Operational Innovation: A Vital Pillar in Achieving the Quadruple Aim

Throughout healthcare, we’ve long been focused on the Quadruple Aim all with the goal of enhancing patient experience, improving population health, lowering costs, and improving the work-life balance of healthcare providers. While much of the attention has been on clinical improvements, a growing number of health systems are discovering that the real key to reducing costs lies in operational innovation. Streamlining processes, automating revenue cycles, and improving administrative workflows are essential to driving sustainable change and achieving the Quadruple Aim.

One of the program’s core goals is reducing costs of care. This goal often requires going beyond clinical care improvements. For many hospitals and health systems, operational inefficiencies within the revenue cycle have become one of the most significant cost burdens. But automating manual tasks and accelerating claims processing, can be key to unlocking this goal.

Recently, one large health system that I worked with automated more than 10,300 full-time equivalent (FTE) hours and reduced as many as 367,000 manual actions in just 30 days, returning nearly $2.5 million to the hospital. In another instance, I recently worked with a large health system that automated more than 5.6 million manual activities in only 60 days. Its efforts meant almost $230 million in accelerated accounts receivable (AR) days. 

These operational transformations not only reduce costs but allow providers to focus on areas more deserving of their time and leading their organizations forward through other priorities and providing the care they’ve been hired to provide.

Automation Success

Centra Health, for example, a leading healthcare provider with a commanding 91% market share in its region, faced severe claims processing delays despite its strength and size. Because of this, it lacked real-time data visibility and possessed little actionable insight. These hurdles left the hospital unable to bill patients for over 12 months and slowed their claim submission process to an average of 20 days. 

These grave inefficiencies impacted their cash flow, obviously, but also increased staff workloads, contributing to burnout and reducing time available for higher-value tasks. But the health system began to monitor real-time revenue cycle intelligence and automating claims processes. Throughout its early stage tests, the hospital soon saw its claims processing times drop from 20 days to just five. 

Additional results? The hospital witnessed increased cash collections by more than $200 million within the first year and reduced denial rates by 70% over four years.

“[Our partner] helped us light up the room,” said Bob Booze, vice president of revenue cycle at Centra Health. “They know Cerner, they speak Cerner. We now get claims out in five days.”

The savings realized from these operational improvements is enabling Centra to reinvest in its workforce, increase staff wages and expand community health projects. By reducing administrative burdens, Centra’s leadership said they can focus on what matters most—delivering quality care to their patients.

Similarly, for years the University Health in Kansas City struggled with manual processes and operational inefficiencies. Although the health system had been using Cerner’s EHR platform since the 1990s, the inability to automate low-value tasks left staff overwhelmed and operational backlogs mounted.

Through automation and custom-built reporting tools, University Health has saved more than 100 staff hours per month. By streamlining account management, the University Health enables its staff to focus on higher-priority tasks rather than repetitive, low-value work. By leveraging its automation efforts, University Health improved workflow efficiency and reduced costs—again, demonstrating how operational innovation drives progress toward the Quadruple Aim’s goals.

“[Our partner] SparkChange brought in-depth knowledge of Cerner’s revenue cycle products,” said Seth Katz, VP of Revenue Cycle at University Health. “Their automation solutions freed up our staff for higher-value work.”

Automation’s Financial Impact

The financial benefits of automation and operational innovation can be seen across multiple healthcare systems:

• One health system automated 10,318 FTE hours and completed 367,000 manual actions, leading to a $2.39 million return within 30 days.
• Another automated 5.6 million actions, resulting in $229 million in accelerated AR days over just 60 days.
• One organization recovered more than 22,200 missed charges, worth $1.4 million in automated recoveries.
• Another health system automated more than 900,000 actions, accelerating $52 million in AR.

These examples underscore how automation directly contributes to lowering the cost of care—a key aspect of the Quadruple Aim. By eliminating manual processes and increasing operational efficiency, health systems of all sizes can realize near-immediate financial gains while improving patient care and reducing workflow strains.

Operational Innovation: Achieving the Quadruple Aim

While clinical care improvements will always be at the heart of healthcare, operational innovation is an often overlooked but essential element in achieving the Quadruple Aim. Lowering the cost of care isn’t solely a clinical issue, but an operational one, too. If you’re willing to and can automate significant portions of your revenue cycle, you’ll identify ways to reduce inefficiencies and streamline workflows.  Any unlocked savings can be used as a cost-cutting exercise or any found cash can be reinvested into patient care, business or workforce developments, and community health initiatives, if those priorities align with your mission.

Of course, automation eliminates some of the most overbearing redundancies in provider task administration. Removing some of these hurdles can address provider burnout caused by administrative overload. The future of care requires clinical advancements as well as the ability of health systems to adapt and innovate across the whole of their operation. Taking a few of the steps mentioned here can help achieve the Quadruple Aim’s goals, creating a more sustainable and effective healthcare system for all.