Decision-makers can turn to AI for additional team assistance. By utilizing AI to analyze past denial trends and alerting staff of the potential denial prior to billing, AR employees can predict claim denials. By implementing an AI-enabled dashboard, teams can gain insight to help reduce recurring denials and improve workflow and understanding. This allows teams to review and correct claims pre-bill. Additionally, self-pay patients can integrate with financial assistance technology that verifies any available aid options, benefiting patients and the AR team.

Select the Best Advanced Analytics to Benefit the Overall Healthcare Facility

To address their growing needs within healthcare organizations, decision-makers must consider innovative investments that will deliver the most value to their teams and patients. As teams remain short-staffed, leadership must remember to support the back-office workflow just as they need to support the bedside staff. New tech solutions can be implemented to address outstanding AR, collect revenue that is owed, and resolve claims, all positively impacting the bottom line. Cash flow increases when money is collected efficiently, and the overall cash position improves. With the growing revenue, operations can be funded, facility expansions can begin, or additional investments can be pursued. This benefits everyone and allows for an enhanced patient experience with high-quality care. To ensure this success, organizations must work with an experienced analytics partner that provides the resources and knowledge to grow.

The best analytics partners provide the most effective guidance and practices in healthcare data management. A partner with a proven deployment platform, in-depth field knowledge, and significant data learning gives your team the foundation and guidance they need to drive facility-wide improvement.

Julie Rezek is Chief Executive Officer atAdvata, a SaaS company that provides advanced analytics that transform healthcare management. For more than 20 years, Rezek has tackled tough business issues for some of the world’s leading marketing and technology companies and successfully led transformative initiatives – from company mergers to strategic alignment of internal divisions. Her career has been centered on data-driving innovation – including as President of global digital agency Wunderman, serving Fortune 500 clients like Microsoft, and as Global Category Director at Facebook, leveraging her e-commerce knowledge to drive partnerships with Facebook’s largest clients, including Amazon.